Lancet Study on Antibiotic Use in India

Context

A new study published in The Lancet Public Health has drawn attention to antibiotic prescribing practices in India, revealing that first-line ‘Access’ antibiotics are underused and that broad-spectrum ‘Watch’ antibiotics are overused. 

Key Highlights

• The study introduces a framework to estimate the optimal antibiotic demand for countries, depending on infection burden and resistance patterns, for the first time in the world.
• It reviewed antibiotic consumption in 186 countries, which accounts for almost the entire world population.
• The results show that Indian antibiotic use needs to be better aligned to the WHO AWaRe Classification system (Access, Watch and Reserve).

WHO AWaRe Classification of Antibiotics

• Access Antibiotics

  • These are the initial antibiotics that are prescribed for common bacterial infections.
  • They work, are cost-effective and have a relatively low risk of fostering antimicrobial resistance.

• Watch Antibiotics

  • These are ‘broad-spectrum’ antibiotics which should only be used for certain infections where standard antibiotics will not be effective.
  • Using antibiotics too frequently can speed up the development of bacteria that are resistant to the drugs.

• Reserve Antibiotics

  • These are medicines that can be used only for multidrug-resistant infections that are most serious.
  • They must be used with great caution to maintain their effectiveness.

Key findings related to India

• The current consumption of antibiotics in India is estimated at 18.3 Defined Daily Doses (DID) daily per 1,000 people, while the optimal is 14.7 DID daily per 1,000 people.
• It was revealed in the study that the use of Watch antibiotics is high, whereas Access antibiotics are under-used.
• Currently, India only uses 27% of the estimated 52% of antibiotic use categorized as Access.
• India has a rising burden of multi-drug resistant infections, which is not matched by the use of reserved antibiotics.
• The study suggests that unnecessary exposure to Watch antibiotics may further accelerate antimicrobial resistance.

Why antimicrobial resistance is a major concern

• Antimicrobial resistance develops when bacteria become resistant to antimicrobial medicines, which were once effective against them.
• Treatment failure, prolonged illness, increased health care costs and mortality are associated with AMR.
• Unnecessary and inappropriate use of antibiotics in humans, animals and food production systems speeds up the development of resistance.
• WHO calls AMR one of the greatest public health threats in the world.

Government initiatives

• National Action Plan on Antimicrobial Resistance (NAP-AMR).
• Under the umbrella of the National Centre for Disease Control (NCDC), the National Programme on AMR Containment was established.
• ICMR Surveillance network for monitoring resistant pathogens.
• Encouragement of Antimicrobial Stewardship Programmes (AMSP) in health care institutions.

Way Forward

• Improve antimicrobial stewardship in both public and private health care institutions.
• Encourage culture-based diagnosis before prescribing an antibiotic, if possible.
• Promote and facilitate rational use of medicines in line with the WHO AWaRe strategy.
• Increase education about self-medication and misuse of antibiotics in the community.
• Improve surveillance, research and One Health collaboration between human and animal and environmental health.

Source: The Indian Express

Prelims PYQ

(Q) Which of the following are the reasons for the occurrence of multi-drug resistance in microbial pathogens in India? (2019) 

1. Genetic predisposition of some people
2. Taking incorrect doses of antibiotics to cure diseases
3. Using antibiotics in livestock farming
4. Multiple chronic diseases in some people

Select the correct answer using the code given below.

(a) 1 and 2
(b) 2 and 3 only
(c) 1, 3 and 4
(d) 2, 3 and 4

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