Resistance and regulation

No getting away from strict enforcement of antibiotic control

The government's notification mandating the sale of antibiotics and certain other medicines strictly on a doctor's prescription came into force at the beginning of this month, after a year's transition period. However, most chemists continue to dispense these drugs for want of effective enforcement of the new norms. Few drugstores have begun asking for the doctor's prescription, and fewer still have begun keeping records of such sales with details such as the doctor's and the patient's names and the quantity of drugs supplied, as is required under the new measure. The notification, which was kept on hold for a year owing to protests from chemists and in order to give pharmaceutical firms time to amend labels on drug wrappers, puts sale curbs on 46 medicines, including Schedule H1 antibiotics, some pain relievers, cough syrups and habit-forming stress busters. It requires drug manufacturers to carry a boxed warning on the labels about their prescription-based sale and display "Rx" sign in red at an easily noticeable spot. Its violation entails penalties, including cancellation or suspension of licences and even prosecution.

Surprisingly, though the government chose to take this much-needed step by amending the rules under the Drugs and Cosmetics Act, 1940, it seems minimally interested in implementing it. Hardly anything has been done to create awareness among people and chemists about the coming into force of the new norms for the sale of these medicines. Nor has much been done to sensitise doctors to be more cautious while prescribing these drugs. These are important prerequisites for the success of this drive. Indiscriminate use of antibiotics is known to cause immunity among individuals against common diseases and drug resistance among pathogens. A business-as-usual approach on this count will, predictably, reduce the effectiveness of common antibiotics and necessitate the use of more and more potent drugs to treat even ordinary ailments.

Curbs on over-the-counter sale of antibiotics and other similar drugs are badly needed, given the rampant tendency to pop up potent drugs without even consulting the doctor. The Washington-based Centre for Disease Dynamics, Economics and Policy has estimated a whopping six-fold increase in the consumption of even the most potent antibiotics, called carbapenems, which are drugs used as the last resort on failure of all other cures. Little wonder, therefore, that the incidence of antibiotic resistance and the presence of the dreaded superbugs - bacteria immune to all known antibiotics - is higher in India than in most other countries. Incidentally, the superbug that caused a near panic the world over after it was discovered in 2009 has been named after the Indian capital - "New Delhi metallo-beta-lactamase-1", or NDM-1 - since it was initially found among European patients who had been to India. It, however, made headlines in India in 2010 when local studies confirmed its existence in many key hospitals in New Delhi, Mumbai, Chennai and elsewhere.

The World Health Organisation has already cautioned that humanity is staring at a post-antibiotic era when common infections will no longer have a cure. Should this warning hold true, India will be among the worst sufferers - thanks to the poor state of hygiene in hospitals and health centres. Even hospitals' intensive care units do not follow the prescribed standards of infection prevention. It is, therefore, imperative for the government to strictly enforce its notification on restricted use of antibiotics. Otherwise, millions of human lives will be in peril.