Antibiotic resistance in India high: survey

Evidence from studies of antibiotics prescribing patterns suggests that medicines are often used in inappropriate ways and often sold without prescriptions.

Antibiotic consumption in India has increased between six and seven per cent annually in the past 5 years. The rise is substantial in the retail sector where antibiotics are mostly sold without a prescription, according to a paper published in the September edition of the Indian Journal of Medical Journal.

Between 2005 and 2009, the units of antibiotics sold in the country increased by about 40 per cent, points out the paper contributed by the Indian working group of the Global Antibiotic Resistance Partnership (GARP), chaired by N.K. Ganguly. Increasing antibiotics use is not, in itself, indicative of a problem. But studies of prescribing patterns suggest that these are often used inappropriately, and many a time, without a prescription.

Presented on the second day here of the ongoing First Global Forum on Bacterial Infections: Balancing Treatment Access and Antibiotic Resistance, the paper, referring to last year's controversy over the New Delhi mettalo-B-lactamase (NDM-1), said it may be the most widely known form of antibiotic resistance in India, but a number of studies in the recent years have documented significant rates of resistance to a wide range of antibiotics. Many of hospital-acquired Gram negative infections suggest that whenever studies have been conducted, the resistance levels have been alarmingly high. The GARP-India research estimates that of the approximately 190, 000 neonatal deaths in India each year due to sepsis, a bacterial infection that overwhelms the bloodstream, over 30 per cent are attributable to antibiotic resistance.

Dr. Ganguly said hospital-acquired infections (HAIs) are a particular concern indicating the low level of infection control in a hospital, since many such infections can be prevented through better hygiene. A study was conducted by the International Nosocomial Infection Control Consortium (conducted in 12 intensive care units in seven hospitals in seven Indian cities), which followed 10,835 patients hospitalised for a total of 52,518 days. The observed patients acquired 476 infections in the hospital of which 46 per cent were Enterobacteriacease, 27 per cent Pseudomonas and 3 per cent S.aureus.

Similarly, a prospective study of 71 burn patients at Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh revealed that up to 59 of them (83 per cent) had hospital acquired infections, 35 per cent of pathogens isolated from wounds and blood were S.aureaus, 24 per cent were P.aeruginosa, and 16 per cent were Beta-haemolytic streptococci.

A six month study conducted in the intensive care units of AIIMS Delhi found 140 of 1,253 patients (11 per cent) had 152 hospital acquired infections, P. aeruginosa made up 21 per cent isolated, 23 per cent were S.aureus, 16 per cent were Klebsiella, 15 per cent were Acinetobacter baumannii and 8 per cent E.coli. Another study of 493 hospitals in a tertiary teaching hospital in Goa found that 103 people (21 per cent) developed 169 infections.

A few hospitals and city-based studies of antibiotic use suggest that antibiotics are often prescribed in irrational or inappropriate ways in India. They are overprescribed and overused in all settings, whether in public or private hospitals, clinics or in pharmacies. Why this overuse persists is not so easily determined but much of this use can be curtailed without harmful results. In fact, reductions in use could actually improve people's health, the paper says.

Antibiotics are not only used to treat human illnesses but have also been used in livestock and poultry for more than half a century to control and treat diseases and in low doses in animal feed to promote growth and improve production of animal products. The precise effect of agricultural antibiotic use on resistance levels in the general population is not known, but the evidence suggests otherwise.

Keeping in mind the serious threat of antibiotic resistance, the international meet has called for action to extend access to effective antibiotics to those who would otherwise be ill or be dying from severe bacterial infections, to prevent as many infections as possible through vaccines, infection control and other proven measures, achieving a balance domestically between access to effective antibiotics and interventions to reduce unnecessary use.

The Global Antibiotic Resistance partnership was established to develop actionable policy recommendations specifically relevant to low and middle income countries where suboptimal access to antibiotics is not a major concern of high-income countries and is possibly as severe a problem as is the spread of resistant organisms.

Keywords: antibiotics, resistance to antibiotics