Irrational use has its origins in production and selling tactics of pharma companies: expert

The private sector continues to clock high levels of antibiotic prescription rates — (412 per 1,000 persons per year), with the rate being highest for children aged 0–4 years (636 per 1,000 persons) and the lowest in the age group 10–19 years (280 per 1,000 persons), according to a new study by researchers at the Public Health Foundation of India (PHFI).

The study is the first ever estimate of outpatient antibiotic prescription rates and patterns in the private sector and has been published this month in PLOS One titled — “Outpatient antibiotic prescription rate and pattern in the private sector in India”.

The authors used the 12-month period (May 2013-April 2014) medical audit dataset and concluded that the prescription rates for certain classes are on a higher side in India as compared to the developed nations.

The study said the percentage of prescriptions for wide-spectrum antibiotics like cephalosporins and quinolones (38.2% and 16.3%) was significantly higher than the U.S. (14.0% and 12.7%) and Greece (32.9% and 0.5%). Unusually high prescription rates of beta-lactams-penicillins and cephalosporins in uncomplicated upper respiratory infections in children is in stark contrast to the prescription rates and pattern reported in Europe.

India is considered to be one of the top users of antibiotics and there is a growing problem of antimicrobial resistance. The study noted that the per capita antibiotic consumption in the retail sector has increased by around 22% in five years from 2012 to 2016.

Though clinical guidelines on judicious antibiotic use explicitly mentions that they should not be prescribed for common cold, non-specific upper respiratory tract infection (URI), acute cough illness and acute bronchitis, the study shows a high rate of prescriptions for respiratory infections in primary care.

The study highlighted that of the 519 million antibiotic prescriptions, the majority were dispensed for the diseases of the respiratory system (55%), followed by genitourinary system (10%) and symptoms, signs and abnormal clinical findings (9%); generally these infections are viral in origin and self–limiting in nature.

The study shows that around 100 million prescriptions were dispensed for acute upper respiratory tract infections alone, which rarely require an antibiotic therapy thereby showing a need for antibiotic stewardship programmes directed towards diagnosis and treatment of upper respiratory infection which could result in significant reduction in antibiotic use.

Dr. Shaktivel Selvaraj, director – Health Financing and Economics, PHFI and one of the authors of the study said: “Irrational prescription and use of antibiotics has its origins in production and selling tactics of pharma companies. This has severe implications for safety and cost to patients in particular and society in general. There is a need to target antimicrobial stewardship programmes to specific constituencies and stakeholders to raise awareness on antibiotics and prevent its misuse.”

The misuse of antibiotics and easy access fuels antimicrobial resistance (AMR) which is a growing concern worldwide and in India. The findings also highlight that primary care physicians in the private sector can play a key role in reducing antibiotic misuse and overuse.