Can one desire too much of a good thing? William Shakespeare may have put this poser in As You Like It in an entirely different context, but the answer as regards the use of a few products promoting hygiene is a big NO.

New evidence has emerged that manufacturers' claims about hand sanitisers, cleaners and soaps keeping diseases at bay could be exaggerated.

On the contrary, excessive use of such anti–bacterial products can prove to be potentially harmful in the long run.

The overuse may even lead to drug resistance, which takes place when disease– causing micro–organisms develop the capacity to withstand exposure to antibiotics previously toxic to them.

Antibacterial compounds added in consumer products at low concentrations create a perfect environment for the evolution of drug–resistant strains, according to experts.

'Alcohol–based hand sanitisers may not be the panacea for hand hygiene they were once supposed to be,' a recent report in the Canadian Medical Association Journal points out.

Such products, the report specifies, 'may not be effective substitutes for soap and water' and, in some cases, may actually increase the risk for resistance developing.

It is on the basis of such research findings emerging from different groups that consumer organisations as well as health experts are demanding the regulation of a range of these products purportedly containing germ–killing substances.

'Overuse of antibacterial products will lead to resistance, just as mosquitoes have become resistant to DDT.

Besides, who has certified their claims? One of them assures that a product will kill 99% of germs,' Pritee Shah of the Ahmedabadbased Consumer Education and Research Centre (CERC) says. 'Plain soap and water are the best options.

And anti–bacterial products should be adequately regulated,' she adds. But in response to queries by CERC, Hindustan Unilever – the manufacturer of Lifebuoy liquid soap – says: 'Scientific evidence is currently inadequate to demonstrate a link between the use of germ–protection products and the development of antibiotic resistance during consumer use.'

The firm further states: 'Antibiotics are known to act through specific mechanisms and, as a consequence, micro–organisms can develop resistance to these.

This is different from the way in which cosmetic products such as germ–protection soaps work. Earlier research done at the Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan (US), has shown no additional health benefits associated with the use of triclosan–containing consumer soaps over the regular ones.

This, coupled with laboratory data showing a likely risk of drug resistance, means regulators need to further evaluate such product claims and advertising.

The extensive use of sanitisers and cleaners containing antibacterial ingredients could contribute to the surfacing of antibioticresistant strains and ultimately reduce the efficacy of prescription drugs, Australian consumer group Choice has cautioned. 'If an adequate amount of anti–bacterial ingredient is not present in a product, germs may become resistant to such agents.

The problem is not so much with resistance to that particular agent, but with a process called cross–resistance – a bug becoming resistant to a whole class of these agents,' Dr C.M. Gulati, the editor of medicine journal Monthly Index of Medical Specialties, says.

According to the Drugs and Cosmetics Act, any substance which controls or ameliorates a disease is a drug. Handwashes, which claim to possess diseasecontrol qualities, should thus fall in this category. 'All such products should be regulated,' Gulati points out.

It is believed once these products are treated as drugs, manufacturers will cease to make tall claims. The Drug Controller General of India will then have to ensure an adequate quantity of antibacterial is added to these products so that they are effective as well as safe.

'If this happens, such soaps and sanitisers will also be subjected to clinical trials and firms would have to mandatorily present evidence of safety and efficacy,' Gulati observes.

But Dr Randeep Guleria of AIIMS differs: 'Enough evidence does not exist to link antibacterial products with antibiotic resistance. They are meant to be used as sanitisers and not to treat an ailment.

The basic objective of using such products is to prevent infection.' Guleria feels such products can be regulated for proper use, strength and effectiveness but should not be banned.

The office–bearers of the Indian Medical Association (IMA), which endorses Dettol liquid soap, did not respond to queries made by Mail Today.