70 research outputs found
Antibiotic use and resistance : patterns, perceptions, policy and the price to pay
No full textBackground: Antibiotic resistance is a major health challenge especially in low and middle income countries such as India. Inappropriate antibiotic use is one important factor contributing to resistance. Strategies to improve use would help contain resistance. In order to develop strategies that are feasible and appropriate, knowledge is needed about patterns and perceptions of antibiotic use, the consequences of resistance and impact of policy guidelines. Current knowledge and evidence is limited in India.Aim: To improve knowledge on the patterns and perceptions of antibiotic use in the community, the consequences of resistance in individual patients, and the impact of policy guidelines on hospital antibiotic use, so as to identify potential interventional targets, generate key messages and subsequently develop appropriate strategies towards improving use and containing resistance. The specific objectives were:1. To determine patterns of antibiotic use through a surveillance system in the community and challenges faced while developing the system. (I)2. To ascertain the perceptions of stakeholders in antibiotic use and resistance and highlight the challenges to changing practice. (II)3. To assess the impact of antibiotic resistance on cost burden and health consequences in patients with suspected sepsis. (III)4. To determine patterns of inpatient antibiotic use over a decade and evaluate the impact of policy guidelines and modes of dissemination on antibiotic use. (IV)Methods: The first two studies (Paper I & II) for this thesis were done in urban and rural areas of Vellore district, south India and the two other studies (Paper III & IV) at Christian Medical College, Vellore (CMC), a not for profit, university teaching hospital with 2140 beds. Surveillance of antibiotic use patterns (prescriptions and dispensations) in thirty community healthcare facilities for 2 years was conducted with a repeated cross-sectional design (I). A qualitative study with eight focus group discussions among doctors, pharmacists and public explored perceptions about resistance, antibiotic use practices, factors driving use, and strategies for appropriate use (II). A one year observational study on inpatients with a preliminary diagnosis of suspected sepsis and a positive blood culture report analysed costs and health consequences in two groups, ‘resistant’ and ‘susceptible’ based on susceptibility of causative bacteria to the empiric antibiotic given (III). A time series segmented regression analysis of antibiotic use across a decade revealed the patterns of use over time segments and the impact of differing modes of policy guideline development and implementation (IV).Findings: Surveillance in community healthcare facilities (I) revealed that among 52,788 patients, 40.9% were prescribed or dispensed antibiotics (antibiotic encounters). There were significant differences among facilities types and areas. Fluoroquinolones and penicillins were widely used, co-trimoxazole more in rural hospitals and cephalosporins in urban private hospitals. 41.1% of antibiotics were for respiratory infections. Focus group discussions (II) revealed that the public had limited awareness of infection, antibiotics and resistance and wanted quick relief through antibiotics. Doctors prescribed antibiotics for perceived patient expectations and quick recovery. Business concerns promoted antibiotic sales by pharmacists. Improving public awareness, provider communication, diagnostic support, and strict regulatory implementation were suggested strategies. Among 220 patients admitted into the hospital with suspected sepsis (III), the median difference between ‘resistant’ and ‘susceptible’ groups in overall costs, antibiotic costs and pharmacy costs was Rs. 41,993 (p = 0.001), 8,315 (p Conclusion: The level of antibiotic use is significant in the community, especially for respiratory infections and fluoroquinolone use. Patterns of antibiotic use varied among healthcare facilities and stakeholders. Knowledge and understanding of resistance was limited. Patient demand and competitive pressures were some of the main challenges expressed in changing practice. Antibiotic resistance had significant impact on cost and health consequences in patients. Containment of rising inpatient antibiotic use was possible with guideline dissemination through intranet computer network.List of scientific papersI. Chandy SJ, Thomas K, Mathai E, Antonisamy B, Holloway KA, Stalsby Lundborg C. Patterns of antibiotic use in the community and challenges of antibiotic surveillance in a lower-middle-income country setting: a repeated cross-sectional study in Vellore, south India. J Antimicrob Chemother. 