23.11.2011
Amoxicillin potassium clavulanate tablets
Antibiotics and bacterial resistance in the 21st century. Developments of superbugs are the result of such kinds of antibiotic associated evils [ 12 Alpert PT. Superbugs: antibiotic resistance is becoming a major public health concern. In addition, few antibiotics have been associated with adverse side effects, including mild to very serious symptoms that depend upon treated microbial sps and individual patients [ 13 Torok E, Moran E, Cooke F. Oxford handbook of infectious diseases and microbiology 2016. [http://dx.doi.org/10.1093/med/9780199671328.001.0001] ]. The antibiotics can sometimes alter the host microbiota and lead to chronic infection and inflammation [ 14 Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. [http://dx.doi.org/10.1186/s13073-016-0294-z] [PMID: 27074706] ]. Usually, antibiotics side-effects are fever, nausea and major allergic reactions, including photo-dermatitis and anaphylaxis. The common side-effect of antibiotics is diarrhea, due to the misbalancing of the intestinal flora species or overgrowth of pathogenic bacteria [ 15 Bhattacharya S. Additional side-effects included the interaction with other drugs, such as the elevated risk of damage of tendon when quinolone antibiotic is given with a corticosteroid [ 16 Lewis T, Cook J. Fluoroquinolones and tendinopathy: A guide for athletes and sports clinicians and a systematic review of the literature. [http://dx.doi.org/10.4085/1062-6050-49.2.09] [PMID: 24762232] ]. The overuse of fluoroquinolone and other antibiotics leads to antibiotic resistance in bacteria, which might inhibit the treatment of antibiotic-resistant infections [ 16 Lewis T, Cook J. Fluoroquinolones and tendinopathy: A guide for athletes and sports clinicians and a systematic review of the literature. [http://dx.doi.org/10.4085/1062-6050-49.2.09] [PMID: 24762232] ]. The article summarizes the adverse effect of antibiotics, mechanisms of resistance, challenges and future strategies to combat antimicrobial resistance to manage the health care system. A side effect of antibiotics is a reaction that occurs in the patients, along with the therapeutic action [ 17 Heta S, Robo I. The side effects of the most commonly used group of antibiotics in periodontal treatments. [http://dx.doi.org/10.3390/medsci6010006] [PMID: 30720776] ]. If the dosage of antibiotics is used appropriately, antibiotics are relatively safe, with very few side effects. However, these side effects can range from mild allergic reactions to severe adverse, which may be extremely variable from patient to patient and from antibiotic to antibiotic [ 18 Thong BYH. [http://dx.doi.org/10.4168/aair.2010.2.2.77] [PMID: 20358021] ]. Moreover, many antibiotics may interfere with the individual patient’s ability to tolerate and complete the course [ 19 Saradamma RD, Higginbotham N, Nichter M. Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India. [http://dx.doi.org/10.1016/S0277-9536(99)00380-9] [PMID: 10695985] ]. Fewer patients having any previous allergic reaction to any kind of antibiotics are not recommended for the same. The allergic reactions may include symptoms like a skin rash and allergic reactions, called anaphylaxis, which can lead to difficulties in breath and swelling of the lips or tongue and face. Here, the common side-effects of major antibiotics are given below [ 20 Warrington RJ, McPhillips S. Independent anaphylaxis to cefazolin without allergy to other ?-lactam antibiotics. [http://dx.doi.org/10.1016/S0091-6749(96)70171-9] [PMID: 8757224] ]. (1) Penicillin: Rash, diarrhea, abdominal pain, nausea/ vomiting, drug fever, hypersensitivity (allergic) reactions, etc . Allergic reactions to drugs: Implications for perioperative care. [http://dx.doi.org/10.1053/jpan.2002.36669] [PMID: 12476405] ]. (2) Cephalosporin: Diarrhea, nausea/vomiting, hypersensitivity reactions, serum sickness, etc . Adverse events associated with the use of oral cephalosporins/cephems. Diagn Microbiol Infect Dis 2007; 57(3)(Suppl.): 67S-76S. [http://dx.doi.org/10.1016/j.diagmicrobio.2006.12.002] [PMID: 17292575] ]. (3) Aminoglycosides: Nausea/vomiting, nystagmus, etc . [http://dx.doi.org/10.1080/00325481.1978.11714923] [PMID: 704499] ]. (4) Erythromycin, azithromycin, clarithromycin: abdominal pain, diarrhea, anorexia, nausea/vomiting, taste