Antibiotics and Their Abuse

When 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 antibiotics 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 year’s 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.