16
becomes difficult and might lead to treatment failure in immuno-compromised
patients. Overall, it increases costs, hospital stays, persistence and severity of disease and thereby undue exposure to side effects (Vishnuraj et al. 2016). Antibiotic
resistance severely limits the surgical and other invasive therapeutic procedures
such as transplantation and anti-cancer therapies, and may need the antibiotics usually secured as the last resort treatment (Friedman et al. 2016).
Many countries have initiated steps to reduce indiscriminate usage of antibiotics.
To assure optimum consumption, clinical use of antibiotics in humans is operated at
two levels: pre-prescription and post-prescription approach. These approaches have
been designed based on regulatory restrictions, local government laws, recommended treatment regimens for the drug, clinical guidelines, pharmacy dosing programs, dosage form and route of administration, etc. The patient facing
(post-prescription) is a better point for regulation of antibiotic usage, because it can
be modified based upon the prevailing medical conditions in the locality, clinical
status and feedback from the patient and doctor’s experience (Garnacho-Montero
et al. 2015). Reduction of antibiotic prescription, orientation of prescribers for regulated usage, and feedback of antibiotic regimen has shown a marked decline in
antibiotic usage in Australia (McKenzie et al. 2013). Brazil, Mexico and Thailand
have passed laws to regulate sale of over-the-counter antibiotics without medical
prescription and have strengthened the hospital and therapeutics committee (SantaAna- Tellez et al. 2013; Holloway et al. 2017). India has reclassified the category of
many antibiotics as Schedule H1, which demands that these antibiotics must be sold
with medical prescription and the pharmacist has to retain its details in a separate
register (for 3 years). This further prohibits the indiscriminate sale of over-thecounter antibiotics from pharmacies (Laxminarayan and Chaudhury 2016). South
Africa has mandated the pharmacists to stick to the government guidelines, only
registered health professionals can prescribe antibiotics and the data must be logged
for checking compliance with the existing good manufacturing practices and safe
medical usage of antibiotics (Gelband and Duse 2011). All of these approaches are
intended for de-escalation of usage of antibiotics and are principal components of
antimicrobial stewardship programmes (Masterton 2011).
1.2.7 Antimicrobial Resistance and Bacteriophages
Bacteriophages are viruses which infect bacteria and kill them. They have been
recently been revisited and proposed as an alternative to antibiotic therapy and for
combating infections against antibiotic resistant pathogens. However, we will focus
here on their potential role in antimicrobial resistance as reservoirs and/or for transfer of antibiotic resistance genes between different microbes. Many studies have
found that bacteriophages are carrying many antibiotic resistance genes and might
be involved in horizontal gene transfer, similar to the role played by plasmids and
integrons (Brabban et al. 2005). Metagenomic and whole genomic studies on microbiome of cystic fibrosis patients has shown drastic alterations in microbial
K. S. Singh et al.
becomes difficult and might lead to treatment failure in immuno-compromised
patients. Overall, it increases costs, hospital stays, persistence and severity of disease and thereby undue exposure to side effects (Vishnuraj et al. 2016). Antibiotic
resistance severely limits the surgical and other invasive therapeutic procedures
such as transplantation and anti-cancer therapies, and may need the antibiotics usually secured as the last resort treatment (Friedman et al. 2016).
Many countries have initiated steps to reduce indiscriminate usage of antibiotics.
To assure optimum consumption, clinical use of antibiotics in humans is operated at
two levels: pre-prescription and post-prescription approach. These approaches have
been designed based on regulatory restrictions, local government laws, recommended treatment regimens for the drug, clinical guidelines, pharmacy dosing programs, dosage form and route of administration, etc. The patient facing
(post-prescription) is a better point for regulation of antibiotic usage, because it can
be modified based upon the prevailing medical conditions in the locality, clinical
status and feedback from the patient and doctor’s experience (Garnacho-Montero
et al. 2015). Reduction of antibiotic prescription, orientation of prescribers for regulated usage, and feedback of antibiotic regimen has shown a marked decline in
antibiotic usage in Australia (McKenzie et al. 2013). Brazil, Mexico and Thailand
have passed laws to regulate sale of over-the-counter antibiotics without medical
prescription and have strengthened the hospital and therapeutics committee (SantaAna- Tellez et al. 2013; Holloway et al. 2017). India has reclassified the category of
many antibiotics as Schedule H1, which demands that these antibiotics must be sold
with medical prescription and the pharmacist has to retain its details in a separate
register (for 3 years). This further prohibits the indiscriminate sale of over-thecounter antibiotics from pharmacies (Laxminarayan and Chaudhury 2016). South
Africa has mandated the pharmacists to stick to the government guidelines, only
registered health professionals can prescribe antibiotics and the data must be logged
for checking compliance with the existing good manufacturing practices and safe
medical usage of antibiotics (Gelband and Duse 2011). All of these approaches are
intended for de-escalation of usage of antibiotics and are principal components of
antimicrobial stewardship programmes (Masterton 2011).
1.2.7 Antimicrobial Resistance and Bacteriophages
Bacteriophages are viruses which infect bacteria and kill them. They have been
recently been revisited and proposed as an alternative to antibiotic therapy and for
combating infections against antibiotic resistant pathogens. However, we will focus
here on their potential role in antimicrobial resistance as reservoirs and/or for transfer of antibiotic resistance genes between different microbes. Many studies have
found that bacteriophages are carrying many antibiotic resistance genes and might
be involved in horizontal gene transfer, similar to the role played by plasmids and
integrons (Brabban et al. 2005). Metagenomic and whole genomic studies on microbiome of cystic fibrosis patients has shown drastic alterations in microbial
K. S. Singh et al.