India considers blue strips for antimicrobials to combat drug misuse

Antimicrobial resistance (AMR) occurs when bacteria and other pathogens develop resistance to antibiotics or other drugs, rendering these medicines ineffective when needed most

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As India intensifies its battle against antimicrobial-resistant superbugs, the drug regulator is considering a proposal to change the colour of all antimicrobial drug strips to blue. This initiative aims to raise consumer awareness that these drugs are not ordinary medications and should be used with caution, reported News18.

Antimicrobial resistance (AMR) arises when bacteria and other pathogens become resistant to antibiotics or other drugs, rendering these medicines ineffective. This escalating health threat is underscored by recent data showing that bacterial AMR caused the deaths of between 300,000 and 1.04 million people in India in 2019, according to the Global Research on Antimicrobial Resistance (GRAM) Project published in The Lancet.

Globally, the GRAM Project estimates that by 2050, antibiotic-resistant infections could lead to over 39 crore deaths. Given the scale of this threat, India’s move to differentiate antimicrobial drugs visually is a crucial step in the fight against AMR.

The proposal to introduce blue strips for antimicrobial drugs, which include antibiotics, antivirals, anti-parasitics, and antifungals, was submitted to the Drug Consultative Committee (DCC) of the Central Drugs Standard Control Organization (CDSCO). The proposal also involves the insertion of new rules under the Drugs and Cosmetics Act and Rules to mandate blue-coloured strips for these drugs.

Although the DCC did not decide during the initial meeting, the proposal is expected to be revisited. A senior official from the Ministry of Health and Family Welfare, speaking on condition of anonymity, told News18, “In the upcoming meetings, the proposal will be considered again as India needs to take strong steps in curbing AMR.”

However, this proposal faces resistance from the pharmaceutical industry. “A strong pharma lobby doesn’t want to make this effort as it will involve some additional investments in making this change,” said the official. 

“The idea is to send a message to consumers that the colour of the medicine has been changed because the drug is not safe for long-term use or self-consumption. We can start by changing the colour of strips of antibiotics and later move on to other categories such as antifungal and antiviral drugs,” the official said.

During the DCC meeting, members were also briefed on the seriousness of AMR and how it has become a growing threat to public health. The panel was informed that under India’s G-20 presidency, the New Delhi Leaders’ Declaration has prioritised tackling AMR by adopting a ‘One Health’ approach. This includes research and development, infection prevention and control, and antimicrobial stewardship within national action plans.

The committee also considered other proposals to curb AMR, including the uniform enforcement of Schedule H and H1 drugs by state drug controllers. These schedules include third and fourth-generation antibiotics that cannot be sold without a prescription. Stricter enforcement aims to curb the sale of these potent drugs without proper medical supervision.

In a related move, the Kerala government has begun selling antibiotics in blue envelopes to help people distinguish them from other drugs. This initiative is part of Kerala’s ‘Rage on Antimicrobial Resistance’ (ROAR) programme, aimed at reducing excessive antibiotic use.

The Lancet report further highlights the urgency of addressing AMR in India. It states that nearly 2.99 million people in the country died in 2019 either directly from sepsis — a severe reaction to infection — or from conditions related to it. Managing infections like sepsis has become increasingly challenging due to AMR, with 60 per cent of sepsis-related deaths caused by bacterial infections and the remaining 40 per cent linked to viruses, fungi, and parasites.