Timely and accurate diagnosis is the bedrock to stop misuse and overuse of medicines

Shobha Shukla (CNS)
Contd from previous issue
But unless we use them at the right time for the right patient, it may not give the right kind of results to help tailor the antimicrobial prescription."
Antimicrobial stewardship is about preventing misuse of antimicrobials by optimising their use- that is, preventing their over use- as soon as a correct diagnosis has been made.
"This optimisation can happen in the form of switching from broad spectrum to narrow spectrum (or targeted) antibiotics, or reducing the number of antibiotics which may no longer be needed for patient management, or prescribing shorter duration antibiotics, or switching from intravenous antimicrobials to oral ones, depending upon the patient situation," said Dr Sharma.
Underuse and overuse fuel AMR
Dr Sharma points out that both overuse and underuse of antibiotics fuel AMR. "Underuse happens if the patients in need of antibiotics are not able to get them, either because of accessibility or availability issues, or perhaps the diagnosis was not done. So, in the absence of treatment the person [with an infectious disease] remains infectious for a longer period of time and infection spreads to more and more people," said Dr Sharma.
More emphasis needs to be put on infection prevention and control. Strong infection prevention and control is a very effective approach to control the spread of AMR. WHO recognises that "the most effective intervention is to improve hygiene in healthcare facilities, including promotion of hand hygiene. Safer hospitals mean fewer infections and every infection prevented is an antibiotic avoided." Proper sanitation, including proper waste disposal, simple hand cleaning practices, and availability of clean drinking water can go a long way in fighting infections, both in and out of hospitals. Antibiotics are not a 'shortcut' to circumvent infection prevention and control
Dr Sharma cautions that antibiotics should not be used as a shortcut (as they often are) to circumvent infection prevention and control activities. She also advises against the use of antibiotics in situations like treating a wound (debridement or simple cleaning would do) or dealing with a normal vaginal delivery.
All these efforts will not only help in managing the individual patient well, they will also slow down the process of AMR and help preserve existing antimicrobials for use by the future generation.
Will world leaders include AMR survivors at the UNHLM on AMR?
World leaders would be meeting at the upcoming 2024 United Nations General Assembly High Level Meeting on AMR. Bhakti Chavan calls upon them to include the voices and faces of AMR survivors in all deliberations at the forthcoming UNHLM on AMR, as they are the ones who suffer the worst consequences of AMR.  And as Bhakti rightly says: "AMR might be invisible, but the survivors are not."