Editorial: Life-savers turn into life-takers

National Medical Commission’s guidelines to prevent the misuse of antibiotics must be strictly adhered to

Antibiotic resistance is rapidly turning into a global menace. 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. India has no public database of mortality caused due to antimicrobial resistance. Given the seriousness of the public health issue, the National Medical Commission (NMC) issuing a set of guidelines recently to prevent the misuse of antibiotics is a welcome development. In a 156-page directive to doctors, the commission has made it clear that no antibiotics should be given without diagnostic tests proving that their use is warranted. In recent years, indiscriminate prescription of antibiotics by doctors to suppress a suspected infectious disease has led to antimicrobial resistance (AMR). The AMR is a condition when microbes, which are exposed to high-grade antibiotics, become used to them over time and become resistant to them. This makes treating common infections difficult, increasing the risk of severe illness and death. This resistance also makes them ineffective for preventing secondary infection during surgeries, chemotherapy and managing chronic infections. As a result, the microbes become superbugs. Since infections can be bacterial, viral, fungal or parasitic, the guidelines say that identifying the clinical problem and making a differential diagnosis at the bedside will help in deciding whether to start any antimicrobial.

Apart from a detailed history of presenting infection, the guidelines say the clinician should go through the history of any surgical, medical disorders and co-morbidities like diabetes as these may predispose an individual to infections. Previous use of antibiotics in such situations may predispose to AMR in current illness. 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 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. In India, doctors routinely prescribe strong antibiotics even in cases where such doses are totally unnecessary. 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.

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