India's Antibiotic Dilemma: Overuse of Powerful Drugs and the Need for Change
In a recent study published in The Lancet Public Health, a concerning trend has emerged regarding India's antibiotic consumption. The research reveals that India is overusing 'watch' antibiotics, which are meant for specific infections, while underutilizing both 'access' and 'reserve' antibiotics. This imbalance in antibiotic usage has significant implications for public health and the global fight against antimicrobial resistance.
The Global Context
The study paints a broader picture, showing that almost three-fourths of countries worldwide are consuming more antibiotics than necessary. This excessive use contributes to the growing issue of antimicrobial resistance, a critical concern for global health. Interestingly, while some countries overuse antibiotics, many others still lack access to these life-saving medications.
India's Antibiotic Map
According to the study, India ideally requires 14.7 defined daily doses (DID) of antibiotics per 1,000 people per day. This includes 7.8 DID of 'access' antibiotics, 6 DID of 'watch' antibiotics, and 0.99 DID of 'reserve' antibiotics. However, the reality is quite different. India currently consumes 18.3 DID overall, with a disproportionate use of 'watch' antibiotics at 9.3 DID, while 'access' antibiotics are underutilized at 4.5 DID, and 'reserve' antibiotics are used sparingly at 0.19 DID.
This discrepancy suggests that India is unnecessarily exposing some patients to 'watch' antibiotics, which carry a higher risk of promoting antimicrobial resistance. At the same time, others may not be receiving the most appropriate medicines for their infections.
Addressing the Imbalance
Prof Ramanan Laxminarayan, one of the study's authors, emphasizes the need for strategies to ensure populations have access to the right antibiotics at the right time while reducing unnecessary use. He highlights that India's higher burden of infectious diseases and antimicrobial resistance justifies a higher need for 'watch' antibiotics compared to other countries. However, the underuse of 'reserve' antibiotics is a cause for concern, especially given the country's resistance burden.
Global Antibiotic Use
The study analyzed antibiotic use across 186 countries, representing 99.8% of the world's population. It found that 72% of countries used more antibiotics than estimated to be necessary, with 99% overprescribing antibiotics that contribute most to antimicrobial resistance. Additionally, 60% of countries continued to use antibiotics that the World Health Organization (WHO) no longer recommends for routine prescription.
The study estimates that around 43 billion antibiotic treatment days were needed globally in 2019, highlighting the importance of appropriate antibiotic use.
India's Prescribing Pattern
The findings align with previous evidence from India. A survey conducted across 20 tertiary care hospitals found that nearly three out of four hospitalized patients were receiving antibiotics, with a significant proportion being 'watch' antibiotics. This pattern raises concerns about the potential for unnecessary exposure to these powerful drugs.
Dr Kamini Walia, an expert in antimicrobial resistance, suggests that India should focus on reducing the unnecessary use of commonly prescribed 'watch' antibiotics. She also emphasizes the importance of restricting 'reserve' antibiotics to patients with documented or strongly suspected multidrug-resistant infections.
Conclusion
India's antibiotic usage pattern is a complex issue that requires careful consideration and strategic interventions. The country must strike a balance between ensuring access to appropriate antibiotics and reducing the unnecessary use of powerful drugs. By implementing effective antimicrobial stewardship programs and raising awareness among healthcare professionals and the public, India can play a crucial role in combating antimicrobial resistance and improving patient outcomes.
