Doctor talks| Misuse of antibiotics and drug resistance are major challenges: Dr Rahul Agarwal

Hyderabad: Do you know more than 14 million deaths occur globally every year from infectious diseases? And 80 % of these infections are preventable with a change in public mindset and maintenance of hygiene?

Award-winning general physician at Care Hospital Dr. Rahul Agarwal, who has recently received a fellowship in General Infectious Diseases from Christian Medical College (CMC), Vellore, speaks to News Meter about the importance of clinical diagnosis, the threats from infectious disease-causing pathogens, challenges from multi-drug resistant bacteria due to misuse of antibiotics and also how infectious diseases can be tackled.

Dr Agarwal, an alumnus of Raipur Medical College (MBBS) and Rewa Medical College (MD) hails from a family, which had many doctors. He came to Hyderabad in mid-2004 to pursue gastroenterology from Nizam’s Institute of Medical Sciences (NIMS). However, his clinical diagnosis as a general physician got him more recognition. So, he decided to continue as a practitioner of general medicine instead of a gastroenterologist.

Dr Agarwal had worked with various private hospitals including Yashoda Hospital, Prime Hospital, Medicover Hospital, Care Hospital, etc., and established himself as a leading physician within three to four years.

“Initially, I faced a major challenge because I was not familiar with the local language, and most of my patients in my early days at a hospital in Chandanagar were Telugu speakers from the peripheral areas, who didn’t know English or Hindi. Gradually, I started learning the language because it is important to communicate and have a rapport with the patients so that they can trust their doctor,” said Dr Agarwal who had also done a one-year diploma course in Geriatric Medicine when his late father was admitted to CMC Vellore with multiple comorbid conditions.

“The fellowship in infectious diseases has given me insight into how to proceed and target people regarding generating awareness about diseases. I want to conduct an antimicrobial stewardship program for health staff and reshape the antibiotics policy for the hospital and vicinity,” said Dr. Agarwal.

Awards and recognition

In his 20-year-long medical career, Dr Agarwal has been the recipient of many awards including the Telugu Academy Award in 2017 for his overall contribution in the field of medicine. For his relentless service during the pandemic time, when he was one of the doctors to treat the highest number of COVID patients during the first wave, Dr Agarwal was given the Abul Kalam Azad Award and was also felicitated by the Cyberabad police.

‘Focus on clinical acumen and not on unnecessary tests for correct diagnosis'

“Better skills at clinically and correctly diagnosing a patient is important and modern generation doctors should focus on it. But rather doctors nowadays suggest a battery of tests, especially fever panel tests whenever a patient visits with fever or some symptoms of a disease. Sometimes, this advice to get tested for a wide variety of ailments is done to safeguard oneself from consumer forum cases. However, I do not support wasting hard-earned money on needless tests. The eyes should be able to see what the mind knows and therefore, medical or clinical knowledge seeing or examining the patient should lead one to the correct diagnosis,” said Dr Agarwal.

Misuse of antibiotics and drug resistance – a major challenge

“A very serious threat looming before us is multi-drug resistant infections and pan-resistance antibiotics. People are still not able to understand the gravity of the situation and are taking it lightly. There is so much rampant, irrational use of antibiotics. No new class of antibiotics is in the offing for a long time to come. So, if antibiotics stop working for multi-drug resistant bacteria and other infection-causing organisms like staphylococcus and streptococcus bacteria, we will have no treatment option even if we identify the pathogen,” averred Dr Agarwal.

“Already, we have malaria, TB, and typhoid-resistant bacteria. All these drugs should be sold only under a valid prescription, which should prescribe narrow-spectrum antibiotics (specific drugs addressing the particular ailment) to prevent drug resistance. Apart from the right choice, duration, and the correct dosage, completion of the dosage is also important,” added the doctor.

Infectious Diseases

There is a lot of work and research to be done in the field of infectious diseases, which cause lakhs of deaths every year in the country, especially among children and also among adults. From various types of flu, vector-borne diseases like malaria and dengue, water-borne ailments like jaundice, typhoid, and diarrhea – there is no dearth of contagious diseases.

“It is found that with climate change, more pollution, and international travel, infectious diseases are no longer restricted to one particular country or zone. For example, dengue was supposed to occur only in tropical zones around the equator but it is now found in at least 45 countries including those in the temperate zones. Sudden floods, heat waves, and droughts even in European countries are causing many infectious diseases, which were earlier unheard of. Animals are also becoming carriers of many infectious diseases, especially bats, rats, birds, and pigs. The pathogens are getting more powerful, and virulent and keep changing every year. For example, a new vaccine is needed for influenza every year as the virus keeps mutating,” informed Dr Agarwal.

How to minimize the risks from contagious diseases?

“Usually infections spread through skin, including injecting needle sticks, blood transfusion, etc., through airways, contaminated food and water, unsafe sexual contact, urinary tract. If personal and community hygiene or sanitation is maintained, immunity is boosted through a good diet and lifestyle, then 80 % chances of getting infectious diseases can be eliminated,” pointed out Dr Agarwal.

“Right from the school level, we need to incorporate chapters on infectious diseases and keeping the environment clean (both home and neighborhood). With more mass awareness programs, continuous effort is required regarding proper garbage disposal and non-littering, preventing water stagnation in the surroundings,” he added.