Antimicrobial resistance (AMR) is no longer just a problem of hospital-acquired or health care-associated infections. Clinicians in Keralam are worried that the resistance profile of primary antibiotics used to treat even acute diarrhoeal diseases like Shigellosis is going up, which has important implications for antibiotic use in the State.
It had also reported that five isolates produced ESBL enzymes, making third-generation Cephalosporins less effective. Most acute diarrhoeal diseases are self-limiting and do not really require treatment with antibiotics. Shigellosis, too, is largely self-resolving with proper rehydration but in vulnerable populations (children below five years and the elderly), the infection can lead to severe dehydration, sepsis and neurological complications, requiring the use of antibiotics. “Clinicians have been using Ceftriaxone for treating Shigellosis in patients who get admitted to hospital. But the clinical implication of growing resistance of Shigella to this drug is immense. This means that for such serious patients, we can no longer depend on Ceftriaxone and have to go for high-end drugs like Meropenem which belongs to the Carbapenem class, widely considered the last-resort antibiotics,” explains Dr. Aravind. This was one of the first studies from Keralam that had given a clear indication that AMR was no longer confined to just the older drugs. Rising drug resistance means more treatment failures, longer hospital stays, greater use of high-end antibiotics and increased health-care costs, apart from the threat that more drug-resistant pathogens might emerge in the community. “Most cases of acute diarrhoea do not require antibiotics. But even when antibiotics are genuinely indicated, particularly for severe bacillary dysentery caused by Shigella, our treatment options are steadily narrowing. This is certainly a wake-up call for everyone that we need to be very careful about using antibiotics,” a senior health official points out.
Data from Keralam’s KARS-NET (Kerala Antimicrobial Resistance Surveillance Network), one of the strongest AMR surveillance systems in the country and which has been tracking the AMR profile of Shigellosis since 2023, says that the resistance profile of primary antibiotics used to treat the infection is growing. Ciprofloxacin, which continues to be included in national guidelines for treatment of Shigella dysentery and which used to be an important treatment option for bacterial dysentery, has a resistance profile of 96% and can no longer be relied upon for empirical treatment of Shigellosis. For Shigellosis patients with severe dysentery going into septic shock and multiorgan failure, it is absolutely important that the correct antibiotic is administered within an hour and that it is 100% sensitive. The 2018 study published by clinicians in Government Medical College, Alappuzha, which studied the antibiotic susceptibility pattern of Shigella isolates (2011-2016) had reported that 91.6% of the isolates were multi-drug resistant and that eight of the isolates were resistant to Ceftriaxone/Cefotaxime.
