The government of India has reportedly constituted a committee to formulate a policy for the rational use of antibiotics. This is in response to a report in a globally reputed medical journal on a drug-resistant bacteria or superbug, which has been found to be currently confined to the subcontinent. A superbug represents the end of the road in fighting infections with newer drugs as bacteria become resistant to older ones. So, the only way to prevent getting to that stage is to slow down resistance to antibiotics by ensuring that they are used sparingly. A policy is welcome, indeed, to have uniform norms for the whole country in this battle. Today individual players in health care do pretty much what they think is sensible and can thus cancel out each other’s efforts. Formulating a policy by putting eminent heads together is the easier part of the battle. But implementing that policy, even if it contains deterrent penalties, is difficult.
The task ahead is Herculean, because it requires a change of culture both on the part of doctors and patients. In a country where a significant portion of the people cannot afford most useful medicines, doctors routinely over-prescribe antibiotics to those who consult them. What is worse, patients are often dissatisfied with a doctor who may advise that, say, a viral infection should be roughed out if it does not get serious and not be pointlessly treated with antibiotics. This is, of course, just a little better than in China where many patients are not satisfied unless a doctor prescribes an injectable. Poor and uninformed patients in India also routinely use an older prescription to treat a new ailment whose symptoms appear similar, and then do not complete a course once undertaken. Further, although antibiotics are to be sold only against prescriptions, chemists routinely sell them over the counter, acting as makeshift doctors in response to patients’ narration of symptoms and request for some golian (tablets).
The regulatory system can begin with implementing the policy in hospitals which should adopt the right treatment protocols and — very important — remain clean so that they don’t become a serious source of infection. Overcrowded government hospitals are a major worry on the latter. But it is far more difficult to re-educate doctors. One weapon which should be made mandatory is continuing education. The current medical code says a physician “should” undertake at least 30 hours of continuing education in every five years. At the least, the “should” can be made “must”. This requires money but online distance education can bring down costs. It is also worth considering whether it should not be made mandatory for doctors to take a simple objective type test periodically to ensure that they know the latest basics in order for them to hold valid practising licences. It is also necessary to examine what can be done to counter the depredations (there is no other word for it) of drug companies and their armies of medical representatives at whose request most doctors do their prescribing. The best long-term weapon is right public awareness on these issues. Civil society has a larger role to play in this regard than government.
