Antibiotics – An Invasion in India, US and China !

Antibiotics consumption in the world is startlingly consumed in majority by India 13 billion as against China 10 billion and USA 7 billion, as brought by a study for the year 2010. Figures must be even more frightening for 2015 because there is nothing to suggest a shift in trends. More population, more infections, more drugs and inverse trends!

Globally, overprescribing antibiotics — or, prescribing it when a simpler drug would do — is the biggest reasons for the evolution of antibiotic resistant pathogens, disease-causing organisms.

Although population of the toppers is to be kept in mind since we are dealing in absolute numbers, the consumption per person is equally alarming. In per capita terms leader is the US with 22 units per person, followed by India 11 and China 7.

According to Mr.Ramanan Laxminarayan, research scholar and lecturer at Princeton University, the reason behind the proliferation of antibiotics in India is “a combination of increasing income and affordability, easy access without a prescription, willingness of physicians to prescribe antibiotics freely, and a high background of infections that should ideally be contained by better sanitation and vaccination.” People forget, he said, that “antibiotics do have side effects and […] they are less likely to work for you when you really need them.”

 

The prescriptions whether private or in a research institute or a government hospital or dispensary will have a tendency to order a heavy prolonged dose of antibiotics to overkill the disease. A broad spectrum regimen such as penicillin shall be adopted backed by an aggressive dosage in both frequency and milligrams to ensure the infection disappears. Generally in the lax atmosphere of drug law enforcement, the chemist also delivers the drugs over the counter even without a prescription and without too much fuzz. Minimum effort. Minimum expense. Maximum result. This psyche of the Indian populace in general aids all such carelessly driven machanisms of the drug market too.

Many broad-spectrum antibiotic drugs (cephalosporins, fluoroquinolones, and carbapenems) are sold over the counter without [the] presence of a documented clinical need.

The ignorance and callousness are at every level of the society – from care providers like doctors, to pharmacists, lawmakers, manufacturers and [even] the consumers.  In 2012, IIMAR reported that the Medical Council of India (MCI) had received 702 complaints of such over-prescription in 2011-12, of which 343 were referred to state medical councils.

“In 2010-11, MCI received 824 such complaints, following which it cancelled the registration of 10 doctors and warned four others,” IIMAR reported.

According to a senior Indian pharmaceutical controlling agency, “Chemist and [drug] associations are not interested in curbing their volume of business and the [pharmaceutical] industry is also silent for the sake of their profit,”

According to the consulting firm  Deloitte, pharmaceutical sales in India stood at 22.6 billion dollars in 2012, with a predicted rise to 23.6 billion in 2013. Sales are expected to touch 27 billion by 2016.

 

The companies developing the drugs have a high level of contact through medical representatives introducing newer brands and creating aggressive awareness, encouraging the prescribers and sellers both to be adventurous too ! Currently there is no oversight on appropriate prescribing. Who cares for the side effects ! Another disease developing could be treated with another regimen of drugs ! As frank Zappa says “another day another sausage”.

The lethal bacteria are starting to have the last laugh. This situation is caused by prolonged use of a particular drug or a family of drugs. This is apart from the side effects that these modern scientifically developed drugs carry with them. Mostly hit organs in general always include the poor liver and the kidneys.

According to a report on world’s anitibiotic report 2015, being released by Washington based Centre for Disease Dynamics,Economics and Policies (CDDEP), bacteria strain “Kleibsiella peneumoniae” has for example, assumed dangerous levels of resistance towards even last resort antibiotic class- the  Carbapenems. In India it is 57% in 2014, increasing from 29%. In Europe the resistance level is below 5%.  To class III generation Cephalosporins, the bacteria strain Keibsiella is 80% resistant, to flouroquinolones 73% and 63% to aminoglycosides. Carbapenems antibiotic class is meant to be used for the most extreme circumstances and as a last resort, only when the patient’s life is in danger and no other treatment will cure the infection.

India has recorded a resistance level of over 80% for 3 different drug classes in the case of the deadly E coli virus, which causes diseases of the intestines such as severe diarrhoea, abdominal cramps and food poisoning.

For a country like India with limited healthcare facilities and a doctor patient ratio of one doctor to every 1,700 people, as well as 29 percent of the population languishing below the poverty line, the emergence of super bugs could be disastrous, experts say. Infections that could be treated in a week or two in Europe could take very long for treatment in India and / or become life threatening!

India, with a diverse patient profile and a mostly unregulated healthcare system, was late to adopt the new protocol for rational use of antibiotics in 2011 and other remedial measures laid out by the World Health Organization (WHO).

Experts say That  there should be “antibiotic protocols for all hospital, clinics and dispensaries and this should be displayed in each healthcare-providing agency [and] institution. There should be statutory warnings on each pack of antibiotics, highlighting the hazards of misuse.”

“Time has come to raise [our] voices against the irrational use of antibiotics.”

They’re invisible. They’re everywhere. And they rule.