Have you been overprescribed antibiotics? Almost 72 per cent patients given antibiotics as preventive, not cure, in hospitals, says survey

We have been documenting increasing antimicrobial resistance rates every year in India and this survey shows the consumption link that leads to it,’ says Dr Kamini Walia, senior scientist, ICMR

Almost three out of four patients who went to a tertiary care hospital was prescribed an antibiotic, often as a prophylaxis to prevent an infection rather than to cure it. More than one in three patients were given double coverage — two antibiotics to treat the same infection.

These are the findings of a survey of 12,000 prescriptions at 20 hospitals across India conducted by the National Centre for Disease Control and show how their overuse is affecting our long-term immunity. The study was conducted between November 2021 and April 2022 under the National Programme of Antimicrobial Containment.

“We have been documenting increasing antimicrobial resistance rates every year in India and this survey shows the consumption link that leads to it. There is an urgent need to educate people about the harms of excessive antibiotic use,” says Dr Kamini Walia, the senior scientist who coordinates the antimicrobial resistance initiative of the Indian Council of Medical Research (ICMR).

What does the report say?

The survey found how 71.9 per cent of patients were prescribed antibiotics, with only a 10 percentage point difference in antibiotic use between intensive care units that have the sickest patients and the other wards. Surprisingly, 55 per cent of the antibiotics were prescribed not for the treatment of an infection but to prevent one. “While it is not recommended, many physicians prescribe antibiotics to people with viral infection to prevent a supra-added bacterial infection. And, when it comes to surgeons, almost everyone prescribes antibiotics for 15 days.

 

They are scared their patients will get an infection but this needs to be avoided,” says Dr Purva Mathur, professor of microbiology and part of the hospital infection control team at the trauma centre of the All India Institute of Medical Sciences (AIIMS).

She says only three doses of antibiotics are recommended as prophylaxis prior to “dirty” surgeries, where internal organs are opened up, and none at all before clean procedures.

The survey also found that 57 per cent of the antibiotics used were from a category reserved for sicker patients and were more likely to lead to antimicrobial resistance. This is the second level of antibiotics as per the international classification. The reserve group includes last-resort antibiotics meant for treating only multi-drug resistant infections.

 

Only six per cent of these antibiotics prescribed were definitive treatment with the other 94 per cent being empirical prescriptions given by the doctors based on what they thought had caused the infection.

 

What happens if antibiotics are over-prescribed?

Dr Mathur says excessive use of antibiotics can create superbugs which travel through sewer and drinking water. She says if cancer and transplant survivors are infected by such resistant pathogens, then “it is difficult, if not impossible, to treat them.” Dr Walia explains that when there is 70 to 80 per cent resistance to drugs such as carbapenems, then very few treatable options remain.

 

What does the report recommend?

The report suggests that hospitals adhere to standard treatment guidelines, have a defined antibiotic policy, encourage use of the access group of medicines, that can take care of disease, and ensure that the reserve group is minimally used. It also suggested avoiding use of multiple antibiotics.

 

The study recommended that only a single dose or one-day dose of antibiotics be given before any surgery and post-surgery infections be treated only after diagnosis.

 

What measures do experts suggest?

Other than curbing irresponsible use of antibiotics, Dr Mathur says there is a need to ensure availability of access group of antimicrobials in hospitals. “Because the access group of medicines are not frequently prescribed, these are often not available in hospital pharmacies,” she says.

 

Dr Walia advocates vigilance by state governments which provide free medicines. “There is an increase not only in the use of antibiotics but use of watch category antibiotics,” she says adding fixed dose combination medicines containing antimicrobials add to the challenge.

 

Dr Chand Wattal, chairperson of Institute of Clinical Microbiology and Immunology at Sir Ganga Ram Hospital, suggests microbial cultures be done before prescribing antibiotics.

https://indianexpress.com/article/health-wellness/have-you-been-overprescribed-antibiotics-9094887/