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While the indiscriminate use of antibiotics is increasingly causing bacteria to become antibiotic-resistant, few hospitals in Bengaluru have antibiotic stewardship programmes to prevent this.
Of hundreds of hospitals in Bengaluru, only around 80 have accreditation from the National Accreditation Board for Hospitals and Healthcare Providers (NABH), which mandates them to have the programme. Many of these hospitals are also part of big chains, which means smaller hospitals are left out.
The NABH comes under the central government's Quality Council of India.
Hospitals with the programme are required to have an antibiotic policy. The policy would prescribe which antibiotics can be used commonly, which are restricted, and which can be used for infection prevention in surgeries. The doctor is supposed to prescribe the weakest antibiotic and escalate, if needed. In case of restricted antibiotics, they would have to take permission from the monitoring officer.
Many hospitals develop their antibiotic policy based on recommendations from the Indian Council of Medical Research (ICMR), Centers for Disease Control and Prevention (CDC), etc. However, NABH recommends that hospitals also develop the policy based on their own antibiogram, which shows the extent to which various bacteria are resistant to antibiotics in that hospital's setting.
"Suppose 30 per cent of patients in our hospital are showing resistance to an antibiotic, we don’t use it for some time as it indicates that resistance to that antibiotic is increasing. Bacterial culture reports take 48 hours, so it's important that we give an effective antibiotic initially so that the patient’s condition doesn’t deteriorate," infectious disease specialist Dr John Paul said.
However, there's little monitoring of hospitals' implementation of antibiotic policies. Hospitals are supposed to do their own documentation and analyses but don't have to share the reports with NABH regularly. They only have to share records when NABH inspects the hospital for accreditation renewal every three years.
"Many hospitals don't have a microbiology lab, so they don't have enough test results to create an antibiogram. Also, some create antibiograms annually only, which means changes in the bacteria's behaviour in the previous three months, for example, can't be understood," said Cornelius Bernard, founder of Ibhar Technologies, which has been working with hospitals on antibiogram development.
According to infectious disease specialist Dr Chintan Kaswala: "Data from hospitals should be available publicly so that we know what infections are common in the community and which drugs are sensitive to them, so as to prescribe drugs accordingly. It will also bring transparency."