New Delhi: The Modi government has asked doctors across the country to specifically mention the indication — or the reason for prescription — every time they prescribe an antibiotic to a patient. The government has also asked pharmacists to stop selling these drugs over the counter without a doctor’s prescription.
The directions have been issued by the Directorate General of Health Services (DGHS), which comes under the Union health ministry, to all medical associations and pharmacists’ networks through letters dated 1 January. A third letter was issued to medical colleges on the same day.
ThePrint has a copy of these letters.
The letters say that antimicrobial resistance (AMR) is one of the top global public health threats facing humanity. Bacterial AMR, it adds, is estimated to have been directly responsible for 1.27 million global deaths in 2019, while 4.45 million deaths were associated with drug-resistant infections.
“AMR puts many of the gains of modern medicine at risk, it threatens the effective prevention and treatment of infections caused by resistant microbes, resulting in prolonged illness and greater risk of death,” the letters say.
Treatment failures also lead to longer periods of infectivity, and the prohibitively high cost of second-line drugs may result in a failure to treat these diseases in many individuals, the government said.
The misuse and overuse of antimicrobials, it added, is one of the main drivers in the development of drug- resistant pathogens.
“With few new antibiotics in the research & development pipeline, prudent antibiotic use is the only option to delay the development of resistance,” the letters say.
The letter addressed to the medical associations add that “it is an urgent appeal to all the doctors to make it a mandatory practice to write indication reason justification while prescribing antimicrobials”.
The one addressed to pharmacists sought to remind them to follow schedule H of the Drugs and Cosmetics Rules, which mandate the sale of antibiotics on valid prescriptions.
Some high-end antibiotics are placed in schedule H1 of the rules, which mandate chemists to retain a copy of the prescription.
The letter written to medical institutions notes that medical colleges don’t just provide tertiary healthcare, but are also education hubs for the younger generation of doctors.
“This makes it important that the doctors at medical colleges set an example of judicious use of antimicrobials for the next generation of doctors who will face the crisis in a much more severe form,” it adds.
Dr R.V. Asokan, president of the Indian Medical Association, the largest group of doctors in India, said the network had received the communique, adding that it was in line with its own policy on the judicious use of antibiotics.
“In fact, during the last flu season, we had asked our members to prescribe antibiotics only when it’s absolutely necessary, and not advise patients to consume them during viral infections,” he told ThePrint.
In order to stop the abuse and misuse of these drugs, Asokan added, government agencies should ensure that no antibiotic is sold without prescription and their abuse in the poultry industry should be strictly regulated.
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Worrying findings
The letters have been issued in the backdrop of alarming findings from the first multicentric point prevalence survey of antibiotic use at 2o hospitals in India, conducted by the National Centre for Disease Control (NCDC), which showed that 57 percent of antibiotics prescribed in India are those with a potential to cause high antimicrobial resistance.
The survey showed a “remarkably high prevalence” of antibiotic usage (71.9 percent), with 4.6 percent of the patients getting four or more antibiotics.
In 2019, the World Health Organization (WHO) listed antimicrobial resistance as one of the top 10 threats to public health.
The NCDC report stressed that antibiotics had become less effective due to various factors, and a key reason was their “indiscriminate, excessive, and inappropriate” use.
(Edited by Sunanda Ranjan)
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