Most Indian hospitals do not have any guidelines on antibiotic prescribing, according at a senior ICMR official, but that is about to change. New guidelines regarding the prescription of antibiotic medications have been issued to a number of hospitals in India. These guidelines, issued by the Indian Council of Medical Research (ICMR) aim to stem the rise of antibiotic resistance in India by better regulation of the prescription of antibiotics across the country.
The directions will advise on antibiotic use, dosages, and treatment duration. Previously Indian doctors rarely had strict guidelines in place. In a discussion with the Thomas Reuters Foundation, Kamini Walia, deputy director of ICMR says “Doctors’ education on antibiotic use has so far been limited to what medical representatives of pharmaceutical companies told them. Some hospitals have prescription guidelines, but most don’t,”
This has left a situation where antibiotic prescription is unnecessarily widespread, unregulated, and poorly monitored. Many patients have been issued antibiotics without any prescription at all. The misuse of antibiotics has been considered one of the primary causes of antibiotic resistance.
This is an area that has seen a large amount of national, and international focus recently. There have been a number of high profile cases such as the “nightmare bacteria” incident in which an American tourist in India contracted a strain of klebsiella pneumoniae that was resistant to the carbapenem class of antibiotics. The resultant infection was unable to be treated due to the resistance and led to the death of the patient.
Both the Indian government and the World Health Organization (WHO) appear to be prioritising the issue of escalating antibiotic resistance. The WHO have released a list of twelve “priority pathogens” of various levels of concern:
Priority 1: Critical
- Acinetobacter baumannii, carbapenem-resistant
- Pseudomonas aeruginosa, carbapenem-resistant
- Enterobacteriaceae, carbapenem-resistant, ESBL-producing
Priority 2: High
- Enterococcus faecium, vancomycin-resistant
- Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
- Helicobacter pylori, clarithromycin-resistant
- Campylobacter spp., fluoroquinolone-resistant
- Salmonellae, fluoroquinolone-resistant
- Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant
Priority 3: Medium
- Streptococcus pneumoniae, penicillin-non-susceptible
- Haemophilus influenzae, ampicillin-resistant
- Shigella spp., fluoroquinolone-resistant
A number of pathogens are becoming resistant to the carbapenem class of antibiotics, these have been prioritised by the WHO. The concern is that carbapenems are the last resort medications, used when treatment by other antibiotics proves ineffective. Should diseases become entirely resistant to these then it may become the case that there is no means left to cure the disease.
The Indian drug authorities have also taken measures to improve awareness, issuing warnings to pharmacies against providing antibiotics without prescriptions. There have also been awareness campaigns broadcast via state run radio channels in the hopes of spreading the message of the dangers of overusing prescription medication. However, the Government introduced a new H1 category of prescription medicines in 2013. Chemists were required to keep details of the prescription against which the medicines had been dispensed. There is widespread scepticism that these rules have had much practical impact.
On a national scale the government has brought together a number of ministries, including pharmaceutical, environmental, and animal husbandry ministries in order to address the issue of antibacterial resistance. The intention is to establish a centralised communication, where data regarding antibiotic distribution from pharmacies and prescriptions can be recorded.
Antibiotic resistance has swiftly become a prime concern on a global scale. WHO intervention and a more proactive approach from the Indian government may show some effect at curbing the onset pace. This trend in resistance however seems geared to continue without large scale efforts in disease eradication, tighter controls on antibiotics, and increased funding to research efforts.