alterations, etc . (5) Tetracycline: Nausea/vomiting, diarrhea, anorexia, abdominal pain, tooth discoloration in children 25 Greer ND. Tigecycline (Tygacil): the first in the glycylcycline class of antibiotics. Baylor University Medical Center Proceedings 2006; 19(2): 155-61. (6) Quinolones ciprofloxacin (cipro), levofloxacin (levaquin), moxifloxacin (avelox), ofloxacin ( floxin): nausea/vomiting, diarrhea, abdominal pain, headache, lethargy, insomnia, etc . Antibiotic therapy for acute watery diarrhea and dysentery. (7) The environments, especially the water bodies, have also reported the presence of resistant organisms or their genes. Specific socio-economic and cultural factors prevalence make the containment of resistance more challenging [ 27 Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. [http://dx.doi.org/10.4103/ijmr.IJMR_331_18] [PMID: 31219076] ]. COMMON MECHANISM TO DEVELOP RESISTANCE IN MICROORGANISM. The key mechanisms of antimicrobial resistance include enzymatic degradation of antimicrobial produced by bacterial cells, a mutation in the antimicrobial targeting agents and prohibition of antibiotic entry inside the bacterial cells via membrane (Fig. The spread of antibiotic resistance occurs through genetic material (plasmid or the bacterial chromosome) [ 28 Naguib MM, El-Gendy AO, Khairalla AS. Microbial diversity of mer operon genes and their potential rules in mercury bioremediation and resistance. Open Biotechnol J 2018; 12(1) [http://dx.doi.org/10.2174/1874070701812010056] , 29 Pitton JS. Mechanisms of bacterial resistance to antibiotics.Ergebnisse der Physiologie Reviews of Physiology 1972; Vol. World Health Organization, European Centre for Disease Control and World Health Assembly highlighted the antimicrobial resistance as a major public health issue and will be a big challenge to grip for health care workers [ 30 Richardson E. The Role of Public Health Organizations in Addressing Public Health Problems in Europe: The Case of Obesity Alcohol and Antimicrobial Resistance 2018; 51 ]. An establishment of multi-resistant strains arises due to the production of a broad spectrum of ?-lactamases using various bacterial spp. after continuous consumption and became very common [ 31 van Duin D, Paterson DL. Multidrug-resistant bacteria in the community: trends and lessons learned. [http://dx.doi.org/10.1016/j.idc.2016.02.004] [PMID: 27208764] ]. Antimicrobial resistance is an important public health concern at the global level. However, in India, recent hospital and community based reports showed an incensement of microbial resistance [ 32 Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, Malini A. [http://dx.doi.org/10.4103/0976-9668.116970] [PMID: 24082718] ]. The reports showed varied resistance in different antibiotic resistance rates of various organisms along with various parts of India, as shown in Table 1 . AMR in the world and emergence of newer Multi-Drug Resistant (MDR) and Extreme Drug Resistance (XDR) strains pose newer diagnostic and therapeutic challenges [ 33 Patil K, Bagade S, Bonde S, Sharma S, Saraogi G. Recent therapeutic approaches for the management of tuberculosis: Challenges and opportunities. [http://dx.doi.org/10.1016/j.biopha.2018.01.115] [PMID: 29710471] ]. However, developed and developing countries are still striving to combat deep-rooted diseases such as tuberculosis, malaria and cholera pathogens, which are becoming with more drug resistant strains [ 34 John TJ, Dandona L, Sharma VP, Kakkar M. Continuing challenge of infectious diseases in India. [http://dx.doi.org/10.1016/S0140-6736(10)61265-2] [PMID: 21227500] ]. Several factors such as poverty, illiteracy, overcrowding and malnutrition further contribute to such kind of situation [ 35 Bajpai V. The challenges confronting public hospitals in India, their origins, and possible solutions. Lower healthcare professional to patient ratios is also involved for such kind of concern. CASE STUDIES OF RESISTANCE DEVELOPMENT AND AFFECTING FACTORS. A study published by the Indian Council of Medical Research (ICMR) has found antibiotic resistant organisms of the digestive tracts in about 66% of the Indian population. The study was performed on 207 individuals with an analysis of stool samples, who had not taken any antibiotic from at least last month. Individuals