RESISTANCE TO ANTIMICROBIAL AGENTS IN INFANTS AND CHILDREN

RESISTANCE TO ANTIMICROBIAL AGENTS IN INFANTS AND CHILDREN

Sania Najeeb - MDCCC-116

INTRODUCTION 

Resistance to antimicrobial agents or simply Antimicrobial resistance is an emerging public health concern in humans.1 It is of more concern in children especially infants. Infants can be defined as the babies right from the birth till 1 year of age. Children and infants are often prescribed with antibiotics for infections even for self limiting ones. Many parents prefer going with antibiotics rather than using home remedies or simply letting the infection or sepsis cure by itself. It is often seen that in rural areas antibiotics for children are purchased with no consultation to physician just on the basis of advice from non- medical friends, family members or pharmacist himself. 

Antimicrobial agents are classified under the schedule H drugs which are prescription only drugs i.e they cannot be dispensed by a pharmacist without a prescription from RMP or physician. In south Asian countries especially India antimicrobial agents are being used as over the counter (OTC) drugs and are easily available in local pharmacies with no requirement of prescription. In low- and middle-income countries (LMICs), where there is inadequate legislation and easy access to over-the-counter antibiotics, antimicrobial resistance (AMR) is a growing concern to global health. Lack of antimicrobial stewardship and poor compliance with infection control recommendations further increase the risk of AMR. By lowering the community's infection reservoir, vaccinations have been suggested as one weapon in the fight against the AMR epidemic. Up to one-third of neonatal fatalities worldwide each year are caused by sepsis. Neonatal sepsis is recognised by the World Health Organisation as a significant worldwide health hazard, with low- and middle-income countries (LMICs) bearing the brunt of the disease. 

METHODOLOGY 

Few studies on antimicrobial resistance were studied form major database sources such as [PUBMED, PMC, EMBASE,GOOGLE SCHOLAR ,etc using search engine and keywords like infants, antibiotic use, antimicrobial resistance, antibiotic resistance, etc. the data was extracted and a conclusion was driven about how frequent is antibiotic resistance. 

RESULTS 

7 articles were reviewed from the databases that included the use of antibiotics and development of resistance to it in infants. The results showed that with frequent and concurrent use of antimicrobial agents in infants led to antimicrobial resistance that can complicate the disease condition as well as future prescription on antibiotics. A Study conducted by Muhammad almas hashmi et.al1 titled as Emerging Antimicrobial Resistance in Neonatal Sepsis included a total of A total of 1,070 neonates, Neonatal sepsis was frequently caused by Styphylococci, Acinitobacter, Klebsiella, and E. coli. Vancomycin and gentamicin sensitivity was seen in gram-positive bacteria. Colomycin was extremely toxic to Gramme negative organisms. Another study conducted by Weizhong Li et.al2 concluded that Antibiotics used during pregnancy significantly altered the source of gut colonisation away from vertical transmission and towards horizontal passage from the atmosphere to the children. Another significant study carried out by Xiaoshan Peng et.al3 which was titled as Prevalence and antimicrobial resistance patterns of bacteria isolated from cerebrospinal fluid among children with bacterial meningitis in China from 2016 to 2018: a multicenter retrospective study concludes that The three main infections responsible for PBM (pediatric bacterial meningitis) in Chinese patients were S. epidermidis, E. coli, and S. pneumoniae. Age had an impact on the distribution of PBM-causing microbes. Concerning factors included the high prevalence of ESBL (extended-spectrum βlactamase) synthesis in isolates of E. coli and K. pneumoniae, as well as CoNS (coagulase-negative Staphylococcus isolates) resistance to methicillin. A significant obstacle to treating PBM is (carbapenem-resistant K. pneumoniae )CRKP Muhammad Imran Nisar.et.al4 conducted a study entitled Antimicrobial Resistance in Pneumococcal Carriage Isolates from Children under 2 Years of Age in Rural Pakistan concludes that pneumococcal variants were largely resistant to cotrimoxazole and tetracycline. There was an increase in erythromycin and tetracycline resistance attributed to increasing prevalence of serotype 19A. Overall all the studies conclude that frequent use of antibiotics to infants as well as exposure of mother to antibiotics during pregnancy can largely affect the sensitivity profile of antibiotics in children. 

PREVENTION 

The biggest concern is how to prevent it. The answer is as simple as it is, by reducing the use of antibiotics. Antibiotics are very good source for treatment of infection or sepsis but overuse may lead to development of resistance and in worst scenario can lead to unwanted side effects like ringing in ears with use of azithromycin, peripheral esinophilia with vancomycin, grey baby syndrome with chloramphenicol, nephrotoxicity and neuromuscular damage with aminoglycosides,etc Also counseling to the parents regarding the dose, dosage strength, duration of antibiotic therapy can also reduce the chances of resistance. Antibiotics must be avoided in Self limiting infections and viral infections where antibiotic use can rarely cause benefits. Conducting health programs and workshops in rural areas, hospitals, health care centres can make people aware of and educate them about the antibiotics with their risks and benefits. Lastly antimicrobial stewardship can also impact the current situation of use of antimicrobial agents and help health care professionals as well as parents in proper management of sepsis and infection in children 

ANTIMICROBIAL STEWARDSHIP 

Antimicrobial stewardship is an effort planned that encourages the responsible use of antimicrobials (including antibiotics), enhances patient outcomes, lowers microbial resistance, and lessens the spread of diseases brought on by multidrugresistant organisms. Stewardship interventions are listed in three categories: broad, pharmacy-driven; and infection and syndrome specific.