We, as clinicians, are aware of the CONSTANT DECLINE in the available spectrum of Effective Antibiotics, with the growing menace of Anti-microbial Resistance, creating huge roadblocks in treating serious Nosocomial Infections in ICU settings.
However, we are still possessing a limited range of lesser used, but Effective Antibioitics – that can help us BUY TIME , till newer Antibiotics can be received from Medical Research Channels across the world.
These Special Category Antibiotics are our RESERVE ANTIBIOTICS . They ought to be deployed only as the LAST RESORT . Their day-to-day usage must be restricted meaningfully.
- The first drug in the Reserved Category is AZITHROMYCIN .
This is a Macrolide group member, which is relatively low – priced ( therefore widely prescribed ) and has the advantage of single oral dosing. However, it can be spared ( better avoided ) from the treatment of Upper Respiratory infections, and kept reserved for more serious infections – like Sexually transmitted infections, Enteric fever, Mycoplasma LRTI, Shigellosis and disseminated MAC infections in HIV patients . ( MAC = Mycobacterium Avium Complex )
There are other effective options for treating Bacterial URTI and LRTI, as well as Skin / Soft tissue infections. WHY ALLOW Anti-microbial Resistance to defeat the wider efficacy of AZITHROMYCIN.
- MEROPENEM is the second Reserve Antibiotic, that needs a regulated use. It is efficacious and safe in the treatment of a wide variety of Nosocomial and Polymicrobial infections in younger children.
We are all aware of the reasonable success of MEROPENEM in Neonatal Sepsis and Meningitis , alongside Gram Negative Nosocomial Pneumonia in young infants. It is also a Group C drug for XDR Tuberculosis. Therefore, Meropenem deployment must be very very selective and with ample logic.
Reserve Antibiotics must be known to all clinicians, as here the choices of Antibiotics ( often empirical ) are likely to made in a mistaken fashion.
Dr. Dhananjay Shah
Ped. Practice of 40 years
@ Rajkot. Gujarat.