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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Rational Antibiotic Use in Office Practice

Ramachandran Padmanabhan¹

¹Department of Pediatrics, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, 600116, India. ramachandran.paeds@gmail.com.

Indian Journal of Pediatrics

|July 2, 2025

Abstract:

Antimicrobial resistance (AMR) is emerging as a global health threat. Microbial resistance emerged almost simultaneously with the discovery of penicillin and has kept pace with almost every new antibiotic molecule. With the increasing AMR and declining initiative for discovery of newer antibiotics from research and pharmacologic industry, humanity may be entering a post-antibiotic era of inability to treat any infection. As per the global estimate, AMR ranks as high as the third leading cause of death. India being the largest consumer of antibiotics faces a huge burden of AMR. ICMR data reveals that methicillin resistant Staphylococcus aureus (MRSA) prevalence is in more than half the specimens and among the Gram negative organisms, carbapenem resistance is seen in nearly 50% in E. coli and klebsiella in 2023.The contributory factors for AMR are patient, prescriber, system and environment related, as well as the rampant use of antibiotics in animal husbandry, aquaculture and biocides. Government of India is making efforts to restrict AMR through a National Action Plan by strategies such as enhancing knowledge about AMR, improving Antimicrobial Stewardship, monitoring antibiotic use and increasing coordination among stakeholders under 'One Health' initiative. To promote rational antibiotic choice and prevent AMR, WHO has categorised antibiotics as per the level of need as Access, Watch and Reserve (AWaRe) antibiotics. Robust National and WHO guidelines are available to treat all the infections encountered in office practice.

Insights

Antimicrobial resistance (AMR) is a growing global crisis, posing a significant threat to public health. India faces a substantial AMR burden, with high rates of resistant bacteria like MRSA and carbapenem-resistant Enterobacteriaceae.

Area of Science:

Public Health
Infectious Diseases
Microbiology

Background:

Antimicrobial resistance (AMR) is a critical global health threat, escalating with the discovery of new antibiotics.
AMR is projected to be the third leading cause of death globally.
India, a major antibiotic consumer, faces a severe AMR burden, with high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem resistance in E. coli and Klebsiella.

Purpose of the Study:

To highlight the escalating crisis of antimicrobial resistance (AMR) globally and in India.
To identify key contributing factors to AMR, including patient, prescriber, system, environmental, and agricultural uses.
To outline India's National Action Plan and WHO strategies for combating AMR.

Main Methods:

Review of global AMR estimates and Indian Council of Medical Research (ICMR) data.
Analysis of contributing factors to AMR across various sectors.
Examination of national and international strategies for AMR containment.

Main Results:

AMR is a leading cause of death globally, with India experiencing a high burden.
Prevalence of MRSA exceeds 50%, and carbapenem resistance is nearly 50% in key Gram-negative bacteria in India.
Rampant antibiotic use in humans and animals significantly contributes to AMR.

Conclusions:

India's National Action Plan and WHO's AWaRe classification are crucial for rational antibiotic use and AMR containment.
Multi-stakeholder coordination under the 'One Health' initiative is vital.
Addressing AMR requires enhanced knowledge, improved antimicrobial stewardship, and robust monitoring systems.

Read full analysis

Keywords:

AWaRe Antimicrobial resistance Antimicrobial stewardship National action plan Office practice One Health

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