selected were not suffering from any chronic illness. Isolates taken from 139 out of these 207 individuals were found to be resistant to one or more types of antibiotic classes. The maximum resistance rate was seen for cephalosporin (60%) and fluoroquinolones (41.5%) [ 36 Gupta M, Didwal G, Bansal S, et al. Antibiotic-resistant Enterobacteriaceae in healthy gut flora: A report from north Indian semiurban community. [http://dx.doi.org/10.4103/ijmr.IJMR_207_18] [PMID: 31219094] ]. A group of All India Institute of Medical Science (AIIMS), New Delhi, India researcher analyzed the water samples from seven different places in Delhi NCR regions along with the river, including its entry and exit points in the city, 35 bore wells and water percolating through waste. They found the concentration of dissolved drugs/antibiotics in the river water increased at an exit point rather than an entry point into the city. This case story concludes that either stopping or recommended use of the drugs/antibiotics by humans, animals and proper disposal method needs to be recommended to save the environment and welfare [ 37 Velpandian T, Halder N, Nath M, et al. Un-segregated waste disposal: an alarming threat of antimicrobials in surface and ground water sources in Delhi. [http://dx.doi.org/10.1007/s11356-018-2927-9] [PMID: 30136185] ]. Resistances against various classes of antibiotics were detected among various parts of the world [ 38 Global Antibiotic Resistance Partnership (GARP)-India Working Group, 2011. Rationalizing antibiotic use to limit antibiotic resistance in India The Indian journal of medical research 2011; 134(3): 281. However, the main reasons for this situation are either antibiotic doses not used under prescription or with proper treatment duration [ 18 Thong BYH. [http://dx.doi.org/10.4168/aair.2010.2.2.77] [PMID: 20358021] , 38 Global Antibiotic Resistance Partnership (GARP)-India Working Group, 2011. Rationalizing antibiotic use to limit antibiotic resistance in India The Indian journal of medical research 2011; 134(3): 281. , 39 Gawande U, Deshmukh S, Kadam S, Potdar G, Salvitthal H. Prescription audit of patients attendees in public health facilities in Maharashtra, India with special reference to rational use of antibiotics. [http://dx.doi.org/10.18203/2320-6012.ijrms20151418] ]. Increasing antimicrobial resistance is now a worldwide problem, compounded by the lack of development of new antimicrobial medicines [ 40 Reardon S. [http://dx.doi.org/10.1038/509141a] [PMID: 24805322] ]. Penicillin medication is used to treat several kinds of bacterial infections. It is also used for the treatment of a number of infections like pneumonia, bronchitis, gonorrhea and infections of the ears, nose, throat, urinary tract and skin [ 41 Venkatesh S, Chauhan LS, Gadpayle AK, Jain TS, Ghafur A, Wattal C. National treatment guidelines for antimicrobial use in infectious diseases. India: National Centre For Disease Control, MOHFW, Government of India 2011; 1-64. Such type of treatments led to develop a resistance and side-effects against the penicillin class of drugs, when un-appropriate doses are given with no medical healthcare supervision/guidance [ 42 Miller EL. [http://dx.doi.org/10.1016/S1526-9523(02)00330-6] [PMID: 12484664] ]. The antibiotic should be prescribed only in case of bacterial infections, when the symptoms are severe, high risk of complications, and infection is not resolving [ 43 Reese RE, Betts RF, Gumustop B, Betts R. Furthermore, in the case of severe infections, combinations therapy of antibiotics should be followed to achieve the synergistic effect of antibiotics at a lower dose under medical supervision. To prevent the development of antibiotic resistance, it is important to use antibiotics in the right way, to use the right drug with the right dose, at the right time for the right duration as per disease condition after diagnosis [ 44 Doron S, Davidson LE. [http://dx.doi.org/10.4065/mcp.2011.0358] [PMID: 22033257] ]. Prescribe the drug only where necessary, and consider benefits versus risks according to patient. The dosage should be prescribed carefully and be followed by manufacturer’s instructions [ 45 De Vries TPG, Henning RH, Hogerzeil HV, Fresle DA, Policy M. Guide to good prescribing: a practical manual (No WHO/DAP/9411) 1994. The manufacture