Representative image showing antibiotics.
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The guidelines issued by the Directorate General of Health Services (DGHS) to doctors and pharmacists on the prescription and sale of antibiotics should hopefully help to reduce their use in the country. The DGHS has told doctors to mention “indication, reason and justification” while prescribing antimicrobials. It has also told pharmacists to sell antibiotics only on prescription from doctors.
Antimicrobials which are covered by the guidelines include antibiotics, antivirals, antifungals and antiparasitics. Antibiotics are included in Schedule H and H1 of the Drugs and Cosmetics Rules, 1945, and they are allowed to be sold only on prescription by a registered medical practitioner. But the rules are hardly enforced. There is lax enforcement of the rules and little awareness of them and the dangers of unchecked use of antibiotics.
These drugs are often sold over the counter without a prescription. The latest guidelines are, in fact, a reminder. They have been issued in the past also.
Antibiotic resistance is a major threat to public health in India and the world over. Patients develop resistance to antibiotics if they are indiscriminately and excessively used. Doctors sometimes prescribe them for quick results and patients are known to ask for them. There are only a limited number of antibiotics and there will not be any defence against many ailments if they become ineffective.
There have even been fears that the world may return to the pre-antibiotic age. The World Health Organisation (WHO) has been concerned about it for a long time. It has issued several advisories and periodically published the lists of pathogens for which new antibiotics are urgently needed, so as to promote research and development of new medicines. It is estimated that bacterial AMR (antimicrobial resistance) was directly responsible for 1.27 million deaths globally in 2019.
The DGHS has pointed out that AMR results in prolonged illness and greater risk of death. In 2016, the Union Ministry of Health and Family Welfare had launched the ‘red line’ awareness campaign on AMR, asking people not to buy or use medicines (including antibiotics) marked with a red vertical line without a prescription.
Apart from issuing guidelines and directives, the health authorities should ensure that they are strictly followed. It is not known whether there are inspections and checks and those who violate the rules are penalised. There is a need for widespread campaigns that educate people about the dangers of excessive use of antibiotics, and in fact about the unnecessary use of all medicines. The public health sector in the country already has many problems. AMR threatens to become the biggest, and most unmanageable, of them all if it is not contained in time.