Antibiotics use in India has risen by 65% in last 15 years

According to researchers, the increasing consumption of antibiotics could mean drug-resistant superbugs spiralling out of control and calls for new policies to control and oversee usage of these drugs. Antibiotic use in India went up from 3.2 billion defined daily doses (DDD) in 2000 to 6.5 billion in 2015, the study said, reflecting increasing economic growth and more access to antibiotics in both the public and private sectors.

Mumbai : Antibiotic use more than doubled in India between 2000 and 2015, fuelling antibiotic resistance that is making common infections such as E.coli, strep throat, pneumonia and tuberculosis more difficult to treat. According to the researchers, the global consumption of antibiotics has soared since the year 2000. This could mean drug-resistant superbugs spiralling out of control and calls for new policies to control and oversee usage of these drugs.

Antibiotic use in India went up from 3.2 billion defined daily doses (DDD) to 6.5 billion in 2015, the study said, reflecting increasing economic growth and more access to antibiotics in both the public and private sectors.

In 2015, the total global antibiotic consumption was 35 billion DDDs, a 65 per cent increase from 2000, according to the analysis of antibiotic use in 76 countries.

Misuse and overuse of antibiotics have made once easily treatable bacterial infections harder and often impossible to cure because bacteria evolve rapidly to evade antibiotics, leading to drug resistance, the study added.

Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Antibiotic resistance is a growing concern and its impact on patients and communities are known to us all. This is a public health problem, one which is rapidly spreading across the globe, with not enough resources to control it. It has made it harder for us to treat many infections such as typhoid, pneumonia, tuberculosis. Antibiotic resistance prolongs hospitalization, increases the cost of treatment and also the risk of death. Several studies have corroborated its adverse impact on health. Doctors, as well as patients, should be aware of and advocate judicious use of antibiotics. Overprescription and self-prescription, both, need to be checked.”

Taking cognizance of the impact of antibiotic-resistant infections, IMA has proposed several initiatives to tackle this public health threat – “Jaroorat Bhi Hai Kya”, “3A Avoid Antibiotic Abuse campaign”, “Use Wisely not Widely”, “Think Before You Ink”.

Dr Aggarwal, said, “One of the biggest reasons for the misuse of antibiotics is buying them over the counter without consultation with a doctor. Before prescribing antibiotic, always ask yourself: Is it necessary? What is the most effective antibiotic? What is the most affordable antibiotic? What is the most effective dose? What is the most effective duration for which the antibiotic should be administered?”

Antibiotics are only effective against bacterial infections.

Two decades ago, scientists tackled drug resistance with new and more powerful antibiotics and drug combinations. But with the last new class of antibiotics (versus variations and improvements on existing ones) discovered in 1987 — a few new ones in development are not ready for market — the world is running out of options.

Worryingly, use of third-generation antibiotics such as cephalosporins and linezolid’s used to treat multidrug-resistant bacteria have increased dramatically in India since 2000, reports the study, done by CDDEP, Princeton University, ETH Zurich and the University of Antwerp.

Data from the Indian Council of Medical Research (ICMR) antimicrobial resistance (AMR) surveillance network shows similar trends. “From data obtained so far, more than 70 per cent Enterobacteriaceae — which include Salmonella, E. coli, Yersinia pestis, Klebsiella, and Shigella — are resistant to third-generation cephalosporins. Among the Enterobacteriaceae species, Klebsiella and E. coli have been found to be resistant to third-generation cephalosporins (80 per cent),” said Dr Kamini Walia, senior scientist and programme officer (AMR) at ICMR.

Cephalosporins belong to a class of antibiotics called fluoroquinolones that can be administered orally. When resistance to these drugs increases, patients have to stay in the hospital longer for antibiotics to be given intravenously or intramuscularly, which pushes up cost and puts them at risk of other hospital infections.

“Linezolid is one of the newest classes of antibiotics available to us and the loss of this drug will be a problem for [treating] enterococci and Staph aureus, both of which are a big problem in the Indian healthcare system,” said Dr Laxminarayan, whose study is the most comprehensive assessment of global trends to date.

Twenty-four potent antibiotics are included in India’s Schedule H1 of the Drugs & Cosmetic Rules that make it mandatory for the medicines to have red-line labelling and for the pharmacist to keep a separate register with the name and address of the prescriber, patient’s name, the name of the drug and the quantity supplied.