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While resistance is a process of natural selection, and thus something we cannot ultimately avoid, there are many instances where we use antibiotics inappropriately and therefore ‘drive’ the development of resistance. Antibiotics are only effective against bacterial infections, and even then specific antibiotics are only effective against specific bacterial infections. So, we need to make sure we use the right antibiotic, at the right time and at the right dose.
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The World Health Organization’s 2013 global tuberculosis report paints a grim picture for India. Once a pioneer in TB treatment among developing nations, the government’s resolution to fight the disease has developed cracks over the years. According to the report, the country has 2-2.5 million TB cases — a conservative figure, given that worldwide three million cases go undetected each year. The other depressing fact is that 33 per cent of the total population suffering from TB worldwide does not have access to treatment.
Statistics show that roughly one third of the world’s population is infected with the bacillus, and it is responsible for 8 to 12 million cases of active tuberculosis each year, and 3 million deaths [1.
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Similar actions would be supported by a majority ofphysicians in the United States. In 1989, the Infectious DiseasesSociety of America sent out a questionnaire regarding antibioticregulation to 881 physicians. Only 4.6% of the responses were againstany interference in the use of antibiotics. 85.4% wanted increasededucation efforts for both physicians and the public and 87.3%actually favored controls of antibiotic use.3 These doctorsrealized that antibiotic use is often unnecessary and that increasedregulation does not necessarily have to interfere with properprescriptions.
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Second, the use of antibiotics in human medicine must beregulated, and evidence exists that this regulation would besuccessful. In 1990, the Laiko General Hospital in Athens, Greeceimplemented a new policy for antibiotics. Several of the most popularantibiotics, such as cephalosporins and vancomycin, could be orderedfrom the pharmacy only after a physician filled out an order formoutlining the antibiotic request. The request was reviewed byinfectious diseases physicians before approval. Along with thisrestriction in policy, other programs were effected. Improved rulesfor hand washing were enforced, and educational programs for physicianson antibiotic misuse were created. As a result, the use of antibioticsin the hospital was reduced by 80%, with no deaths attributable to thepolicy. Within the span of a few years, the resistance of to ceftazidime was reduced from 45% to 8%within the hospital. Before that time, 55% of infectious bacteriain the hosptial were resistant to amikacin, and 85% were resistant togentamicin. After implementation of the policy, resistance to theseantibiotics dropped to 12% and 19% respectively.3
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We know that only 10 per cent of sore throats benefit from antibiotic treatment (because most are viral), yet antibiotics are prescribed in as many as 60 per cent of cases, meaning that many of these prescriptions are unnecessary. A recent study found that nearly a third of antibiotics prescribed by doctors in the US were prescribed for conditions that do not respond to antibiotics. This translates to 47 million unnecessary prescriptions each year.
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Regulation of antibiotics would take two forms. First,elimination of antibiotics as growth enhancers for food animals wouldgreatly alleviate the resistance problem. Unfortunately, with lowergrowth efficiency, farmers would have to spend more money on food forthe animals. However, with decreased antibiotic use, money would besaved that could be used as government subsidies to compensate thefarmers for the loss. For instance, welfare programs would not have topay for more expensive antibiotics if the older, currently ineffective,antibiotics again become useful.