Necessity of Reviewing and Establishing the National Guidelines Regarding Antimicrobial Therapy for Bacterial Isolates Pharmaceutical and Biosciences Journal Available at www.ukjpb.com

The emergence of anti-microbial resistance (AMR) is one the biggest challenges faced by the clinicians around the Globe. To coup up with the situation, further management options are heading towards deficiency. In such condition appropriate selection of antibiotics in light of results obtained from culture and sensitivity harbors great significance. The currently used microbiological diagnostic and management options are based upon the guidelines derived from Western data. The National data regarding accurate guidelines for diagnostic and management modalities are deficient. Therefore, the objectives of this review article will be to identify the significance of reviewing and establishing the National guidelines, as a stride to reduce AMR. The literature review had emphasized the need of reviewing and establishing the regional and National guidelines as a significant factor to reduce antimicrobial resistance.


Introduction
The era from the years 1930s to 1960s was a golden period for the discovery of many efficacious antibiotics. This short era unfortunately ruined earlier, when the researchers became helpless in view of emergence of resistant bugs. Thus, catastrophe for the development of newer antibiotics, malpractices and injudicious use of antibiotics, trends of sailing the drugs without prescription, self-medications, etc, all are the predisposing factors for emergence of AMR. The resultant of all this, lead to increased morbidity and mortality rates 1,2

. An
Australian study recognized that 47% of the prescribed antibiotic were not in acquiescence with patient's culture and sensitivity reports or the recommended guidelines 3 . Same is the situation in US hospitals, where 50% usage of anti microbials for any age group, was considered unnecessary 4 .
The emergence of AMR has become a challenging task around the globe 1 . It is ranked amongst the leading cause of mortalities 5 .
A published WHO report for the year 2014, concluded that about 700,000 to several million people die annually as a consequence of AMR 6 . While as per the report of year 2019 by center for disease control (CDC), 2.8 million people per anum develop AMR, out of which 35,000 people die. Thus necessity of a collaborative global approach is the need of time to combat this emerging threat 7 .
Like the state of Global insurgence, Pakistan is facing the same challenge i.e increasing prevalence of AMR. A study report for the year 2017, concluded that injudicious use of antibiotics, self medication, culture for sale and buying without proper prescription, predisposes to AMR. However, super added factors includes, lack of good diagnostic facilities, increased use of antibiotics in domestic animals, lack of surveillance systems, and trend of aggressively managing the patient by using more potent drugs. All are considered to promote emergence of AMR 8,9 . Besides all this, the trend of malpractices focusing scanty A published report by WHO showed that 20% of childhood mortality in Pakistan, is the result of acute respiratory tract infections (ARTIs) 13 . However, Global statistics revealed that 40% of childhood mortality in developing countries i.e Bangladesh, Indonesia, Nepal, and India, results from ARTIs 14 .
The major factor behind such high mortality is the lack of health care facilities and accurate management options 15 . Other highlighted factors includes malpractice for antibiotics prescription i.e penicillins, cephalosporins, and macrolides, to treat viral ARTIs 16,17 . Comparatively various International guidelines recommend the limited use of antibiotics for ARTIs 18,19 . Nutshell of all this has resulted in increased economical burden for the health care system. Besides that a substantial increase in AMR was observed, adding up to increased morbidity and mortality 20,21 .

Reported data
In view of this current situation, only way out will be the enactment factors. Amongst all these, maximum focus was given for the establishment of Regional and National guidelines for anti microbial. The resultant will be a step forward to review accurate management options, which in turn will be helpful to reduce the emergence of resistance pattern.

Conclusion
The literature review had emphasized the need of reviewing and establishing the regional and National guidelines as a significant factor to reduce anti-microbial resistance.