EDITORIALS

Antibiotics and Their Abuse

India needs a policy on the prescription of antibiotics but will it be possible to effectively implement it?

hen the 11 August issue of Lancet published a report on the origin of the new antibiotic-resistant bacteria, the New Delhi metallo-beta-lactamase-1 (NDM-1), indignant Indian responses called this a conspiracy by the jealous west to defame the medical tourism industry here. However, the following month the central health and family welfare ministry set up a 13-member task force to draft a national policy that would curb the indiscriminate use of anti biotics that leads to disease-causing organisms evolving resistance to drugs. The ministry has now admitted what many Indian medical activists have been saying for nearly 20 years: most hospitals claim to have a policy on the use of antibiotics but it does not seem to be followed; more significantly, doctors need to be educated about both over- and under-prescribing antibiotics. The task force was mandated to look into the rational use of drugs, compulsory surveillance and pharmacy audits among other aspects. Its report is now awaiting clearance from the ministry before being placed in Parliament. It says that doctors will have to write prescriptions for antibiotics in duplicate and the chemist will have to retain one copy for a year. Non-compliance will lead to a (minimum) fine of Rs 20,000 and a years imprisonment, which can be increased to two years. Hospitals must compulsorily set up a drug control committee and an infection control committee. Media reports quoting the task force members say that the policy will also affect the use of antibiotics in agriculture and the poultry industry. (Poultry feed is often mixed with antibiotics to make the chickens plump and many brands of honey sold in Indian market have been found to contain antibiotics.) About 16 high-end antibiotics, including Meropenem, Cefepime and Moxifloxacin have been put under the new schedule. Also, 58-odd antibiotics such as Penicillin, Ampicillin and 15 drugs containing codeine as well as first-line TB drugs such as Rifampicin, Isomiazid, Pyrazinamid and Ethambutol will require duplicate prescriptions. The guidelines will be introduced first in three hospitals in Delhi as a pilot project. However, implementing the new policy, when it is formally announced, will be an extremely difficult task given the complex factors that have produced the alarming situation involving

doctors, patients and the pharmaceutical companies. There are many factors responsible for the present situation: a lack of awareness on the patients part leading to a demand for the magical anti biotic even for viral rather than bacterial infections, easy availability of prescription drugs over the counter and often on the chemists advice, the doctors willingness to fall in with the patients insistence on being treated quickly with unnecessarily powerful antibiotics, the aggressive marketing by pharmaceutical companies with in-built incentives for doctors, the patient stopping the drug as soon as there is a little relief (this is seen classically in tuberculosis treatment and India has had to pay a heavy price), thus leading to increased drug resistance, poor diagnostic capability of the prescriber, and the worryingly large presence of spurious drugs in the market. Another cause for alarm is the reluctance of pharmaceutical companies to concentrate resources on research and development in antibiotics. These drugs are used for a fixed duration and carry resistance problems, thus making it profitable to instead focus on drugs for chronic illnesses. So we have a situation where resistance is growing to the antibiotics already in the market and no new ones are being introduced. Antibiotics are also used in animal husbandry, particularly poultry farming, and in agriculture. The Journal of Association of Physicians of India (JAPI), which carried the results of a study that isolated 22 NDM-1 producing enterobacteriaceae in a period of three months in one hospital in Mumbai, even before the Lancet article, said in an editorial that adequate knowledge on the spectrum of antibiotics is missing in a good percentage of the medical fraternity and that doctors must update their awareness of antibiotics not through pamphlets issued by companies but through unbiased medical information. However, the track record of the government in tackling the spurious drug industry, checking the unethical practices of many pharmaceutical companies, and enforcing the ban on harmful drugs has not been an encouraging one. The implementation of the antibiotics policy will call for a high level of commitment and a considered approach to the health and well-being of the poor in India.
represents the Congo is something that the people of the Congo should be enabled to say by reopening of the channels in which public opinion normally expresses itself in a democracy but until such time as the authentic and duly expressed voice of the Congolese could he heard, it was best to postpone the issue of its representation in the United Nations. This is not the first time, of course, that the West has actively helped to install an amenable clique in power in a foreign land; but the consequences this time could easily be disastrous to the United Nations itself certainly as a future helper of distressed people in Africa or Asia.

From 50 Years Ago

Vol XIi, No 48, november 26, 1960

editorial

The Congo Plot

Even in politics there must be very few instances of such irony as is inherent in the criticism, said to be prevalent in the United States, that by opposing the resolution to seat the Kasavubu delegation in the United Nations, India gravely

compromised her position as a neutral. The terms aligned and non-aligned are evidently but little understood in Washington or New York, the impression being that neutralism obliges its practitioners to suspend all thought and judgement... In the circumstances, Shri C S Jha did well to strip Indias vote of all its subtlety and explain its implications and meaning in the most elementary possible terms. As he made clear, it was not India that was seeking to keep Mr Kasavubu or his delegation out of the United Nations, but the United States and its western camp-followers who were trying to keep Mr Lumumba out Who

Economic & Political Weekly EPW november 27, 2010 vol xlv no 48