A third of most commonly prescribed antibiotics were third generation cephalosporins, a class of critically important antimicrobials, findings show
Photo: iStock The findings of a new survey by the National Centre for Disease Control (NCDC) underscored the need for directing more efforts for appropriate stewardship in antibiotic use practices, particularly Critically Important Antimicrobials (CIAs) and in mitigation of antimicrobial resistance.
Antimicrobial consumption tracking efforts, like seen for human consumption, should be considered for use of antibiotics in India’s food animal production sector. Currently, there is no data in the public domain on how much and what kind of antibiotics are used in food animals and crops.
At the same time, there should be efforts towards conserving the use and effectiveness of Critically Important Antimicrobials (CIA), especially considering the weak and fragile global pipeline for new and future antibiotics.
Out of overall antibiotic prescriptions, the third generation cephalosporins was the most commonly prescribed class of antibiotics (33.1 per cent), the NCDC survey found. Ceftriaxone was found to be one of the top antibiotics prescribed in this class, it added.
According to NCDC guidelines, ceftriaxone is usually prescribed in the treatment of diseases such as enteric fever, biliary tract infections, acute bacterial meningitis, community acquired pneumonia, among others. Third generation cephalosporins are categorised as the highest priority critically important antimicrobials (HPCIA) by the World Health Organization (WHO).
In addition to cephalosporins, aminoglycosides were also identified among the most commonly prescribed antibiotics (12.1 per cent) in the survey. Aminoglycosides are CIAs, according to the WHO classification. The commonly prescribed antibiotic identified in this class was amikacin.
CIAs represent a class of antimicrobials in the WHO classification, categorised based on their importance in human medicine and the urgency to preserve their effectiveness in treating infectious diseases. HPCIAs constitute a subcategory within CIAs, signifying antimicrobials of the highest priority in preserving their effectiveness.
Apart from cephalosporins and aminoglycosides, prescription of other CIAs belonging to the classes of carbapenems, penicillins, fluoroquinolones, glycopeptides and macrolides was also highlighted according to the survey results.
An earlier report published by the Centre for Science and Environment in 2021, also highlighted the use of CIAs in food-producing animals in India. The third generation cephalosporins, including ceftriaxone, were found to be used in the Indian dairy sector, while aminoglycosides, including amikacin were reported in the Indian poultry sector. These antibiotics were being used to prevent, control or treat diseases, the research found.
Widespread use of these important antibiotics both in food animal production and healthcare poses a potential threat, as it can lead to these antibiotics becoming ineffective soon. Recent data from the Antimicrobial Resistance Research and Surveillance Network of the Indian Council of Medical Research (ICMR) as well as National Antimicrobial Surveillance Network (NARS-Net) of NCDC also showed a trend of increasing resistance towards CIAs, including third generation cephalosporins and aminoglycosides.
This was the first multicentric point prevalence survey of antibiotic use at 20 NAC-NET sites. The report highlighting the results of the survey was released by Mansukh Mandaviya, Union Minister of Health and Family Welfare, earlier last week.
NAC-NET, the National Antimicrobial Consumption Network, is a network comprising 35 state medical colleges across India. It carries out surveillance of antimicrobial usage in healthcare settings and is coordinated by NCDC.
This survey involved 20 NAC-NET sites across 15 states and two Union territories. It is one of the few studies in India that has adopted WHO’s Global Point Prevalence Survey methodology to monitor antibiotic use patterns.
Out of 9,652 patients included in this study, 6,944 (71.9 per cent) were prescribed antibiotics. The total number of antibiotic prescriptions for these patients was 12,342, which means the average antibiotic prescription per patient was 1.8. The overall antibiotic use was recorded maximum in the Intensive Care Units and surgical wards.
Over 55 per cent of the patients were prescribed antibiotics for prophylactic use, preventive purposes rather than to treat existing infections. This raises growing concerns regarding the increasing risk of antimicrobial resistance (AMR).
The report recommends hospitals to adopt standard treatment guidelines and to have well-defined antibiotic policies in place.
It further highlights the need for conducting point prevalence surveys periodically in hospitals to monitor changes in antibiotic usage with time.
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