Times of India
28 October 2010
By Shobha John
New Delhi, India

We all know someone who has popped antibiotics at the first hint of a sneeze or who hasn’t completed his full course of these medicines. All this could be a thing of the past as India, for the first time, readies a national antibiotic policy. It’ll also include the poultry industry and agriculturists. A policy statement in this regard will be finalized by November.

A 13–member expert panel was constituted by the health ministry in September to lay down the policy and ways to implement it. While antibiotics can, no doubt, tackle a severe illness speedily, their indiscriminate use can lead to microbes becoming resistant to drugs. This can be increasingly seen in tuberculosis, gonorrhea, malaria and ear infections. According to the Infectious Diseases Society of America, the cost of antimicrobial resistance to the US health care system in 1998 was nearly $5 billion. By 2010, this could have increased 10 times.

The need for such a policy in India was felt after the super bug controversy in March, where researchers reported a new Indian–origin bug, NDM–1, which was resistant to carbapenem, the strongest antibiotic known. Many developed countries such as Sweden and UK already have such a policy. In India, Tamil Nadu recently set up a panel to frame an antibiotics policy.

Components of the policy, accessed by TOI, show a well–thought–out strategy which will affect doctors, patients, pharmacists, veterinary doctors, agriculturists and the poultry industry. A task force will be set up in each state to develop and implement strategies in both the public and private sector. NGOs too will be involved.

Another component is that drugs and therapeutic committees as well as hospital infection committees will be set up in all hospitals. A national reference microbiology laboratory will be set up and will have links with a network of accredited diagnostic labs.

Further, antibiotics will be classified – for non–restricted, restricted and very restricted use. There will be a selected list of antibiotics which shouldn’t be sold in pharmacies without a prescription, such as Ofloxacin which is used in fevers, says Dr Ranjit Roy Chaudhury, a member of the expert panel. "Stringent penalties will be imposed if this is violated. Normally, violators are taken to court but this is a long process; we want something more drastic," he says. Antibiotics not on the essential drugs list should not be procured, prescribed or be made available.

Shailendra, a chemist in South Delhi, welcomed this policy, saying it’s a must. "Often, small–time doctors prescribe antibiotics when there’s no need to. This overprescription, increases the body’s resistance and more and more expensive antibiotics are prescribed. If we refuse to sell them, patients, especially from the lower strata, threaten us. It’s very important to educate this section of society," he says.

The policy will also make it mandatory to test for the presence of antibiotics in food items. "Many times, antibiotics are introduced in chicken feed to make the birds plump. Once injested, they get into our system, increasing resistance. With this new policy, poultry too will get tested, says Chaudhury. Honey too has been found to have antibiotics.

Special attention will be paid to make the prices of antibiotics affordable. Otherwise, patients will stop using them as soon as they feel better without completing the full course, increasing resistance. Standard treatment guidelines for antibiotics will be developed. Special insurance programmes too will be formulated only for reimbursement of antibiotics. This is a pill everyone would welcome.

Over–prescribed antibiotics

• Ciprofloxacin: Used for fever, back pain, TB
• Augmentin: For sore throat
• Ceftriaxone: For Respiratory infection
• Gentamycin: For urinary infection