Editorial: Public health menace

Antimicrobial Resistance threatens effective prevention and treatment of infections caused by resistant microbes, resulting in prolonged illness and greater risk of death

Antibiotic resistance is rapidly turning into a global menace and is estimated to be directly responsible for 1.27 million global deaths in 2019. What is alarming is that India has emerged as an epicentre of this catastrophe. Easy access to the strongest of antibiotics without prescriptions or diagnoses and their indiscriminate use have created a perfect storm, leading to the super-resistant microbes that irreparably damage our health. Given the seriousness of the public health issue, the Director General of Health Services (DGHS) has rightly asked all pharmacists to dispense antibiotics only on the prescription of a qualified doctor, so that the over-the-counter sales (OTC) are restricted. In fact, under the Drugs and Cosmetics Rules, antibiotics are included in the list of drugs specified under Schedule H, which are required to be sold by retail on the prescription of a Registered Medical Professional (RMP) only. However, due to lax enforcement of the rules and widespread lack of awareness, these drugs are often sold over the counter without a prescription. Antimicrobial Resistance (AMR) threatens effective prevention and treatment of infections caused by resistant microbes, resulting in prolonged illness and greater risk of death. The misuse and overuse of antimicrobials are one of the main drivers in the development of drug-resistant pathogens. India has no public database of mortality caused due to antimicrobial resistance. Providing proper sanitation, clean water and increasing public health expenditure and better regulating the private health sector are necessary to reduce antimicrobial resistance. A study, done by researchers from India, Qatar and the UK, had found that most of the antibiotic FDC (fixed-dose combination) formulations sold in India are unapproved or banned.

Though the drug regulators have taken several initiatives to deal with the issue, including imposing a ban, several banned FDCs continue to be available in the market. What is alarming in the Indian context is that the doctors routinely prescribe strong antibiotics even in cases where such doses are totally unnecessary. In 2016, the Ministry of Health and Family Welfare had launched a novel ‘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. It is vital to assess how the campaign has fared over the past eight years and plug the loopholes that are reducing its efficacy. Doctors, pharmacists, pharma companies and customers must adhere to the guidelines 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. A study published in the World Health Organisation bulletin has found that 58% of FDCs of antibiotics sold across the country were on the WHO’s “not recommended” list.