India's antibiotic usage patterns are a cause for concern, according to a recent study published in The Lancet Public Health. The research reveals a complex interplay of over- and under-prescription, highlighting the need for a nuanced approach to antibiotic management in the country.
The study estimates that India ideally requires 14.7 defined daily doses (DID) of antibiotics per 1,000 people per day, with a breakdown of 7.8 DID of 'access' antibiotics, 6 DID of 'watch' antibiotics, and 0.99 DID of 'reserve' antibiotics. However, the actual consumption data paints a different picture. India currently uses 18.3 DID overall, with a significant imbalance in the distribution of antibiotic types. Only 27% of antibiotic use comes from the 'access' category, falling short of the estimated requirement of 52.3%. This discrepancy suggests that some 'watch' antibiotics are being used unnecessarily, potentially replacing the more appropriate 'access' antibiotics.
The 'watch' antibiotics, which are broad-spectrum and carry a higher risk of promoting antimicrobial resistance, account for 9.3 DID in India's current usage. This is concerning, as it indicates that some patients are being exposed to these powerful drugs unnecessarily, while others may not receive the most suitable antibiotics for their infections. The study's authors emphasize the need for strategies that ensure populations have access to the right antibiotics at the right time while reducing unnecessary use.
The findings are part of a global trend. Nearly three-quarters of countries are using more antibiotics than needed, and almost every country is overusing antibiotics that contribute most to antimicrobial resistance. This overuse is coupled with a lack of access to essential antibiotics for millions worldwide. The study estimates that around 43 billion antibiotic treatment days were needed globally in 2019 to appropriately treat bacterial infections, highlighting the urgent need for better antibiotic stewardship.
India's prescribing patterns have raised concerns in the past. A 2021 survey found that nearly three-quarters of hospitalised patients received antibiotics, with a staggering 57% of prescriptions being for 'watch' antibiotics. This over-prescription of 'watch' antibiotics, such as ceftriaxone, cefixime, and azithromycin, is a significant issue. Dr Kamini Walia, a Programme Officer at the ICMR, underscores the need to reduce the unnecessary use of these antibiotics through better antimicrobial stewardship and awareness.
The study's methodology involved grouping countries with similar infection burdens, antimicrobial resistance patterns, healthcare access, and socioeconomic characteristics. By comparing countries with the lowest antibiotic use and fewest infection-related deaths, the researchers identified benchmarks for optimal antibiotic consumption. This approach revealed that while high-income countries consume the most 'watch' and 'reserve' antibiotics, the majority of the world's need for these medicines lies in lower-income countries, where infectious disease and antimicrobial resistance burdens are highest.
The findings of this study should serve as a wake-up call for India and the global health community. It highlights the need for a balanced approach to antibiotic usage, ensuring that patients receive the right antibiotics at the right time while minimizing the risk of antimicrobial resistance. As Prof Ramanan Laxminarayan, one of the study's authors, notes, the focus should be on improving antibiotic use through strategic interventions, addressing both over- and under-prescription to safeguard public health.
