World
Antibiotic Awareness week was held in the third week of
November. The theme this year centred on the question of safe use of
antibiotics in a prescribed form. It also tackles the increasing global problem
of antibiotic resistance. To understand the term antibiotic resistance first we
have to understand the meaning of the generic term – antibiotic. An antibiotic
is a medicine that is used to cure a disease caused by bacteria. This means
antibiotics are useful only against bacterial infections. Antibiotic resistance
as the term suggests is a phenomenon which refers to resistance developed by
bacteria against antibiotics or the ability of bacteria to mutate or change so
as to resist the effects of antibiotics. The more a person uses antibiotics the
greater his/her resistance becomes to antibiotics. This in turn can pose a
serious health hazard when a person suffering from a life -threatening disease
cannot recover because the antibiotic administered to the person will not act
since the person’s body has developed a resistance towards the same. And this
problem is the crux of the need for global awareness on antibiotic resistance.
In a country
where antibiotics are easily available for sale over and under the counter the
chances of antibiotic resistance rises exponentially. In India the infectious
disease burden is among the highest in the world and recent reports have shown
that the inappropriate and irrational use of anti-microbial agents against
bacterial diseases, have led to far more increased anti-microbial resistance
compared to other countries of the world. Studies have also indicated that
because the health sector in India suffers from inadequacy of public finance in
some levels, the chances for conditions favourable for development of drug
resistance further increases. Anti-microbial resistance results in difficulty
in controlling the diseases in the community and ineffective delivery of
health care services.
In 2015, WHO
conducted a survey in India which revealed a widespread misunderstanding about the
use of antibiotics as well as antibiotic resistance. In India the problem of
antibiotic resistance is unique. Those who need antibiotics do not have access
to it while others who do not need it have it in large amounts. A large part of
the almost 40,000 children who die of pneumonia every year in India do so due
to non- availability of requisite antibiotics while others are administered the
same indiscriminately. India is perpetually torn between these two sides which
therefore hampers efforts to issue any blanket order on administration of
antibiotics and regulation on the same. To counter this, the government in 2011
came with the concept of Schedule H1 drugs. The Schedule H1 list,
contains 24 critical antibiotics such as cephalosporins and carbapenems, the
sales of which are tightly controlled.
Schedule H is a
class of prescription drugs in India appearing as an appendix to the Drugs and
Cosmetics Rules, 1945.These are drugs which cannot be purchased over the
counter without the prescription of a qualified doctor. The manufacture and
sale of all drugs are covered under the Drugs and Cosmetics Act and Rules. They
are revised from time to time based on the advice of the Drugs Technical
Advisory Board, part of the Central Drugs Standard Control Organization in the
Ministry of Health and Family Welfare. The Schedule H1 list was introduced in
2011 with the hope that it would control the unregulated use of over the
counter sale of antibiotics while curbing the problem of antibiotics
resistance. However this program has not been as successful as it was envisaged
to be. Unlike Schedule X drugs for which a mandatory documentation trail is
required, there is no such provision for Schedule H1 drugs which has resulted
in flouting of norms. Pharmacists often do not adhere to the rules while
manufactures cannot keep track, thereby making the process less effective.
The lack of
awareness regarding antibiotic resistance further complicates the issue. As
antibiotics are the bedrock of modern medicine needed in a large variety of
reasons, increased antibiotic resistance will also result in increased costs
thereby making the medicines less affordable for an average consumer or
patient. Thus there is an increasing need to address these issues so that
the problem of antibiotic resistance does not exacerbate.
The first step
towards combating this menace is large scale public awareness. The problem of
resistance towards a certain kind of drug had taken the shape of an epidemic in
Australia. But over a period of time with sustained efforts the antibiotic
resistance has been cut down remarkably. India must follow a similar trend. The
general population as well as the health practitioners must be made aware of
the dangerous implications of self administration of antibiotics. Doctors and
other health practitioners must also teach and counsel patients regarding the
same. Pharmacists can be leveraged to counsel those who come to their shops
without consultation to buy antibiotics. These people should be encouraged to
seek the advice of qualified health experts first. If these small steps are
followed then the problem can definitely be solved and the National Action Plan
on Antibiotic Resistance is a right step in this direction. As we move into a
new era, health challenges are going to morph themselves into increasingly
different forms and as a nation we must keep reinventing ourselves to meet such
challenges.
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