Appropriate Use of Antibiotics

Any time antibiotics misuse is discussed, prudent use of antibiotics is always mentioned as the remedy to the aforementioned vice. You can’t help but wonder: How hard can it be to use antibiotics appropriately? As simple as it sounds, there still is a lot of misuse of antibiotics all over the world.

Criteria for Appropriateness – Medical Practitioner’s Point of View

Give Antibiotics to the Right Patient

The first step is of course prescribing antibiotics only to the right patient which means identifying which patient needs antibiotics. Here is where trick diagnoses like viral vs bacterial infection need to be precise and accurate.

Some common infections that are often wrongly treated as bacterial infections include malaria, viral diarrhea or respiratory infections.

Antibiotics are wrongly given for a multitude of reasons including the lack of diagnostic tools.

The second aspect to be considered is the large groups of patients who would benefit from antibiotic treatment but don’t have access to it. Lack of access could be due to the antibiotics not being available or the bacteria being resistant to the available antibiotics. Another reason could be the relevant antibiotics being too expensive for the patients who need them.

Right Antibiotics

After you have made the decision to administer antibiotics, the next step is deciding which antibiotic to use. Different antibiotics are effective against different types of bacteria. Antibiotic resistance adds another layer of complexity when deciding which antibiotics to administer.

The general rule is that narrow spectrum antibiotics are preferred over drugs that have an effect on a larger group of bacteria. Narrow spectrum antibiotics are drugs that are active to only a few species of bacteria.

Another important aspect to consider here if you want appropriate use of antibiotics is microbiological diagnostics. Microbiological diagnostics involve identifying the actual pathogen and its susceptibility pattern.

Give Antibiotics at the Right Time

In lots of infections, time is of the essence to lower morbidity and mortality. In cases like these, immediate broad spectrum antibiotic treatment is appropriate until the pathogen can be accurately identified.

In infections that are not as time-sensitive, a delay in administering antibiotics may not be that bad. Au contraire, it can actually be beneficial as the infection may be cleared by the patient’s immune system without antibiotics.

Give the Right Dose

A dose too low not only fails to clear the infection but also contributes to selection of resistance subpopulations that would have been inhibited by a sufficiently high dose of the antibiotic. In this step, medical practitioners need access to knowledge about dosing principles and national guidelines on dosage.

You may need to adjust the dosage for a couple of reasons like different patient characteristics, site of infection and the infecting pathogens.

On the other end of the spectrum, a dose too high is bad on the patients’ microbiomes. Toxicity may be an issue and the environmental impact will be greater and the costs for the antibiotics will definitely increase.

Right Duration of Antibiotics

The right duration is just as important to avoiding antibiotics misuse as the right dosage. It is affected by both the prescription and the patient’s adherence to the prescription.

The guidelines suggest prescribing the shortest antibiotics course that is effective. However, a medical practitioner might want to administer a longer course just in case of anything.

Some reasons for a longer course would be unclear diagnosis, risks of complications or the infection being severe.