Antibiotic overuse

RED-FLAGGING antimicrobial resistance (AMR) as one of the leading public health threats globally, India’s Directorate General of Health Services (DGHS) has asked doctors and pharmacists to ensure judicious use of drugs and follow prescription guidelines. Doctors have been instructed to mention ‘indication, reason and justification’ while prescribing antimicrobials, which include antibiotics, antivirals, antifungals and antiparasitics. Antibiotics are included in Schedule H and H1 of the Drugs Rules, 1945; as per the stipulation, they ought to be sold only on prescription by a registered medical practitioner. However, due to lax enforcement of the rules and widespread lack of awareness, these drugs are often sold over the counter without a prescription.

Misuse and overuse of antimicrobials contribute significantly to the development of drug-resistant pathogens. Bacterial AMR was responsible for 1.27 million global deaths in 2019, while 4.95 million deaths were associated with drug-resistant infections. The DGHS has emphasised that AMR threatens effective prevention and treatment of infections caused by resistant microbes, resulting in prolonged illness and greater risk of death.

In 2016, the Union Ministry of Health and Family Welfare had launched the ‘red line’ awareness campaign on AMR, asking people not to buy or use medicines (including antibiotics) marked with a red vertical line without a prescription. A UK study, whose report was released later that year, had lauded India for this initiative and recommended that the labelling for antibiotic packaging could be improved, if required, and then expanded globally. It is vital to assess how the campaign has fared over the past eight years and plug the loopholes that are impeding its efficacy. Various stakeholders — doctors, pharmacists, pharma companies and customers — must adhere to the guidelines and rules in order to curb indiscriminate prescription, sale and use of antibiotics. At the same time, the AMR surveillance and research network, established by the Indian Council of Medical Research, needs to be strengthened to make India better prepared to deal with AMR-induced health hazards. 

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