Working within a biological safety cabinet, a researcher splits and redistributes cells in a science lab at the Influenza Research Institute at the University of Wisconsin-Madison on Sept. 2, 2011. The facility is led by Yoshi Kawaoka, professor of pathobiological sciences in the School of Veterinary Medicine, one of the world's premier virologists and researchers of influenza viruses. (Photo by Jeff Miller/UW-Madison)
Working within a biological safety cabinet, a researcher splits and redistributes cells in a science lab at the Influenza Research Institute at the University of Wisconsin-Madison on Sept. 2, 2011. The facility is led by Yoshi Kawaoka, professor of pathobiological sciences in the School of Veterinary Medicine, one of the world's premier virologists and researchers of influenza viruses. (Photo by Jeff Miller/UW-Madison)

New Delhi : The Indian Council of Medical Research (ICMR) has recommended restrictions on the use of some antibiotics, stressing on at least two sets of blood cultures from different sites before providing patients with suspected serious infections presumptive antibiotic therapy.

  In a set of guidelines intended to curb the abuse of antibiotics and promote infection control, the council has called on hospitals to test multiple blood samples of patients and choose antibiotics according to the results of the culture tests.

The guidelines, released by the Union health ministry, caution that a set of last-resort antibiotics called carbapenems should not be used for presumptive therapy, but restricted to seriously ill patients with sepsis displaying specified clinical and physiological symptoms.

Doctors familiar with hospital practices in the country say the guidelines have been long overdue because, for various reasons, antibiotic-choice practices vary from hospital to hospital and are not always guided by laboratory-backed blood culture results.

“Decisions on the choice of antibiotics should rely more on laboratory results,” said Chand Wattal, chair of the clinical microbiology department at the Sir Ganga Ram Hospital, New Delhi, who was not associated with the guidelines.

Union Health Minister Jagat Prakash Nadda released the ICMR guidelines at an international conference to discuss strategies to combat antibiotic resistance that opened in the capital on Tuesday. The meeting has been called amid growing concerns that the abuse of antibiotics in India and other countries could make some common bacteria known to cause skin sores or diarrhoea lead to untreatable and life-threatening infections.

However, the guidelines clarify that carbapenems may be used to treat other infections in patients with non-severe allergy or intolerance to penicillins when the bacteria is resistant to other classes of antibiotics such as quinolones.

The ICMR has also cautioned that high-end antibiotics such as colistin, tigecycline, fosfomycin or daptomycin should be endorsed by an appropriately qualified physician within 24 hours and their use re-evaluated every 48 hours.

The World Health Organisation estimates that about 7 lakh people die every year as a result of bacterial infections that were earlier treatable through antibiotics. Inappropriate use of antibiotics and incomplete courses can contribute to antibiotic resistance.

“Treatment (for infections) is becoming more difficult and consuming more time and resources – antibiotic resistance is becoming a massive problem in a region where health systems are already stretched,” Poonam Khetrapal Singh, regional director of the WHO (southeast Asia), said.

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