Article 3: For antibiotics, the right dose is restraint
Why in news: A Lancet Public Health study revealed that India excessively uses "watch" antibiotics while underutilising first-line "access" antibiotics, raising concerns over antimicrobial resistance (AMR) and irrational antibiotic prescribing.
Key Details
- Imbalanced antibiotic use: India consumes 18.3 defined daily doses (DDD) per 1,000 people/day, exceeding the optimal 9.9–14.7 DDD.
- Overuse of "Watch" antibiotics: Usage stands at 9.3 DDD against the recommended 6 DDD, increasing AMR risk.
- Underuse of "Access" antibiotics: First-line antibiotics are used at only 4.5 DDD, much below recommended levels.
- Systemic drivers: Poor diagnostics, fragmented healthcare, patient demand, and overburdened doctors encourage irrational antibiotic prescriptions.
- Beyond healthcare: Extensive antibiotic use in livestock and agriculture further accelerates antimicrobial resistance.
Overdependence on Stronger Antibiotics
- India relies heavily on broad-spectrum ("watch") antibiotics for common illnesses instead of safer first-line medicines.
- This excessive use has become a major public health concern.
- A Lancet Public Health study identifies a serious imbalance in antibiotic consumption.
- Overuse of stronger drugs accelerates antimicrobial resistance (AMR).
- Routine illnesses are increasingly treated with medicines meant for more specific infections.
WHO Classification of Antibiotics
- Access antibiotics: First-choice medicines for common bacterial infections.
- Watch antibiotics: Broad-spectrum drugs to be used only in specific situations.
- Reserve antibiotics: Last-resort medicines for highly drug-resistant infections.
- WHO recommends prioritising access antibiotics to reduce resistance.
- Rational use of all three categories is essential to preserve antibiotic effectiveness.
India’s Antibiotic Consumption Pattern
- India's optimal antibiotic use is estimated at 9.9–14.7 defined daily doses (DDD) per 1,000 people per day.
- Actual consumption is much higher at 18.3 DDD, indicating overuse.
- Watch antibiotics are used at 9.3 DDD, well above the recommended 6 DDD.
- Access antibiotics are used at only 4.5 DDD, far below the desired level.
- This imbalance reflects irrational prescribing and consumption practices.
Why Stronger Antibiotics Are Overused
- Patients often expect quick relief, encouraging prescriptions of stronger drugs.
- Overburdened healthcare providers may prescribe broad-spectrum antibiotics as a precaution.
- Limited diagnostic facilities make targeted treatment difficult.
- Poor awareness about antibiotic stewardship among prescribers and patients contributes to misuse.
- Every unnecessary dose increases the risk of future drug resistance.
Systemic Challenges and Wider Drivers
- Reserve antibiotics remain underused even in genuine drug-resistant infections due to poor access.
- Fragmented healthcare delivery delays appropriate treatment.
- Inadequate diagnostic infrastructure leads to empirical antibiotic use.
- Widespread use of antibiotics in livestock and agriculture further fuels antimicrobial resistance.
- Strengthening antibiotic stewardship, diagnostics, and regulation is essential to combat India's growing AMR burden.
Conclusion
India's fight against antimicrobial resistance requires a shift from indiscriminate antibiotic use to evidence-based prescribing and strong antibiotic stewardship. Expanding diagnostic facilities, regulating antibiotic sales, promoting WHO's AWaRe framework, and curbing misuse in healthcare, livestock, and agriculture are essential. Preserving antibiotic effectiveness today is critical for safeguarding public health and ensuring effective treatment for future generations.
Descriptive question:
"Antimicrobial resistance is a silent pandemic driven by irrational antibiotic use. Discuss the challenges in antibiotic stewardship in India and suggest measures to promote responsible antibiotic use." (15 Marks, 250 words)
Source: The Indian Express