Genesis of Antibiotic Resistance XXIV: Impediments in Implementation of Antibiotic Time Out (ATO) To Mitigate Antibiotic Resistance Pandemic (ARP): A Sniffle for Inclusive Approach
Authors: Lehler Raul , Picazo Antonio , Blackmon Sarah , Asplaugh Deborah , Fielder Ronald , Johnson Dennie , Kannan Subburaj 
Published: November 2023

Mitigating an impending ARP is a vanguard objective for the global medical community. Although standard core elements such as leadership commitment, accountability, drug expertise, action and treatment with ATO considerations, tracking and monitoring antibiotic prescription and resistance patterns, reporting, education with the aim of educating clinicians about resistance and optimal prescription have been indexed in hospital and nursing home antibiotic stewardship programs, such a scenario in developing countries such as India is far from reality either in the government hospitals or private medical facilities. According to the data, India as a nation lacks a coordinated scheme to address the issues for successful implementation of ATO to mitigate ARP. Comparative analysis of data published by the World Health Organization and The Center for Disease Dynamics, Economics & Policy relating to public health in developed and in developing countries reveals statistical connotations and exposes disparities that require immediate improvement. Drainage and flood control structures and protocols, along with wastewater and hazardous material contamination directives and procedures must be developed to ensure abatement of acute contamination and mitigation of chronic forms of pollution such as the foam formation due to mixing of untreated waste water with lake water in Bangalore, India, or the sporadic and periodic flooding which delay cleaning efforts in Madras, India, and de‐escalation of smog and fog formation due ineffective solid waste reclamation practices in Bombay, India. Implemented practice must also endeavor to halt heat assimilation that increases mutagenic potential that is attributed to rapid urbanization. Of grave concern in developing countries is the absence of a central coordinating bodies that are akin to the Centers for Disease Control and Prevention (CDC) that monitor and analyze morbidity and mortality rates attributed to AR pathogen induced infectious disease. These coordinating bodies would greatly contribute to the adequate implementation of Absolute Risk Reduction (ARR) by antibiotic prophylaxis in surgical care, proscription of Colistin in patient care while monitoring the use in animal growth promotion and disease control in caged animal operations (CAO), and the implementation of evidence based and documented diagnoses by the physician in private practice and prescription of antibiotics in the retail sector. Further assistance from coordinating bodies would bolster physician efforts to be un‐yielding to patient pressure and demand. Coordinating bodies would monitor the periodic per capita consumption of antibiotics, uniquely important post‐influenza would be collect and analyzed. There must exist a necessity for mandatory continuing medical education (CME) activity that addresses AR for physicians to continue prescribing antibiotics, and studies that correlate of animal protein consumption versus the incidence of AR pathogen induced infectious disease. Emphasis must also be given to the prompt withdrawal of Ab causing toxicity and resistance from the market, and centralized data base established that compiles detection data for API (active pharmaceutical ingredients of Ab) in soil and water. The synergistic accumulation of derogatory factors constitutes a demand for a coordinated and timely global effort to address the disparaging elements and authentic concerns prior to implementing ATO for mitigating ARP in developing countries. Data analysis to be presented in EB2017.

Support or Funding Information

Professional development funds to Subburaj Kannan