Centre mulls mechanisms to check misuse of antibiotics

Prescription auditor on way

New Delhi: The Union health ministry on Wednesday said it is mulling mechanisms to introduce audits of doctors' prescriptions as part of efforts to curb the misuse of antibiotics that is contributing to the emergence of bacteria resistant to even last-resort medicines.

Senior ministry officials said the government has recognised antimicrobial resistance as a "huge challenge," and is preparing an action plan that will demand initiatives by multiple government departments, including audits of prescriptions written by doctors.

"We are moving towards prescription audit, the problem is prescription audit is very easy to enforce in the public sector, not that easy in the private sector," Chandra Kishore Mishra, the health secretary, said today. "We have three committees working on antimicrobial resistance coming up with detailed guidelines on these things."

Health minister Jagat Prakash Nadda said Rajasthan already has a mechanism through which government hospitals upload prescriptions their doctors write, enabling the government to keep track of the drugs being prescribed to patients. "It is not so much about stopping, you can't. A patient who needs an antibiotic will have to be given (the drug), but at least we know where we are going," Nadda said while conceding that auditing the private sector is a "tricky issue".

Antibiotics are primarily intended for use against bacterial infections and have no role in most viral infections, including those that cause sore throats and diarrhoea. The misuse of antibiotics - such as for viral infections - can contribute to the emergence of antimicrobial resistance.

But doctors and public health analysts in India caution that audits will not be easy to implement across the country and will have limited impacts because other "bigger factors" are also contributing to antimicrobial resistance.

"They can do (prescription) audits, but antimicrobial resistance also comes from prescriptionless sales of antibiotics by chemists and from the misuse of antibiotics by practitioners of traditional medicine," said Krishan Kumar Aggarwal, president of the Indian Medical Association.

Health officials say the government has recognised the need for a multi-sectoral strategy and has called a meeting of health, agriculture, animal husbandry, and pharmaceuticals officials on February 22 to discuss a coordinated strategy to curb antimicrobial resistance, which also emerges from antibiotic misuse on farms.

"I'm thrilled to hear about such a multi-agency meeting," said Ramanan Laxminarayanan, director of the Centre for Disease Dynamics Economics and Policy, a research think tank in Washington and New Delhi. "Antimicrobial resistance will demand actions from multiple agencies. It is not health alone," he said.

The initiatives come amid long-standing concerns that bacteria that can cause life-threatening infections and high levels of resistance to last-resort antibiotics is a growing public health problem in India.

A nationwide survey of bacteria isolated from 135,000 patients' blood cultures in 425 cities across India had last year noted that an average of 10 per cent of E coli and 60 per cent of K pneumoniae showed resistance to carbapenems, a class of antibiotics used when all others have failed.

Although the government had in 2013 set new rules for the sales of prescription-only drugs, including several key antibiotics, and urged retail pharmacies to document these sales, there has been no assessment of its impact on antibiotic abuse. One hurdle is the absence of prescription audits.

But, Ramanan said prescription audits would be difficult given that they would require a strong information technology infrastructure - something many government hospitals lack. Combating antimicrobial resistance, he said, demands multiple measures, including the adoption of infection control and regular infection tracking practices by hospitals and clinics, and the adoption of standard treatment guidelines to avoid misuse of antibiotics.