Doctors must spell out reason for giving antibiotics: DGHS

Aditi Tandon & Aksheev Thakur

Tribune News Service

New Delhi, January 18

With growing evidence of antibiotic resistance diminishing the efficacy of common medicines against widespread bacterial infections and superbugs emerging, the Union Health Ministry on Thursday asked doctors and pharmacists to ensure judicious use of drugs and compulsorily follow prescription guidelines.

In separate letters to doctors across medical colleges, the All-India Pharmacist Association and medical associations (IMA and state units), Director General of Health Services (DGHS) Atul Goel said writing of “indication, reason and justification while prescribing antimicrobials” be made a mandatory practice.

Pharmacists have been instructed to ensure antimicrobials were not given without prescription. “While pharmacists are being reminded to implement the Schedule H and H1 of the Drugs and Cosmetics Rules and sell antibiotics only on valid prescriptions, it is important that doctors write the indication on the prescription while prescribing antibiotics,” the letter said. The DGHS said antimicrobial resistance (AMR) was one of the top public health threats globally.

“It is estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019, and 4.95 million deaths were merely 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 letter said, adding that misuse and overuse of antimicrobials was one of the main drivers of drug-resistant pathogens.

With a few new antibiotics in the research and development pipeline, prudent antibiotic use was the only option to delay the development of resistance, the letter said.

The Centre’s letter has a background. A 40-nation study had earlier found India reporting the highest rates of antibiotic-resistant bacteria in the world.

The Indian Council of Medical Research (ICMR), apex medical research body, had then shown that most top tertiary hospitals in the country were potential breeding grounds for drug-resistant bacteria. The ICMR studied 20 tertiary hospitals and found half were not implementing Antimicrobial Stewardship Programme, developed way back in 2013 to ensure effective antibiotic prescription.

In 2022, the ICMR studied 95,728 samples from hospitalised patients across hospitals and found severe disease-causing bacteria to be resistant to top class antibiotics in 87.5 per cent of the patients who were tested for AMR. Resistance to carbapenems in superbug Acinetobacter baumannii, associated with nearly 20 per cent ICU infections, was recorded as 87.5 per cent limiting the availability of treatment options for people.

Fighting resistance

• Amid superbug fears, the govt has cautioned docs, pharmacists on misuse of antibiotics
• Antimicrobial resistance (AMR) is one among the top 10 global health threats, says the WHO
• AMR led to 1.27 million global deaths in 2019, and 4.95 million deaths were merely due to drug-resistant infections

Pandemic proportions

AMR is assuming pandemic proportions in India. Sagacious use of antibiotics is urgently advised or we will be back to the pre-antibiotic era. — Kamini Walia, ICMR researcher