Antibiotics are critical in the treatment of bacterial infections. The discovery of penicillin was followed by an extraordinary progress in research related to antibiotics and their extensive use. Drastic improvement in mortality and morbidity due to infectious diseases during 1980s led to great euphoria and complacence amongst medical fraternity. The result of this was misuse or inappropriate use of antibiotics with emphasis of curative medicine at the cost of disease preventive measures. Excessive use of antibiotics resulted in the emergence of bacterial resistance1. The resistant strains had a survival advantage, and under the selective pressure of antibiotics propagated and spread throughout the world.
Antibiotic resistance, a well known phenomenon in nature2 assumes significant public health importance when it gets amplified many folds due to human misuse and neglect. In the present age the threat has become global due to rapid spread of organisms from one part of the world to another. It is no longer a problem of the developing countries alone. Today even after all the advances in therapeutics and the availability of a large number of antibiotics, a person can die in a developed country also due to infection with resistant bacteria3. Antibiotics resistance has become a serious public health concern with economic and social implications throughout the world, be it community acquired infections like Streptococcal infections, pneumonia, typhoid fever, etc., or hospital acquired infections due to methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE), vancomycin intermediate S. aureus (VISA) or extended spectrum beta-lactamase (ESBL) enzyme producing Gram negative bacteria. These infections lead to higher rates of hospitalization, longer hospital stay, and increase in the cost of treatment and thus increased economic burden on the community 4. The problem is much larger in developing countries5. The economic consequences have greater implications on the already overburdened economy of these countries. There are many factors that could be responsible for the increase in antibiotics resistance in developing countries6. The combination of a heavy disease burden, huge populations, rapid spread through crowding, poor sanitation and inappropriate use of the available drugs all contribute to this problem. This is further complicated by the availability of antibiotics in open markets without proper prescriptions in majority of these countries. Many a time, the amount of antibiotics given is inadequate to treat serious infections due to poverty or lack of education. Infectious diseases, and therefore antibiotic resistance also thrive in conditions of civil unrest, mass migration and unhygienic environmental conditions where large numbers of people are exposed to infectious diseases with little health care infrastructure6.
The situations where overuse or abuse of antibiotics is common in clinical practice are many, for example, treatment of non bacterial diseases or of self limiting bacterial diseases; inappropriate antibiotic prophylaxis; errors in generic choice, route, dosing and duration of therapy or inappropriate combination therapy7. There are various reasons which influence this decision like feeling of insecurity; patients’ expectations; aggressive marketing by pharmaceutical companies; lack of uniformity among physicians to follow antibiotic policy; impact of recent clinical trials and at times lack of knowledge of the microbiological aspects of infectious diseases or the pharmacokinetics of the drug7.
For sometime, progress in the development of newer and effective antibiotics kept pace with the emerging antibiotic resistance. But the present scenario is such that the available antibiotics have become ineffective in diseases of proven bacterial etiology especially in a hospital setting.