2013 Jan;68(1):229-36. https://doi.org/10.1093/jac/dks355 II. Chandy SJ, Mathai E, Thomas K, Faruqui AR, Holloway K, Stalsby Lundborg C. Antibiotic Use and Resistance: perceptions and ethical challenges among doctors, pharmacists and the public in Vellore, South India. Indian J Medical Ethics. 2013 Jan-Mar;10(1):20-27. https://pubmed.ncbi.nlm.nih.gov/23439193III. Chandy SJ, Naik GS, Balaji V, Jeyaseelan V, Thomas K, Stalsby Lundborg C. High Cost Burden and Health Consequences of Antibiotic Resistance – The Price to Pay. [Submitted]IV. Chandy SJ, Naik GS, Charles R, Jeyaseelan V, Naumova EN, Thomas K, Stalsby Lundborg C. The Impact of Policy Guidelines on Hospital Antibiotic Use over a Decade: A Segmented Time Series Analysis. PLoS One. 2014 Mar 19;9(3):e92206. https://doi.org/10.1371/journal.pone.0092206 </p
A One Health Review of Community-Acquired Antimicrobial-Resistant Escherichia coli in India
No full textAntimicrobial resistance (AMR) threatens to undermine nearly a century of progress since the first use of antimicrobial compounds. There is an increasing recognition of the links between antimicrobial use and AMR in humans, animals, and the environment (i.e., One Health) and the spread of AMR between these domains and around the globe. This systematic review applies a One Health approach-including humans, animals, and the environment-to characterize AMR in Escherichia coli in India. E. coli is an ideal species because it is readily shared between humans and animals, its transmission can be tracked more easily than anaerobes, it can survive and grow outside of the host environment, and it can mobilize AMR genes more easily than other intestinal bacteria. This review synthesized evidence from 38 studies examining antimicrobial-resistant E. coli (AR-E) across India. Studies of AR-E came from 18 states, isolated from different sample sources: Humans (n = 7), animals (n = 7), the environment (n = 20), and combinations of these categories, defined as interdisciplinary (n = 4). Several studies measured the prevalence of AMR in relation to last-line antimicrobials, including carbapenems (n = 11), third-generation cephalosporins (n = 18), and colistin (n = 4). Most studies included only one dimension of the One Health framework, highlighting the need for more studies that aim to characterize the relationship of AMR across different reservoirs of E. coli
Medico Friend Circle Bulletin, 316-317, April-June 2006
No full textContents: Impressions from a Rural Laboratory - Jan Swasthya Sahyog Surgical Care for Rural India – A Perspective - George Mathew Excessive Use of Screening and Diagnostic Tests - Anant Phadke Are Glass Syringes Inferior? - Jan Swasthya Sahyog, Bilaspur The Quality and Cost of Health Care: Some Notes on the Context - Binayak Sen Quality and Costs of Health Care in the Context of the Goal of Universal Access - Sara Bhattacharji Cost Containment in Trauma Care Services - Jacob John What can we learn from the AIDS Movement? - Anand Zachariah Quality of Medical Care: Public versus Private - Alpana Sagar Some Strategies to Cut Health Care Costs - Vinod Shah Medical Facilities and Health Needs on Wheels: Still Unviable? - Dr. N. Kannan Rational Drug Therapy: Principles, Realities and Road Ahead - Sujith J Chandy Quality of Care: The Ayurvedic Perspective - P. Ram Manohar Quality Assurance in the National Rural Health Mission (NRHM): Provisions and Debates - Rajib Dasgupta Financing the NRHM - Ravi Duggal Declaration of Women Healers and CHWs Terrorism, Pfizer Style - James Love Vadodara: The Context of the Dargah Demolitionpublic health, NRHM, quality of care, medical care, health care costs, medical facilities, ayurveda, rational drug therapy,healers, CHWs, Pfizer, Health Studies
Commentary on: “Chronic Use of Hydrochlorothiazide and Risk of Skin Cancer in Caucasian Adults: A PharmLines Initiative Inception Cohort Study
No full textAbstract is missing (Correspondence
- …
