ORGANISING THE TEACHING ON INFECTION AND ANTIBIOTICS

Dr.T.V.Rao MD With the rapid advancement of new discoveries in microbiology research, many Teachers continually look for new teaching techniques that will give their undergraduate students a more fascinating and rewarding experience in the course. Till know we never though much on rationalism of use of Antibiotics, it is already a wakeup call that there an Antibiotic resistance and Super bugs in many of our hospitals, the curricular changes should happen to impress the Medical students .Antibiotics are not solutions for everything but only effective if used with scientific sense, Antibiotics is the term used to describe drugs that kill or inhibit the growth of bacteria. A more general term “anti-infective” describes drugs that do the same to any type of organism that could infect humans, including: viruses, parasites, bacteria or fungi. Take the example Cotrimixazole is not a not an Antibiotic just chemotherapeutic agent.If you wish or want do cultures, do them before you start antibiotics since after you give antibiotics, and collect the specimens, the drug will be in the patient’s system and will inhibit growth of specimens collected from the patient after that point in time. More than 50% of the specimens are collected after starting an antibiotic it makes many of the cultures sterile losing the confidence on Laboratory and loss of economic resources. Learning antibiotics can be overwhelming for the following reasons:

• There are about a many hundreds of antibiotics

• There are about a billion infectious organisms

• Every year, drug resistance patterns change

• Geographically, drug resistance patterns are different

• Multiple drugs kill multiple bacteria

Our students are much impressed with Clinical sciences than basic sciences, once they pass Microbiology they are impressed by the Clinical teachers, in the recent University examination whenever I ask a question on remedial measures for any infection they are eager to tell the names of 3rd generation cephalosporin’s forgetting all the rationalism we taught as basic teachers, the majority answered Ceftriaxone, however the students should Know which category the individual drugs belong to and learn the category as a whole. For example, Ceftriaxone is a 3rd generation cephalosporin. Therefore, learn about cephalosporin in general and then know the general differences between 1st, 2nd, 3rd and 4th generation cephalosporins. In some circumstances there might be one or two extra important bits of information pertaining to Individual drugs that are important to learn, We should change our attitude to teach the basics on Antibiotics, however today it is not just loading the information, but we have to solve the issues of antibiotic misuse, I decided to change to teach the approach which can be better with the ideas what drug for what bug approach. Antibiotics can usually be classified in terms of the categories of bacteria they kill.

These categories include:

O Gram positives (which are usually cocci but sometimes rods)

O Gram negatives (which are usually rods but sometimes cocci)

O Anaerobes

O Atypical (like Chlamydia, Rickettsia, etc.)

O Mycobacterial (TB) The basic teaching should be combination of Anti tuberculosis drugs and never a single Antibiotic which can be catastrophic

We can organise our teaching in

O Drugs → which bugs do they kill?

“List the bacteria’s that are sensitive to Penicillin.”

O Bugs → which drugs kill it?

Teach them with dedication on common hospital acquired infections, just to impress “MRSA is usually sensitive (killed by) which drugs?” just not Pencillin.

O Infections → which microbes usually cause them, every empirical decision should taught on common isolates from the hospital we are practising Medicine

“Dental abscesses are most commonly caused by …” a complex flora we certainly need a broad spectrum antibiotic which will act on aerobic and anaerobic bacteria,

• In order to adequately learn infectious disease, we will need to establish a mental Framework which organizes our knowledge in the above method It is required that we learn the mechanism of action of a drug and also the Mechanism of resistance by which bacteria commonly develop to enable them to not be killed by the drug. This is important because when selecting an antibiotic, if our first choice did not work, we will have a better understanding of why it did not work and will be better educated to select a different antibiotic which will have a greater probability of killing it second time round. For example, if a beta lactam antibiotic was given and the bacteria is known to produce beta lactamase, another beta lactam (even if had a greater spectrum of activity and was “stronger”) would be a poor choice. Just teach our students, a common cold has s effective drug to cure, just diagnose be confident not to use antibiotic. If you use the broad spectrum antibiotics, our normal flora attains the drug resistance faster than when the patient is infected never forget we have 10 times normal flora than our cells, which are matter of Eco balance in our body, we talk of green life, Broad spectrum drugs tend to be more expensive and more “powerful” and should be reserved for situations in which narrow spectrum is not indicated. Development of resistance is a very real risk every time an antibiotic is used. Therefore, always using the powerful drugs will result in bacterial becoming resistant to them. Then what do you use? Teach every Medical student the pipe line of antibiotics is drying if we do understood, you can never treat your patients with confidence and success. As teacher we have responsibility of basics sciences of Microbiology and Pharmacology totally clinically oriented as Learning in the clinical environment has many strengths. It is focused on real problems in the context of professional practice. Learners are motivated by its relevance and through active participation. Professional thinking, behaviour, and attitudes are “modelled” by teachers. It is the only setting in which the skills of history taking, physical examination, clinical reasoning, decision making, empathy, and professionalism can be taught and learnt as an integrated whole, however we should impress more decision making on Antibiotic selection a word of caution on every prescription how adversely affect the patient and create the Superbugs in the environment we work i.e. it is our Hospitals.

Dr.T.V.Rao MD Professor of Microbiology Freelance writer