Antimicrobial Stewardship: Ensuring The Future Of Effective Treatments

Since time immemorial, antibiotics have been considered wonder drugs, capable of treating every infection, irrespective of pathogen (bacteria, fungus, viral or parasites). But microorganisms have always been one step ahead, as it is known that even before the discovery of Penicillin, the first antibiotic, bacteria had developed their ways to circumvent its therapeutic effect. Antimicrobial Resistance (AMR) is a menace, staring at humankind with an ugly face. Its unfathomable effects on economics, productive manpower, and rising costs of hospitalisation & treatment are immeasurable. The statistics are overwhelmingly alarming; bacterial AMR caused >1.2 million deaths worldwide.

Antimicrobial resistance (AMR) is a growing concern in India, as it is globally. Notable reasons that have contributed to India being a hub of antimicrobial resistance include unregulated antibiotic use, including self-prescription & being easily available over the counter without prescription; large-scale use in agriculture & husbandry for growth promotion and disease prevention; inadequate healthcare infrastructure and infection control practices & emergence of drug-resistant superbugs. These factors have created a perfect storm, fueling the emergence, and spread of antimicrobial resistance in India.

The World Health Organization (WHO) has warned that we could be heading toward a "post-antibiotic era" where minor infections or routine surgeries could become life-threatening due to untreatable infections by superbugs. The emergence of newer & virulent pathogens coupled with the discovery void of new molecules brings our attention to Antimicrobial Stewardship. 

The concept of AMS dates back to the 1970s when the first formal program was established at a hospital in Boston, Massachusetts, to control antibiotic use and curb resistance. AMS holistically stands for coordinated efforts to promote the responsible use of antimicrobials. AMS is one of the three pillars of an integrated approach to strengthening the health care system. The critical components like Antimicrobial Resistance (AMR) surveillance and sufficient supply of quality medicines linked with three pillars help promote equitable and quality health care. Antimicrobial Stewardship (AMS) is crucial for ensuring safe treatment in the future by optimizing antimicrobial use, reducing resistance, and promoting infection prevention. 

Key stakeholders of a successful AMS program include healthcare providers, patients and families, government and policymakers, pharmaceutical industry & research institutions, and academia.

It has multipronged advantages: improvement in physician’s prescribing practices; selection of appropriate antimicrobials with regards to choice, doses, & durations; enhancing patient safety by minimizing adverse effects; & prevention of healthcare-associated infections through evidence-based guidelines. AMS also ensures continuous quality improvement by tracking antimicrobial use and resistance & evaluating program effectiveness. By adopting AMS, healthcare providers can ensure safe, effective treatment for patients while addressing the growing threat of antimicrobial resistance.

AMS is not limited to human medicine. The "One Health" approach integrates human, animal, and environmental health to tackle AMR holistically, recognizing the interconnectedness of ecosystems. The future for AMS is promising with the advent of artificial intelligence and machine learning applications, precision medicine approaches novel antimicrobial development & alternative treatment strategies (e.g., bacteriophage therapy). Emerging technologies like CRISPR-based diagnostics and nanopore sequencing hold promise for quicker, more accurate pathogen identification, potentially transforming AMS.

 More than implementation, the role of antibiotic prescribing nudges e.g. interventions including having doctors sign a commitment poster in their office to prescribe antibiotics only, when necessary, have been shown to reduce inappropriate prescriptions greatly. 

It is a major health issue, despite improvement. As of November 2023, 178 countries, including India, have developed AMR national action plans aligned with the Global Action Plan (GAP) on AMR. Enhancing public awareness in terms of awareness campaigns on AMR risks and consequences and integrating AMR education into medical and veterinary curricula & international organizations will be key drivers of its implementation. 

Dr. Ankit Gupta

Guest Author Head - Quality Assurance (International), Metropolis Healthcare Ltd.