Realisation finally dawned on the Union Health Ministry when last week it made mandatory for doctors to list reasons for prescribing antibiotics or antimicrobial drugs to patients. “It is an urgent appeal to all doctors in medical colleges to mandatorily mention exact indication/reason/justification while prescribing anti-microbials,” said an advisory from the Directorate General of Health Services. This is a crucial first step in a country where over-prescription by doctors and self-medication by unsuspecting patients is a norm. Just to avoid seeing the doctor, getting tested, spending a huge sum of money and taking rest for a few days, it is a tendency among most Indians to take over-the-counter antibiotics. From common cold to other non-serious conditions, antibiotics are overused and misused by millions, leading to a major health crisis – Antimicrobial Resistance (AMR).
The World Health Organization (WHO) has described AMR as a silent pandemic that could cause about one crore deaths by the year 2050. AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and even death.
According to the WHO, AMR was directly responsible for an estimated 1.27 million deaths globally in 2019 and indirectly contributed to about 4.95 million casualties. The rise and dissemination of pathogens that are resistant to these antimicrobial drugs pose a significant challenge to our capacity to effectively tackle common infections and carry out critical procedures like cancer chemotherapy, caesarean sections, hip replacements, organ transplants, and various other surgeries. Furthermore, drug-resistant infections have adverse effects on the well-being of animals and plants, diminish agricultural productivity, and ultimately pose a threat to food security.
Apart from causing fatalities and impairments, AMR entails substantial financial implications. According to the World Bank, the impact of AMR could lead to an extra $1 trillion in healthcare expenses by 2050. Additionally, it is projected that between 2030 and 2050, there could be annual gross domestic product (GDP) losses ranging from $1 trillion to $3.4 trillion under the impact of AMR.
The Health Ministry advisory has also asked pharmacists across the country to “stop over-the-counter sale of antibiotics and sell them only on prescription of a qualified doctor.” It is not that the Health Ministry’s notification was the first in this direction. There are already laws that mandate chemists to sell antimicrobials only when prescribed by the doctor. For instance, under the Drugs & Cosmetics Rules 1945, antibiotics are included in the list of drugs specified under Schedule H, which are required to be sold by retail on the prescription of a registered medical practitioner only. However, such rules are thrown to the winds by pharmacists.
In a country like India where a majority of people even today are just one medical bill away from poverty, arresting this growing trend of antibiotic overuse and misuse is a top priority. Our ill-equipped healthcare system simply remains incapable of bearing the burden of another crisis if the scenes at our hospitals during the COVID-19 pandemic were any indication.