Indiscriminate use of antibiotics is one of the factors responsible for
the rising antibiotic resistance in India [1]. The World Health Assembly
in 2005 sent a call for rational use of antimicrobial agents to curb the
problem of rising antimicrobial resistance [2]. Many strategies have
been advocated to counter the ever increasing threat of antimicrobial
resistance. One such strategy is antimicrobial stewardship [3]. One
other important aspect that is a major determinant of appropriate use of
antibiotics is the availability of antibiotics.
The overall prevalence of Methicillin-resistant
Staphylococcus aureus (MRSA) among hospitalized patients in India is
about 40-50% [4,5]. Although MRSA prevalence is on the rise, Methicillin-sensitive
S. aureus (MSSA) continues to be the more common type of
Staphylococcus. For MSSA bacteremia, early adminis-tration of beta-lactams
is crucial as empirical Vancomycin therapy for MSSA bacteremia is
associated with increased risk of morbidity and mortality compared to an
anti-staphylococcal penicillin (oxacillin and nafcillin) or
first-generation cephalosporin (cefazolin) [6]. Waiting for culture
reports also would be deleterious as delays in initiation of antibiotics
for staphylococcal bacteremia have also been associated with an
increased odds of infection related mortality [7]. Given this
background, the non-availability of Cloxacillin, especially in the
private sector hospitals, makes it difficult to treat a patient with
MSSA (especially the strains resistant to penicillin but sensitive to
oxacillin). Treating doctors are forced to use combinations as
ampicillin-cloxacillin or costlier drugs like amoxycillin-clavulanate
despite knowing that these are not ideal. Moreover, at times, they are
forced to use therapeutically inferior drugs such as Vancomycin [8] or
drugs reserved for resistant organisms like Linezolid. Thus,
non-availability of antibiotics also paves way for irrational use and
hence may defeat the antimicrobial stewardship efforts. Through this
letter, we would like to forward our plea to the policy-makers to take
into account this important issue and make all first-line antibiotics
available by strict regulations.
References
1. Yewale VN. IAP-ICMR call to action to tackle the
antimicrobial resistance. Indian Pediatr. 2014;51:437-9.
2. Leung E, Weil DE, Raviglione M, Nakatani H. The
WHO policy package to combat antimicrobial resistance. Bull World Health
Organ. 2011;89:390-2.
3. Bedi N, Gupta P. Antimicrobial stewardship in
pediatrics: An Indian perspective. Indian Pediatr. 2016;53:293-8.
4. Indian Network for Surveillance of Antimicrobial
Resistance (INSAR) group, India. Methicillin resistant Staphylococcus
aureus (MRSA) in India: Prevalence and susceptibility pattern.
Indian J Med Res. 2013;137:363-9.
5. Senthilkumar K, Biswal N, Sistla S. Risk factors
associated with methicillin-resistant Staphylococcus aureus
infection in children. Indian Pediatr. 2015;52:31-3.
6. McConeghy KW, Bleasdale SC, Rodvold KA. The
empirical combination of vancomycin and a â-lactam for Staphylococcal
bacteremia. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;57:1760-5.
7. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ.
Outcomes analysis of delayed antibiotic treatment for hospital-acquired
Staphylococcus aureus bacteremia. Clin Infect Dis Off Publ Infect Dis
Soc Am. 2003;36:1418-23.
8. Wong D, Wong T, Romney M, Leung V. Comparative
effectiveness of