recommended doses are determined using clinical trial studies and assume one dose fits all [ 46 Shen J, Swift B, Mamelok R, Pine S, Sinclair J, Attar M. Design and Conduct Considerations for First-in-Human Trials. [http://dx.doi.org/10.1111/cts.12582] [PMID: 30048046] ]. The newer drugs are launched and necessary to review the patient to assess for effect, side-effects (Adverse Event; AE and Serious Adverse Events; SAE) and the need to continue [ 47 Gliklich RE, Dreyer NA, Leavy MB. Adverse event detection, processing, and reporting.Registries for Evaluating Patient Outcomes: A User’s Guide 3 rd ed. Antibiotics are life-saving drugs, should be used safely and effectively [ 48 Centers for Disease Control and Prevention (CDC) and Aware. During the entire course of any prescribed antibiotic, complete the course so that it can be fully effective and does not induce resistance [ 49 National Collaborating Centre for Women’s and Children’s Health. Antibiotics for early-onset neonatal infection: antibiotics for the prevention and treatment of early-onset neonatal infection 2012. It is required that necessary precautions should be taken by health care professionals to minimize the unnecessary prescribing and overprescribing of antibiotics [ 48 Centers for Disease Control and Prevention (CDC) and Aware. , 50 Fleming-Dutra KE, Linder JA, Hyun D, Iskander JK, Thorpe P, Laird S. Many antibiotics such as amoxicillin, ampicillin, cephalosporin, etc . cause mild side effects such as diarrhea and abdominal pain, and need to be prescribed with appropriate stomach care supplement or probiotics [ 51 Visone DNP. The Use of Probiotics to Prevent Antibiotic Associated Diarrhea: Current Primary Care Practice and Introduction of an Evidence Based Practice Protocol 2012. It is recommended that, the prescribed treatment should be continuous, the side-effects of medicine may occur and subside gradually after a few days [ 52 Cunha BA. [http://dx.doi.org/10.1016/S0025-7125(05)70309-6] [PMID: 11190350] ]. Try to practice good hygiene and use appropriate infection control procedures. Additional precautions should be taken for patients or suspected to be infected or colonized with highly infectious pathogens [ 53 Leblebicioglu H, Rodriguez-Morales AJ, Rossolini GM, Lopez-Velez R, Zahar JR, Rello J. Management of infections in critically ill returning travellers in the intensive care unit-I: Considerations on infection control and transmission of resistance. [http://dx.doi.org/10.1016/j.ijid.2016.04.019] [PMID: 27134158] ]. The usage of combination therapy would provide prevention against drug-resistant bacterial strains [ 54 Worthington RJ, Melander C. Combination approaches to combat multidrug-resistant bacteria. [http://dx.doi.org/10.1016/j.tibtech.2012.12.006] [PMID: 23333434] ]. GOVERNMENT INITIATIVE POLICIES TO CONTROL ANTIBIOTICS RESISTANCE. (1) To prevent the misuse of important antibiotics, the Central Drugs Standard Control Organization (CDSCO), Govt of India has implemented Schedule H1 in India [ 55 Ahmad A, Patel I. Schedule H1: Is it a solution to curve antimicrobial misuse in India? [http://dx.doi.org/10.4103/2141-9248.121228] [PMID: 24349854] ]. (2) Implementation of the National Health Policy, 2017 to public health and creating the awareness [ 56 Prinja S, Downey LE, Gauba VK, Swaminathan S. Health technology assessment for policy making in India: current scenario and way forward 2018. (3) Hospital infection control and prevention program [ 57 Pai M, Kalantri S, Aggarwal AN, Menzies D, Blumberg HM. [http://dx.doi.org/10.3201/eid1209.051663] [PMID: 17073077] ]. (4) The regulation of antimicrobial’s sale [ 58 Shet A, Sundaresan S, Forsberg BC. Pharmacy-based dispensing of antimicrobial agents without prescription in India: Appropriateness and cost burden in the private sector. [http://dx.doi.org/10.1186/s13756-015-0098-8] [PMID: 26693005] ]. (5) Training program to control antibiotic usage [ 59 Chandy SJ, Michael JS, Veeraraghavan B, Abraham OC, Bachhav SS, Kshirsagar NA. ICMR programme on antibiotic stewardship, prevention of infection & control (ASPIC). (6) An establishment of the National Centre for Disease Control (NCDC) [ 60 Choudhry A, Singh S, Khare S, et al.
Amoxicillin mk
875 mg
Enterococcus faecalis amoxicillin
Amoxicillin 600 mg
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