In March, the Morbidity and Mortality Weekly Report by the Centre of Disease Control in the United States placed Clostridium difficile infection and six antibiotic-resistant bacteria in the “highest concern” category amongst a list of hospital-acquired infections. Chances of a hospital-acquired infection being caused by one of these six antibiotic-resistant bacteria is one in seven in short-term acute care hospitals and one in four in long-term care hospitals. To fight the problem, from 2010 to 2011, antibiotics were prescribed for outpatients at a rate of 506 per 1,000 population. Only an estimated 353 of these, however, were likely appropriate suggesting that 30 per cent of these antibiotics may have been unnecessary.
The Indian scene
Here, the numbers speak for themselves. Fifty per cent of healthcare providers believe costlier medicines are stronger and better; 70 per cent say newer drugs are better and stronger; 87 per cent feel that minimum of two antibiotics are required for fever; 80 per cent co-relate cough with the need for antibiotics; 90 per cent use Levofloxacin for respiratory tract infections and 50 per cent are not aware of healthcare-associated infections. And 70 per cent of them feel it is cheaper to give an antibiotic than to thoroughly investigate a patient in an overcrowded OPD.
Viral illnesses do not need bacterial antibiotics. Presence of cough with cold and fever indicate viral aetiology and needs no antibiotics. But sore throat, without cough, can be due to strepto infection and needs timely antibiotics. Most practitioners are afraid of legal implications. We have not come across a legal case against a doctor for using antibiotics. In most of the cases, complaints were filed for not using antibiotics.
Additionally, most doctors work in adverse situations and the Drug Controller General of India does not effectively disseminate the news of new drugs or the ban on a drug to doctors. Just putting the information in a newspaper or on a website is not really the answer. As per MCI regulations, medical graduates need to update their knowledge on a regular basis but the Council has not made it mandatory for the medical colleges to hold annual review programmes. Most of the medical updates then, are pharma-sponsored and the information a practitioner gets, is often biased.
The problem lies in pricing too
Drug price variations are allowed in the country. A recent study by the Indian Medical Association found that the drug Meropanam (an ultra-broad-spectrum injectable antibiotic used to treat a variety of infections) is on sale for Rs 500 as well as at `2,800. In a country with multiple brands and huge prize variations, it becomes difficult for doctors to make decisions and it becomes easier for the pharma companies to lure medical professionals. A list of drug prices is also not available on a centralised government website.
As far as antibiotics are concerned, a couple essential rules must be kept in mind:
1. Extreme care is needed while administering a combination of antibiotics.
2. Before giving any injectable antibiotic, ask if it is necessary. Also, prepare to shift from intravenous to oral antibiotics as soon as possible. After the shift, make sure oral antibiotics are not continued for a duration longer than indicated.
The writer is National President Elect and Honorary Secretary General IMA, and a Padma Shri awardee...