Overkill of antibiotic drugs making liver cure difficult

CHANDIGARH: In a first-of-its kind global study published recently, doctors found a 34% overall prevalence of multidrug resistance (MDR) in cirrhosis (end-stage liver disease) patients, with the Indian figure being even a more alarming 73%, highlighting the abuse of strong antibiotics because of free availability over the counter.

End-stage patients of liver disease developed resistance to antibiotics because of indiscriminate use. This resistance in cirrhosis patients means higher chances of new organ failure and higher hospital mortality than non-MDR bacteria cases.

The study was done in 46 centres worldwide, including three in India—the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, the Institute of Liver and Biliary Sciences in Delhi, and Srirama Chandra Bhanja Medical College and Hospital in Cuttack. Doctors enrolled 1,300 patients of cirrhosis in the study. Co-author Dr Virendra Singh said: “This study is important because it shows high prevalence of MDR bacteria in India. About 69% of the patients are men.”

Alcohol is the most common cause of cirrhosis, followed by hepatitis-C viral infection. Doctors found MDR bacterial infections to be common in Indian centers, while quite low in North America (16% in the United States and 24% in Canada).

Resistance was quite enormous even in South America and other Asian centres, while there was a relevant variability across Europe (from 57% in Israel to 17% in Russia). Known risk factors include at least five days of antibiotics course in the previous three months for the treatment of a bacterial infection. The factors also include invasive procedures in the previous month and exposure to hospital-acquired infections.

Dr Virendra Singh said: “Two potential reasons are responsible for this finding-—firstly, over-the-counter access to antibiotics in the community and, secondly, the presence of antibiotics in the environment.” The study confirmed that infections due to MDR are more difficult to treat because of association with a high risk of organ fa ilure, septic shock, and 28-day mortality.