Antibiotic use on a high across India

Hyderabad: A recent countrywide study on the pattern of antibiotic prescription among outpatients in private healthcare establishments has said that for every 1,000 persons in a year, at least 412 prescriptions of patients contain antibiotics. The data analysis by a team of researchers said that back in 2014, doctors at private healthcare establishments across the country gave a staggering 519 million (i.e., 51.9 crore) prescriptions containing antibiotics.

The usage of antibiotics was observed to be highest among children (0 to 4 years) at 636 prescriptions per 1,000 children and lowest in the age group of 10 years and 19 years at 280 prescriptions per 1,000 persons. The most common kind of antibiotic that is prescribed by private doctors to patients is cephalosporins, a broad-spectrum antibiotic used to treat wide ranging ailments like skin infections, ear infections, pneumonia, sinus infections, meningitis etc.

The study said that 38 per cent of all antibiotic prescriptions contained cephalosporins, followed by penicillins at 22 per cent. The cephalosporins were the most commonly prescribed antibiotic across all diagnoses with the exception of disorders of urinary system where quinolones (16 per cent) were more commonly prescribed.

The study was funded by Public Research Grant of Department of Science and Technology (DST), and published in the PlosOne science journal this November. The study essentially provides the first ever estimate of outpatient prescription rates and patterns in the private sector across the country.

Led by public health expert Dr Habeeb Hasan Farooqui, Indian Institute of Public Health (IPH), New Delhi, Public Health Foundation of India (PHFI), the study’s primary focus was to measure antibiotic prescription per 1,000 persons per year in private healthcare establishments.

Antibiotics abuse

Due to wide prevalence of infectious diseases, patients in India have been amongst top users of antibiotics; as a result, public health specialists attribute this high usage to development of resistance to antibiotics. The rampant usage of antibiotics has led to a situation wherein special laboratory tests are conducted just to find out the level of resistance towards antibiotics among patients so that more agreeable antibiotics can be administered.

There have been several studies in the past that have indicated that per capita antibiotic consumption in the retail sector in India has increased by around 22 per cent between 2012 and 2016. Public health experts attribute this increased usage of antibiotics to higher burden of infectious diseases.

Compared to government hospitals, there is relatively higher prescription rate of antibiotics in private healthcare establishments and also frequent use of higher and newer classes of antibiotics, when compared to the older ones. The study articulated that one of the possible reasons for the higher rate of antibiotic prescription could be due to the domination of private health sector in outpatient visits and even during hospitalisation.

For what diseases

The PHFI study said that out of the 519 million antibiotic prescriptions in 2014, given by 4,600 doctors from 23 metropolitan areas across the country, 55 per cent were meant for diseases of upper respiratory tract infections, followed by 10 per cent for urinary infections. Other major ailments for which antibiotics are prescribed include cough, bronchitis, pharyngitis, injuries and asthma.

The study said that ‘prescription rates for broad-spectrum antibiotics are much higher as compared to European nations, especially in children. Approximately one-fifth antibiotic prescriptions were dispensed for upper respiratory infections, which rarely require an antibiotic therapy. The primary care physicians in private sector can play a key role in reducing antibiotic misuse and overuse’.

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