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16 August 2010
By Rupali Mukherjee
‘India needs an antibiotics audit’
Discovery of a ‘multi–resistant superbug’ linked to surgeries in the country has triggered a debate on the need for a clear and discernible national policy on antibiotics, which would curtail irrational use of these drugs, monitor and increase surveillance at hospitals, and lay down norms for infection control in healthcare facilities. At present, there are no tangible guidelines on the use of antibiotics and much is left on the judgement of doctors.
Doctors and experts across the country feel that there should be regulatory guidelines on the "scientific’’ use of antibiotics, curbs on easy availability of drugs at chemist shops, periodic surveillance of antibiotic resistance in all hospitals (especially those dealing with infected patients), and antibiotic auditing at healthcare centres (which drugs are given for what ailment or patient condition).
A cross section of doctors TOI spoke to was of the opinion that The Lancet report on the drug–resistant superbug originating from India should serve as a wake up call for the country’s medical establishment. "Though the superbug may exist in other parts of the world, doctors and hospitals should administer high–end antibiotics with discretion," said one of the doctors.
V M Katoch, secretary of department of health research and director general of the Indian Council of Medical Research, said, "The government will establish a structure of drug monitoring and surveillance for proper use of antibiotics. Advisories will be sent out to hospitals and doctors.
Though the existence of drug–resistant bacteria has been known for the last threefour years, we have been insensitive to it. Now, (with this study) there will be a bigger momentum to act."
Dr Anoop Misra, director and head department of diabetes at Delhi–based Fortis Hospitals, said, "Physicians should restrict irrational use of drugs, scientists and microbiologists should focus on more research on these bacteria, and policy–makers should issue and ensure implementation of an antibiotic policy. Finally, resistance pattern of not only these bacteria, but other more deadly ones (Pseudomonas, Staphylococcus, etc) should be studied periodically."
Resistance, doctors explained, develops when highpowered (broad spectrum) antibiotics are repeatedly administered to patients for minor infections.
"In order to prevent antibiotic resistance, most hospitals formulate their own guidelines in consultation with microbiologists, physicians, surgeons, and intensivists. The guidelines are implemented by the hospitals’ infection control committees," Dr Camilla Rodrigues, consultant microbiologist who discovered the multi–resistant superbug in a study conducted at Mumbai–based Hinduja Hospital earlier this year, said. "Before prescribing any antibiotics to a patient, doctors should ask for culture/sensitivity report so that the therapy comprises only specific drugs."
Sometimes, pharma companies also influence doctors to prescribe expensive, newer and stronger antibiotics, when a patient can easily do with simple, regular ones. Another important issue that needs to be addressed is accessibility of antibiotics at retail outlets without prescription.