Beating the Rhetoric
World Antibiotic Awareness week was held in the third week of November. The theme this year centred on the question of safe use of antibiotics in a prescribed form. It also tackles the increasing global problem of antibiotic resistance. To understand the term antibiotic resistance first we have to understand the meaning of the generic term – antibiotic. An antibiotic is a medicine that is used to cure a disease caused by bacteria. This means antibiotics are useful only against bacterial infections. Antibiotic resistance as the term suggests is a phenomenon which refers to resistance developed by bacteria against antibiotics or the ability of bacteria to mutate or change so as to resist the effects of antibiotics. The more a person uses antibiotics the greater his/her resistance becomes to antibiotics. This in turn can pose a serious health hazard when a person suffering from a life -threatening disease cannot recover because the antibiotic administered to the person will not act since the person’s body has developed a resistance towards the same. And this problem is the crux of the need for global awareness on antibiotic resistance.
In a country where antibiotics are easily available for sale over and under the counter the chances of antibiotic resistance rises exponentially. In India the infectious disease burden is among the highest in the world and recent reports have shown that the inappropriate and irrational use of anti-microbial agents against bacterial diseases, have led to far more increased anti-microbial resistance compared to other countries of the world. Studies have also indicated that because the health sector in India suffers from inadequacy of public finance in some levels, the chances for conditions favourable for development of drug resistance further increases. Anti-microbial resistance results in difficulty in controlling the diseases in the community and ineffective delivery of health care services.
In 2015, WHO conducted a survey in India which revealed a widespread misunderstanding about the use of antibiotics as well as antibiotic resistance. In India the problem of antibiotic resistance is unique. Those who need antibiotics do not have access to it while others who do not need it have it in large amounts. A large part of the almost 40,000 children who die of pneumonia every year in India do so due to non- availability of requisite antibiotics while others are administered the same indiscriminately. India is perpetually torn between these two sides which therefore hampers efforts to issue any blanket order on administration of antibiotics and regulation on the same. To counter this, the government in 2011 came with the concept of Schedule H1 drugs. The Schedule H1 list, contains 24 critical antibiotics such as cephalosporins and carbapenems, the sales of which are tightly controlled.
Schedule H is a class of prescription drugs in India appearing as an appendix to the Drugs and Cosmetics Rules, 1945.These are drugs which cannot be purchased over the counter without the prescription of a qualified doctor. The manufacture and sale of all drugs are covered under the Drugs and Cosmetics Act and Rules. They are revised from time to time based on the advice of the Drugs Technical Advisory Board, part of the Central Drugs Standard Control Organization in the Ministry of Health and Family Welfare. The Schedule H1 list was introduced in 2011 with the hope that it would control the unregulated use of over the counter sale of antibiotics while curbing the problem of antibiotics resistance. However this program has not been as successful as it was envisaged to be. Unlike Schedule X drugs for which a mandatory documentation trail is required, there is no such provision for Schedule H1 drugs which has resulted in flouting of norms. Pharmacists often do not adhere to the rules while manufactures cannot keep track, thereby making the process less effective.
The lack of awareness regarding antibiotic resistance further complicates the issue. As antibiotics are the bedrock of modern medicine needed in a large variety of reasons, increased antibiotic resistance will also result in increased costs thereby making the medicines less affordable for an average consumer or patient. Thus there is an increasing need to address these issues so that the problem of antibiotic resistance does not exacerbate.
The first step towards combating this menace is large scale public awareness. The problem of resistance towards a certain kind of drug had taken the shape of an epidemic in Australia. But over a period of time with sustained efforts the antibiotic resistance has been cut down remarkably. India must follow a similar trend. The general population as well as the health practitioners must be made aware of the dangerous implications of self administration of antibiotics. Doctors and other health practitioners must also teach and counsel patients regarding the same. Pharmacists can be leveraged to counsel those who come to their shops without consultation to buy antibiotics. These people should be encouraged to seek the advice of qualified health experts first. If these small steps are followed then the problem can definitely be solved and the National Action Plan on Antibiotic Resistance is a right step in this direction. As we move into a new era, health challenges are going to morph themselves into increasingly different forms and as a nation we must keep reinventing ourselves to meet such challenges.
( Views expressed by the author are personal)