antibiotic alert

New Delhi, Nov. 3: If you drive to your doctor, your chances of being unnecessarily prescribed antibiotics become higher.

Patients’ socio-economic status influences how often doctors in India prescribe antibiotics, with well-off people likelier to receive needless antibiotics, a study suggests.

The four-city study, which examined 8,910 prescriptions from 100 government and 135 private clinics, has found that antibiotics were widely prescribed for uncomplicated viral illnesses that would probably not have needed antibiotic treatment.

“There are significant differences from city to city, but overall there is widespread antibiotic abuse,” said Indira Kumari, head of pulmonary medicine at the Amrita Institute of Medical Sciences, Kochi, who led the study.

The researchers examined prescriptions of patients who had either acute respiratory infections, typically caused by viruses that thrive in the nose and throat, or had diarrhoea that too appeared to have been caused by viral infections.

Less than 20 per cent of such acute viral infections need antibiotics, Kumari said.

Antibiotics were listed in 47 per cent of the prescriptions in Kochi, 73 per cent in Chennai, 76 per cent in Vellore and 81 per cent in Lucknow. The findings have just been published in the Indian Journal of Medical Research.

Many doctors have warned in the past against the abuse of antibiotics in India and its possible consequence — bacteria becoming resistant to drugs faster because of repeated exposure to them, and thus harder to treat.

“Our study validates those concerns and shows how social factors determine prescription patterns,” said Rashmi Kumar, a paediatrician at the King George Medical College, Lucknow, who examined prescriptions from her city.

The study found that 72 per cent of patients from high-income groups received antibiotics in contrast with 64 per cent in low-income groups. The rate was 81 per cent for patients who had travelled to hospital in private vehicles compared with 67 per cent for those who used public transport.

“The illness alone does not appear to be influencing prescriptions,” Kumar said. Almost all antibiotics target bacteria rather than viruses, and are needed in viral infections only if there is a secondary infection by bacteria.

“Doctors need to be judicious with these drugs. Patients need to be asked to come back if they do not improve, followed up and treated (with antibiotics) only if required,” she said.

The study found antibiotic prescription rates higher in government clinics than in private clinics. But private doctors were prescribing expensive and new antibiotics.

Two classes of relatively new antibiotics called quinolones and cephalosporins — “reserve drugs” that are to be used only if ordinary antibiotics fail — accounted for more than 40 per cent of prescriptions from private doctors.

Needless use of these new drugs can speed up bacterial resistance to them too, robbing them of their USP. This can have “serious consequences” in the future, the researchers have warned.

In government clinics, the prescriptions matched what was available in their free drug stocks.

The researchers say they cannot yet explain the variations across the four cities.

“It is possible that literacy and awareness among the general population in Kerala is contributing to lower rates of antibiotic abuse,” Kumari said. “We have patients who ask their doctors why they’re being given antibiotics.”