Moderation and informed consent key to prescribing antibiotics

Health Care, Heart Care Foundation of India Comments Off
  • Antibiotic resistance is on the rise in India
  • Increased sales of unapproved, unscrutinized antibiotics in the country an issue of concern

New Delhi, 07 February 2018: About two-thirds of multi-drug antibiotic cocktails sold in India between 2007 and 2012 were unapproved, indicates recent research. These compounds are responsible for catalyzing the spread of drug-resistant diseases. In the five years under review, about 118 different types of “fixed-dose combination” antibiotics were sold in the country. Of these, 64% were not approved by the national drugs regulator, the Central Drugs Standard Control Organization.

It is illegal to sell unapproved drugs. The research has also indicated that the 118 formulations were sold as 3,307 different brand-named products, produced by 476 pharmaceutical companies. These include about a dozen multinationals.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “The prevalence of antibiotic resistance is escalating worldwide at an alarming pace with not enough resources available to control it. The WHO has recognized antibiotic resistance as a significant public health problem in its first global report Antimicrobial Resistance: Global report on surveillance, released in 2014. Considering this, selling unapproved, unscrutinized antibiotics undermines the measures taken to control antimicrobial resistance. India already has one of the highest rates of drug resistance in the world as also one of the highest rates of antibiotic consumption. Emerging drug-resistant germs threaten any progress made by modern medicine with people dying of diseases that can be cured.”

As per reports, antibiotic-resistant infections could kill 10 million people per year globally by 2050, making these the leading cause of death just after heart disease and cancer.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “The wrong type of antibiotics can stimulate the bacteria or other microorganisms to fight back instead of killing the germs. This is possible due to either spontaneous DNA mutations or transfer of resistant genes between them. We are on the verge of a post-antibiotic era where many of the antibiotics to which bacteria have developed resistance may become obsolete and there may no longer be any cure for many common infections which once again may take their toll on human life like in the pre-penicillin era.”

When prescribing antibiotics, clear instructions should be given to the patient about no refill of antibiotic prescription without the signature of the doctor. The role of antibiotics should be discussed in an informed consent. Apart from this, doctors should not prescribe antibiotic cover or prophylactic antibiotic without a high degree of clinical suspicion. No antibiotics should be prescribed for small bowel diarrhoea, fever with cough and cold, dengue, chikungunya, malaria and fever with rashes. However, early initiation of antibiotics is the rule in suspected sepsis bacterial pneumonia meningitis and confirmed tuberculosis cases.