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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9 Comments

  1. Manju Wadhwan
    Posted Jun 2013 at 12:45 pm | Permalink

    The only way to avoid over usage is to have some law to avoid sale of antibiotics without the prescibtion
    Of the doctor by the pharmacist.

    • amlan nath
      Posted May 2014 at 12:10 pm | Permalink

      Law is already been enforced in some countries outside india.

  2. rajeshree patil
    Posted Jul 2013 at 4:36 pm | Permalink

    it is the duty of every doctor to see that they prescribe antibiotics judiciously and with care

  3. narendra gupta
    Posted Jul 2013 at 4:50 am | Permalink

    There needs to record keeping, even all OPD papers (Carbon copy) to kept by all doctors/Hospitals.. THERE SHOULD BE AUDIT, pharmacovigilance, Drug delivery by all chemists sud be mandatory and online, u will that ranbaxy (for example) manufactured some 100 injections and sale is 1000 so 900 is fake/fraud
    The crime in all fields is growing exponentially so is in medical profession as we are part of them

    • bhaskaranravikumar menon
      Posted Sep 2014 at 4:03 pm | Permalink

      Doctors are the main culprits by administering antibiotics for even uncomplicated viral fever.

  4. Sanjay Datta
    Posted Aug 2013 at 4:30 am | Permalink

    the main problem is that all types of antibiotics are easily available in a medical shop without any doctor’s prescription . A patient uses to go to a shop to purchase 3 -4 tabs / caps of an antibiotic. as soon as symptoms subside they stop to take the atibiotics . No one use to tell him or her to complete the course .

  5. saleem hanchinal
    Posted Aug 2013 at 9:20 am | Permalink

    This morning dropped in casualty to say hello to the medical officer on duty and found that the doctor was on antibiotics for flu type of symptoms! I said, doctor, since you have mainly a sore throat why don’t you go for a throat swab? The doctor replied, “Sir, this is the third day I am taking medication and no use doing the test.” I said, in that case you should have not started antibiotics at all before doing the test and trying to find out whether it was bacterial or otherwise.

    Now coming to the wards, most of the cases main diagnosis is, “Acute Febrile Illness” Surprisingly there is no such diagnosis in ICD. Antibiotics are used in all these cases without evidence of any bacterial infections.

    In our country it is a pathetic situation. We peers also don’t advise them as it amounts to questioning their actions. We think all doctors are divine and no one will do mistakes. Pharmacies are run by tenth pass girls and boys in well known corporate pharmacies. For name sake a framed photo of a qualified pharmacist hangs with wry smile. None of these tenth pass know the generic name and half of pharmacists. They know only trade name. I only know generic names ever since I worked overseas. Can anybody suggest a solution please?

    Dr. Saleem Hanchinal

  6. sharmila rao
    Posted May 2014 at 1:47 am | Permalink

    Great input, there are two areas that You have not included that is googlemata blessed self medicators, and the priest called the Pharmacist

  7. surya prakash
    Posted May 2014 at 4:39 am | Permalink

    Only a LST of few general antibiotics should be available in chemist shop’,second and third generation should be sold on prescription and a duplicate copy of sold medicine should be kept by chemist for further auditing.

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