India cracking down on antibiotics overuse. Here’s why it matters

India is cracking down on the overuse of antibiotics.The health ministry has asked doctors prescribing antibiotics to mention the reason they are doing so.But what happened exactly? Why is India doing this? Can overuse of antibiotics cause harm?Let’s take a closer look:What happened?As per CNBC, the Director General of Health Services, Dr Atul Goel, has in a letter to doctors told them to “mandatorily mention the exact indication/reason/justification while prescribing antimicrobials.”

The DG Health Services comes under the auspices of the Union health ministry.

As per News18, “exact indications” are defined specific and accurate reasons or medical conditions for which antibiotics or antimicrobial drugs are prescribed.Goel also asked pharmacists to “implement Schedule H and H1 of the Drugs and Cosmetics Rules and sell antibiotics only on valid prescriptions. It is important that doctors mention the exact indication on their prescriptions while prescribing antimicrobials,” as per a copy of the letter seen by CNBC."Misuse and overuse of antimicrobials are one of the main drivers in the emergence of drug-resistant pathogens. With few new antibiotics in the Research & Development pipeline, prudent antibiotic use is the only option to delay the development of resistance," the letter stated.According to News18, Goel wrote to all doctors of medical colleges, medical associations and pharmacist associations in India on 1 January.Pharmacists also have been told to halt ‘over-the-counter sale of antibiotics’.Why is the government doing this?The Centre's move comes as concerns grow around the world about Antimicrobial Resistance (AMR).

The World Health Organisation calls Antimicrobial resistance one of the top global public health and development threats.

It says AMR makes infections harder to treat and makes other medical procedures and treatments – such as surgery, caesarean sections and cancer chemotherapy – far riskier.“AMR affects countries in all regions and at all income levels. Its drivers and consequences are exacerbated by poverty and inequality, and low- and middle-income countries are most affected,” the WHO states on its website.The letter stated, "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."[caption id="attachment_13629272" align="alignnone" width="640"]

Experts say overuse of antibiotics is making Antimicrobial Resistance worse – which in turn is killing patients[/caption]"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 a greater risk of death. Treatment failures also lead to longer periods of infectivity, and the prohibitively high cost of second-line drugs may result in failure to treat these diseases in many individuals."“The medical colleges not only provide tertiary healthcare in the country but also are hubs for the education of the younger generation of doctors. This makes it important that the doctors at medical colleges set an example of judicious use of antimicrobials for the next generation of doctors who will face this crisis in a much more severe form,” the letter concluded.Can overuse of antibiotics cause harm?The Hindu quoted a National Centre for Disease Control (NCDC) survey as showing that more than half of hospital patients were given anti-biotics to prevent infection.As per India Today, the study showed that nearly 72% of patients were prescribed antibiotic.The survey, which examined patients at 20 tertiary care institutes across 15 states and two Union Territories between November 2021 and April 2022, showed 55 per cent of the patients surveyed were prescribed antibiotics as a preventative cure.Just 45 per cent were given antibiotics to cure infections, of which just six per cent were prescribed drugs after identifying the specific bacteria.

Exactly 4.6 per cent of patients had been given four or more types of antibiotics, as per India Today.

Besides, some situations simply do not warrant anti-biotics being prescribed.According to the Mayo Clinic website, taking an antibiotic for a viral infection:

• Won't cure the infection
• Won't keep other people from getting sick
• Won't help you or your child feel better
• May cause needless and harmful side effects
• Promotes antibiotic resistance

“If you take an antibiotic when you have a viral infection, the antibiotic attacks bacteria in your body. These are bacteria that are helpful or are not causing disease. This incorrect treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria. Or it can create an opportunity for potentially harmful bacteria to replace the harmless ones,” the website states.Experts say that AMR is already causing harm.The Hindu quoted Dr Sumit Ray, head of department, critical care medicine, Holy Family Hospital, Delhi, and secretary, Indian College of Critical Care Medicine, as saying, “The immediate threat is clear. I am an intensivist and I see people dying because of AMR. The study that we are quoting has also shown that nearly 75 per cent of the surveyed patients who had an E. coli or a Klebsiella infection in hospital were resistant to what we simply called a third- or fourth-generation antibiotic. What is more worrying is that resistance to the next generation of antibiotics (carbapenem resistance) is also high.”

They say this a major problem.

Dr Rajiv Dang, senior director and HOD, internal medicine and medical director, Max Hospital, Gurgaon, told The Times of India, "Resistance to antibiotics means that the drug which is supposed to be working against a particular group of microorganisms is not able to work. So to say the organism is resistant to the effect of the medication, which is because of undergoing some chromosomal change."“So you have often seen that after getting the culture report of urine, blood or some pus, the doctors likes to make changes in the antibiotic that he is using because as per the report, this is likely to be resistant, while we want a drug which should be sensitive so that the effect is seen and therefore the patient recovers. This is a big concern and a serious one because medical science at this point of time does not have a new drug that is undergoing investigation and research so we are not expecting any good new antibiotic in a short term. There is no such drug in the pipeline as of now,” Dang added."Antibiotics should be sold only on prescription and not at free wish," added Dr Saibal Chakravorty, senior consultant, internal medicine, Metro Hospital, Noida."We have to see at the level of the doctor, We have to see at the level of the patient as well as at the level of the chemists. So involvement of all three are equally important to curb this menace. At the level of the antibiotics, the antibiotics should be sold only on prescription and not at free wish. At the level of the patient, they should realise that all the infections are not bacterial, " he explained With inputs from agencies