Special Report: Battling Antimicrobial Resistance in India

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Outline-Map-Of-India-With-Pill Antimicrobial resistance is a worldwide problem, but is a particular major health threat to India, where bacterial disease burden is among the highest in the world and healthcare spending is low. The World Health Organization (WHO) defines Antimicrobial Resistance (AMR) as “resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive.” AMR is dangerous and costly, causing patients with AMR infections to resort to expensive 2nd- and 3rd-line medicines to treat the persistent illness. A primary cause of AMR is prescription (Rx) antimicrobial drug misuse.


“The increasing resistance of microorganisms calls for serious interventions to prevent the emergence of new resistant strains and the spread of the existing ones. One approach is to control the inappropriate use of antibiotics in both the hospital and the community settings and their sale without prescription.”
-Rathnakar U.P. et al. A Study on the Sale of Antimicrobial Agents without Prescriptions in Pharmacies in an Urban Area in South India. Journal of Clinical and Diagnostic Research. 2012 Aug; 6(6): 951-954.


Key Point: Antimicrobial resistance (AMR) is a growing problem in India. Inappropriate prescribing practices and misuse of Rx drugs are some of the main factors that contribute to AMR. Doctors can prevent the spread of AMR and can positively influence community behaviors and perceptions of antibiotics through good prescribing practices and patient education on AMR.

Antibiotic sales have steadily risen in India, however a more striking finding is that studies show inappropriate prescribing practices are common. An estimated 20-50% of antibiotic use is inappropriate – over-used, under-used, or wrongly prescribed. A survey by the Center for Disease Dynamics, Economics and Policy in Washington, DC, USA found that Indian pharmacy sales of carbapenem, a second-line antibiotic, increased by almost 6-fold between 2005 and 2010. A revision of the National List of Essential Medicines of India was completed in 2011 to advise doctors on the recommended first-line drugs for patients. Despite this circulating document, a recent study surveying antibiotic use among private retail pharmacies, public sector facilities, and private clinics reveal different prescribing patterns for private vs. public facilities, notably that the private sector prescribed virtually only newer antibiotics over the older, recommended antibiotics.

What can cause antibiotic resistance?...

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