MEDICINES WITH A RED LINE ON THE STRIP

India faces a twin challenge of over consumption of antibiotics breeding drug-resistant bacteria while ensuring that the poor and vulnerable have easy access 

              To check irrational use of antibiotics, packs of certain medicines will soon carry a 'red line' differentiating them from other drugs. The move is aimed at discouraging unnecessary prescription and over-the-counter sale of antibiotics causing drug resistance for several critical diseases including TB, malaria, urinary tract infection and even HIV.

The Centre is set to kickstart an awareness campaign - 'Medicines with the Red Line' -to spread awareness about irrational use of antibiotics. "India is committed to combating antimicrobial resistance (AMR). However, a collective action is required by all stakeholders within a country. A much-needed public awareness campaign to highlight the dangers of misuse and irrational use of antibiotics .

High disease burden, rising income, cheap, unregulated sales of antibiotics and poor public health infrastructure are some of the reasons for the sharp increase in antibiotic use. A report (August 2014) in the journal The Lancet Infectious Diseases, said that in 2010, India consumed 13 billion units of antibiotics, the highest in the world. Between 2005 and 2009, consumption shot up by 40 per cent.

A case of contradictions

The consequences of increased prevalence of antimicrobial resistance are best illustrated in the case of neonatal sepsis. On average 57,000 neonates die each year in India, the highest in the world, due to sepsis infection that is resistant to first-line antibiotics; in 2012, India had the highest neonatal deaths (nearly 7,79,000).

The irony is that at the same time, the lack of access or delayed access to effective antibiotics is causing more deaths in India than from drug-resistant bacteria. One way to reduce the dependence on antibiotics, particularly in the case of pneumonia, is by increasing the coverage of immunisation, which is currently hovering around 72 per cent for DTP (diphtheria-tetanus-pertussis).

So like many other developing countries, India has to turn the spotlight on ensuring sustainable access even while maintaining sustainable effectiveness of all antibiotics. The only way to achieve this twin objective is by ensuring that all stakeholders — government, patients, veterinarians, doctors, pharmacists, pharmaceutical companies and health-care facilities — play their respective roles more responsibly.

First, people should be made aware that stopping antibiotics midway, missing doses, taking sub optimal dosages, or consuming antibiotics for cold and other viral infections, to name a few, makes them resistant to antibiotics; when ill the next time, their only recourse will be more expensive drugs or probably nothing at all. 

Cracking down

1.For the government, the top priority should be to crack down on drug companies manufacturing irrational fixed-dose combination drugs. 

2.The government should also urgently regulate drug companies discharging antimicrobial waste into the environment and regulate the use of antibiotics in animal feed to combat antibiotic resistance and obtain healthier animal products 3.Better sanitation and effective infection control measures in health-care settings will also drastically cut the spread of drug-resistant strains.

            The collusion of drug companies and chemists is also apparent in the rampant over-the-counter (OTC) sale of antibiotics, particularly carbapenems (that is among the highest in the world), even for ailments where they are not indicative. The introduction of Schedule H1 category from March 2014 to prevent the sale of 24 third- and fourth-generation antibiotics without prescription is a step in the right direction. 

But restricting OTC sales of antibiotics, particularly the commonly used ones, is a double-edged sword. Any intervention to limit access by enforcing prescription-only laws unwittingly cuts off a vast majority of the population, particularly in the rural areas, that lacks access to doctors.

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