High use of antibiotics found; recommends defined policies and monitoring consumption
Photo: iStock About 57 per cent of prescribed antibiotics fall into a category of drugs with a high potential for antimicrobial resistance (AMR) that generally have to be monitored for misuse, a report released this week by the Union Ministry of Health and Family Welfare found.
The study was conducted by the National Centre for Disease Control (NCDC) under the ministry over six months from November 2021 to April 2022. The survey included 9,652 patients and 12,342 antibiotic prescriptions across 20 tertiary care institutes across the country. The sites showed a wide variation in prescription activity, ranging from 37 per cent to 100 per cent.
The antibiotic prescriptions were classified based on AWaRe categories developed in 2017 by the World Health Organization (WHO) Expert Committee on Selection and Use of Essential Medicines.
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The 57 per cent of drugs of concern belong to the “watch” group. The other 38 per cent of antibiotic prescriptions belonged to the “access” group, which are antibiotic drugs with a lower potential for misuse that are widely available and are used to treat a wide range of infections. About two per cent of antibiotic drugs prescribed as a last resort belonged to the “reserve” group used to treat severe infections caused by multidrug-resistant pathogens.
“It is noteworthy that about 3 per cent of the prescriptions were in the “not recommended” group by the WHO,” the study said. “The high use of watch group antibiotics is of concern as these antibiotics have a higher potential to develop antibiotic resistance.”
Antibiotics were considered a groundbreaking medical discovery to treat infectious diseases. They became less effective over time due to excessive and inappropriate use. As of 2019, the WHO placed AMR in the top 10 public health hazards.
The institutes included in the survey are part of the National Antimicrobial Consumption Network, which has been in place since 2017. The network, comprising 35 tertiary care institutes, collates data on antibiotic consumption and resistance.
The National Action Plan on AMR was intended to be a surveillance mechanism to gather information on antibiotic usage at tertiary care institutes. It faced the roadblock of not being able to acquire information at the patient level on how antibiotics are used and prescribed. There is an acute lack of comprehensive data on antimicrobial consumption in low- and middle-income countries.
To overcome this lacuna, the WHO developed the Global Point Prevalence Survey (PPS) methodology to understand prescribing patterns and compare them over time. NCDC has been conducting training workshops on PPS on antibiotic use for partner sites since September 2021.
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Of the 9,652 patients surveyed, 71.9 per cent of the patients were put on antibiotics, ranging from 68.6 per cent in paediatrics to 78.9 per cent in intensive care units, showing a remarkably high prevalence of antibiotic usage. About 4.6 per cent patients got four or more antibiotics.
“Overall, 53 per cent of the patients on antibiotics were on more than one antibiotic. Patients were on a single antibiotic maximally in [general] medicine (60 per cent) whereas three or more antibiotics were commonly practiced in obstetrics and gynaecology (26.9 per cent),” the survey revealed.
Third-generation cephalosporines were the most commonly prescribed class of antibiotics (33.1 per cent). The top antibiotics being prescribed across classes were Ceftriaxone, Metronidazole and Amikacin.
Overall antibiotic prescriptions across the 20 sites according to WHO-Anatomical Therapeutic Chemical Class.
Source: NCDC
“Almost a quarter of the patients on antibiotics (26.4 per cent) were on double cover from the gram-negative bacteria. It was observed that more than half of the patients were prescribed antibiotics for prophylactic indications, with 91 per cent of patients receiving surgical prophylaxis for more than one day,” the study said.
“In the selected institutes, only 6 per cent of patients on antibiotics were put on definitive therapy and stop / review date was recorded in only 10.4 per cent prescriptions. Only eight out of 20 institutes have an antibiotic policy in place,” the paper added
Read more: Global experts discuss challenges, possibilities around antibiotics becoming a global public good
The NCDC emphasised that each institute should have a defined antibiotic policy that encourages the use of the ‘access’ group of antibiotics, keeping the consumption of the ‘reserve’ group of antibiotics at low levels while monitoring the usage of the reserve group drugs obtained from outside the hospital pharmacy.
The survey also found rampant polypharmacy, the practice of handing out five or more medications to treat infections. “Combining two antibiotics can increase the risk of adverse effects and drug interactions. Therefore, institutions are suggested the adoption of standard treatment guidelines,” the institute said.
The PPS should be conducted periodically to monitor changes in antibiotic consumption over the long term and institutions are advised to share its results to make appropriate changes in the prescribing behaviours of physicians, the institute added.
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