Warning for use of Antibiotics for low-grade fever: ICMR guidelines

According to HAI surveillance data included in this report, Acinetobacter causes almost 70 percent of urinary tract infections in critically ill (ICU) patients.

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ICMR

Last Updated on November 28, 2022 by The Health Master

New Delhi: The Indian Council of Medical Research (ICMR) has issued guidelines warning against the use of antibiotics for conditions such as low-grade fever and viral bronchitis and advising doctors to follow a timeline when prescribing them.

The ICMR guidelines stated that antibiotics should be prescribed for a duration of five days for skin and soft tissue infections, five days in case of community-acquired pneumonia, and eight days for hospital-acquired pneumonia.

“A clinical diagnosis most often helps us predict causative pathogens fitting into a clinical syndrome, which would tailor the correct antibiotic rather than blindly relying on fever, procalcitonin levels, WBC counts, cultures, or radiology to make a diagnosis of infection,” the guidelines said.

It stated that empiric antibiotic therapy should be limited to seriously ill patients.

Generally, empiric antibiotic therapy is only recommended for a select group of patients suffering from:

  • Severe sepsis and septic shock,
  • Community-acquired pneumonia,
  • Ventilator-associated pneumonia,
  • Necrotizing fasciitis.

Hence, it is important to start smart and then focus, i.e., evaluate if empiric therapy can be justified or de-escalated, and then make a plan with regard to the duration of therapy, the guidelines said.

An ICMR survey conducted between January 1 and December 31, 2021, suggested that a big chunk of patients in India may no longer benefit from the use of carbapenem, a powerful antibiotic administered mainly in ICU settings for the treatment of pneumonia, septicemia, etc., as they have developed anti-microbial resistance to it.

The analysis of the data pointed towards a sustained increase in drug-resistant pathogens, resulting in difficulty treating certain infections with the available medicines.

Resistance to Imipenem, which is used to treat infections caused by E. coli bacteria, increased from 14 percent in 2016 to 36 percent in 2021.

The trend of decreasing susceptibility of bacteria to specific antibiotics was also observed with Klebsiella pneumonia as it registered a drop from 65 percent in 2016 to 45 percent in 2020 and was at 43 percent in 2021.

The term “susceptibility” here was used to describe the vulnerability of the bacteria to the antibiotic.

Carbapenem resistance isolates of E Coli and K pneumonia are also resistant to other antimicrobials, making it very challenging to treat carbapenem-resistant infections.

The resistance to the broad-spectrum antibiotic carbapenem with respect to infections caused by Acinetobacter baumannii bacteria was recorded in 87.5 percent of the patients who were part of the study in 2021, limiting the availability of treatment options, the ICMR report said.

According to HAI surveillance data included in this report, Acinetobacter causes almost 70 percent of urinary tract infections in critically ill (ICU) patients.

High levels of carbapenem resistance in acinetobacter baumanii are therefore very alarming and limit treatment options in these patients.

The report stated that the susceptibility of the same bacteria to minocycline is close to 50 percent, making it the most susceptible antibiotic after colistin for Acinetobacter baumannii.

In Pseudomonas aeruginosa, another bacteria that cause infections in the blood, lungs (pneumonia), or other parts of the body after surgery, there has been a consistent increase in susceptibility to all the major antipseudomonal drugs in the last few years.

According to the ICMR report, Staphylococcus aureus, which causes a wide range of clinical diseases such as skin infections such as abscesses and boils, as well as pneumonia, endocarditis, and osteomyelitis, showed greater susceptibility to erythromycin, clindamycin, ciprofloxacin, co-trimoxazole, and high-level mupirocin when compared to MRSA (Methicillin-

MRSA rates have increased every year from 2016 to 2021 (28.4 percent to 42.6 percent). Enterococci is another important pathogen that is quickly evolving, and drug susceptibility has changed considerably in the last few years.

Several fungal pathogens, like C. parapsilosis and C. glabrata, are showing increasing resistance to commonly available antifungal medicines such as fluconazole, thus requiring close monitoring in the next few years.

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