India largest user antibiotic meant for multi-drug resistant bacteria

A recent study has shown that India is the largest user of an antibiotic called carbapenems meant only as a "last resort drug" for fatal multi-drug resistant bacteria.

The Telegraph reports, "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."

Ramanan Laxminarayanan, a health economist and vice-president of research at the Public Health Foundation of India, New Delhi told The Telegraph, "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."

Representational image. AFP

And this is not the only alarming statistic regarding India and antibiotics.

India has also emerged as the world's overall largest consumer of antibiotics followed by China and the US, according to a study by Princeton University researchers who have conducted a broad assessment of antibiotic consumption around the world.

The study, "Global Trends in Antibiotic Consumption, 2000-2010," which quantifies the growing alarm surrounding antibiotic-resistant pathogens, and a loss of efficacy among antibiotics used to combat the most common illnesses, found that worldwide antibiotic use has risen a staggering 36 percent over those 10 years, with five countries -- Brazil, Russia, India, China and South Africa (BRICS) - responsible for more than three-quarters of that surge.

Among the 16 groups of antibiotics studied, cephalosporins, broad-spectrum penicillins and fluoroquinolones accounted for more than half of that increase, with consumption rising 55 percent from 2000 to 2010.

In India, the problem is most widely seen in cases of Tuberculosis, which the country has been trying to fight on a war footing for decades.

Despite a concerted effort on the part of government and health authorities however, cases of TB have only been rising, with new, stronger and drug resistant strains of the fatal disease constantly evolving.

And while the abuse of strong antibiotics may be one of the reasons behind the mutation of the virus, it turns out that premature discontinuation of a course of antibiotics is also an issue.

An editorial in The Financial Express points out, "India's success with TB control, despite $182 million being pumped into the National TB control Programme in 2013 alone, has been marginal because of the lapses in treatment, especially with patients failing to follow through with the due course of medication. Given how the course of treatment is long, a bulk of the patients, usually from the lower economic sections, often stop medication at the first sign of recovery."

This is not the case only with tuberculosis. The tendency to stop a course of antibiotics before the prescribed duration is a common trait among Indians, whether they are fighting TB, fever or the common cold.

Researchers in the Princeton study had also noted that antibiotic use is not being effectively monitored by health officials, from doctors to hospital workers to clinicians. Consequently, antibiotic use is both rampant and less targeted. That reality is driving antibiotic resistance up at an unprecedented rate, researchers said.

As a means of combating this problem, the government had made it mandatory for retail pharmacists to sell antibiotics only when the patient had a prescription. It had also suggested that a government executive audit the sales.

However, The Telegraph reports, "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."