The discovery of antibiotics were massive achievement in feild of medicines. Antibacterial agents proves to be life saviour from centuries. Once the mild infection that was difficult to treat became easy, not only that but the discovery of antibiotics paves way for surgical interventions,organ transplantation, premature birth care made easy and also proves to be helpful in chemotherapy.
It dates back in 1928 when staphylococcus culture were unintentionally been contaminated with Penicillin Notatum and the infected area inhibit the staphylococcus growth in that region. It was discovered by A.fleming a Scottish biologist he reasoned that mold were secreting something that killed the bacteria and named the substance as penicillin that was purified 10 years later. Penicillin was widely used during 2nd World War.
However in 1940 Florey and Chain first time used penicillin clinically. Before that in 1909 Paul Enrlich discovered an arsenic derivative "Salvarsan" that has modest activity against syphilis( sexually transmitted disease) In 1935 Dr Gerhard Domagk discovered the protonsil sulfonamide( synthetic).
Antibiotics are characterized by their mode of activity either bactericidal( that kills bacteria) and bacteriostatic( that inhibit bacterial growth). However their use depends on the patient conditions.
In pharmaceuticals research more innovations are carried out by synthesizing more Antibiotics. Since1980 pharmaceuticals companies have turned away from antimicrobial research and driven toward the drugs for treatment of non communicable diseases. Due to resistance concerns few numbers of antibiotics are produced and trails are carried out on Small populations. Based on pathogen resistance and clinical importance of pathogens antimicrobial agents are synthesize.
According to WHO important microorganisms are uttermost important concern of pharmaceuticals companies. One of the most importance factor that is cause of resistance of many bacterial strain is the misuse and overdoses of antibacterial agents in humans and agriculture sectors. Dilemma is that for most of the viral infections people irrational taking antibiotics.
Programs throughout the world working with aim of optimising use of Antibiotics in appropriate way.These programs include policies, guidelines, surveys( local and international) combinely termed as "antimicrobial stepwardship" which includes duration and dose calculations of the suitable antibiotics with minimal side effects which will help in reducing resistance with maximum therapeutic activity by choosing appropriate selection of important factors. Which is one of the important objective of antimicrobial stepwardship.[2]
Moreover the concern for antibacterial resistance significantly increases research work on that in 2008 were only 48 articles till now 804 are published on antibiotic resistance it also changing clinical practices of antibiotics selection according to the situation.[2]
Another challenging task is to decrease the mortality and morbidity rate due to resistance bacterias which make infections difficult to treat. Multidrug resistance MDR pattern in Gram positive and Gram negative is more problematic because it not respond to conventional antibiotics. And their are few last resort antibiotics which work against resistant bacterias.[2]
Poor practice in controlling infections can easily be transmitted in environment and to others patients.
Recently World Health Organisation WHO on World health day created a theme "Combat drug resistance" no action today means no cure tomorrow. This theme triggered research activity at significant rate.
Community acquired infections such as pneumonia were easily treatable with penicillins now developed resistance. Keeping health at risk. Bacterial infections in females cystitis which were treated by oral dosage form now required injectable treatment and are costly too.
Neonates infections are increasing and challenging to treat requires treatment that was given to adult later developed resistant to such antimicrobial agents.
Prophylactically antibiotics are given before surgeries to prevent infections are also not working to conventional antibiotics due to increased resistance.
Health practitioner prescribing broad spectrum antibiotics developing more resistance due to exposure of antibiotics to bacterias unnecessarily which can alter their targeting site and inhibit drug activity.
Another problem is that many people with lack of basic knowledge of dose due to poor patient counselling and easy access to antibiotics to retails pharmacies taking antibiotics in erect way, many even not complete course of antibiotic. Which is making patients more vulnerable for relapse of infectious condition.
Antibiotic resistance is taking us back to same time when mild infections were life threatening. Increased medical emergencies due to combined factors of poor lifestyle, health along with the problem of antibiotics resistance is risk to health care.
Even many of the bacterias are resistant to almost all antibiotics. E.coli was easily treatable with oral fluroquinolones is become ineffective. In 2014 WHO published its first Global report on antibiotic resistance with the date of 114 countries. In United States 2 millions of people yearly experience antibiotic resistance and 23,000 die each year. Antibiotic resistance is not a future warning for healthcare it is scenario of present day affecting the globe but it is serious issue of underdeveloped countries 70% of Asia region is under Antibiotic resistance curse. In U.S more than 2.8 million antimicrobial state infections occur each year.
Antimicrobial stepwardship needed to be extended to family doctors where is the over consumption of antibiotics. It's misuse and inappropriate prescription should also be monitored in state level. The awareness to the common public will also result in decline of overuse.Additionally development of new antimicrobial is also the need of time