The Telegraph
Tuesday , July 15 , 2014
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India among worst abusers of life-saving antibiotics

New Delhi, July 14: India’s retail sales growth of antibiotics called carbapenems intended primarily for use against the most deadly multi-drug resistant bacteria is among the highest in the world, a new study has shown, indicating widespread abuse of these life-saving drugs.

The study, described as the world’s largest analysis of antibiotics consumption, has found that retail sales of carbapenems in India jumped from 0.15 standard units per 1,000 population in 2005 to nearly 3.8 standard units per 1,000 population in 2010, one of the steepest gradients in the world.

“The trends are unmistakable — in no other country do we see such widespread and uncontrolled access to these life-saving drugs,” said Ramanan Laxminarayanan, a health economist and vice-president of research at the Public Health Foundation of India, New Delhi, and a co-author of the study.

The study, published last week in the journal Lancet Infectious Diseases, has warned that the rise in the consumption of such last-resort antibiotics raises serious concerns for public health.

Sections of doctors have long been worried that the inappropriate use of antibiotics has been contributing to the emergence of drug resistant bacteria that are becoming increasingly difficult to treat with new generations of antibiotics.

Carbapenems are currently considered the most powerful available antibiotics against multi-drug resistant bacterial infections that are typically seen among patients admitted in intensive care units. The carbapenems are seen as “last-resort” antibiotics, Laxminarayanan told The Telegraph.

India first reported carbapenems use in 2002, with 0.04 standard units per 1,000 population. But it doubled within a year, reaching 0.08 standard units in 2003. By the end of 2010, the consumption levels had crossed 3.8 standard units.

In contrast, the sales were stable at about 0.3 standard units per 1,000 population in the US and the Netherlands, and about 1.5 units per 1,000 population in Indonesia. Only Pakistan and Egypt registered higher sales growth than India.

India’s health ministry through drug regulatory authorities has introduced new rules that require retail chemists to sell certain classes of antibiotics only on prescriptions and record the sales for audit by government drug inspectors.

But representatives of retail chemists in India had themselves earlier this year expressed concerns that the new rules are impractical. “In this country, many patients can’t afford to pay doctors’ fees but need antibiotics,” a representative of the retail pharmacists in Delhi had said earlier this year.

Microbiologists suspect that the abuse of carbapenems has already given rise to bacteria resistant to these drugs.

A study published in 2006 — only four years after carbapenems were introduced in India — had found that a significant proportion of several bacteria that have the potential to cause intestinal and respiratory infections displayed carbapenem resistance.

Arti Kapil, a senior microbiologist at the All India Institute of Medical Sciences, New Delhi, and her colleagues who conducted the study had in the Indian Journal of Medical Research warned: “There is a need to alarm our clinicians (doctors) for judicious use of antibiotics.”