The risk of AMR is increasing due to the apathy of the administration. (AI Generated Representational Image)
Anoop Kumar Singh, New Delhi. Laxity on OTC (over the counter) sale of antibiotics in the country, non-binding guidelines for doctors, weak regulation and lack of monitoring in agriculture and animal husbandry, limited capacity of agencies, all these together are increasing the threat of antimicrobial resistance (AMR) in the country.
The absence of an intensive monitoring system for the development of drug resistance and lack of coordination among human, animal and environmental health departments are promoting AMR to worrying levels.
Danger increasing due to indifference of administration
This situation shows how apathetic our administrative system remains in its duties regarding the ever-growing threat of Antimicrobial Resistance (AMR) in India and its control. It is his carelessness that is thwarting efforts to control AMR in the country.
Also read- Indiscriminate use of antibiotics can make you miserable, use without advice is posing a serious threat.
This failure is not just a paper debate. The deaths of children due to poisonous cough syrup in Chhindwara and Betul of Madhya Pradesh show its seriousness.
Which shows that the system is not working properly at all three levels of medicine quality, utilization and monitoring. In such a situation, it is natural to raise the question that when the danger is clearly visible, why is there no strictness and accountability yet?
OTC sales: rules present, restrictions missing
Under the Drugs and Cosmetics Act, antibiotics fall under Schedule-H and H-One category, which means they should be sold and purchased only on the prescription of a registered doctor. Despite this, around 50 percent of antibiotics in the country are being sold without prescription.
Also read- Hospital waste becomes source of 'superbugs' in India, increased risk of antibiotics becoming ineffective
The reports of Central Drugs Standard Control Organization (CDSCO) and Health Ministry also confirm this. It has also been accepted in various parliamentary committees that the system of checking and recording prescriptions at the retail level in the country is weak.
This is the reason why despite the Red Line campaign and warnings on packets, no real control has been achieved on OTC sales.
Guidelines for doctors, not compulsion
The Indian Council of Medical Research (ICMR) has issued antibiotic stewardship and standard treatment guidelines for doctors, but these are not legally binding.
According to ICMR, even in cases like viral fever and cold, antibiotics are being given to more than half of the patients.
There is no mandatory audit system of antibiotic prescriptions outside government hospitals, resulting in excessive and unnecessary use of broad-spectrum antibiotics, which is increasing antimicrobial resistance (AMR).
Animal husbandry and agriculture: weak rules, big danger
The use of antibiotics in animal husbandry, poultry and fisheries sector is a big concern, because antibiotics are being used the most.
This is the reason why the Central Government banned the use of critical antimicrobials in animals, but due to lack of monitoring of sale and use of veterinary drugs, no concrete effect is visible on the ground. Because the inspection framework for veterinary drugs in the states is extremely weak.
Not only this, there is no integrated system of human and animal health data in the country, even though both the department and the government recognize that animal-to-human AMR transmission remains a serious risk.
Also read- Antibiotics Awareness: Negligence is becoming a serious challenge for public health, bio medical waste found thrown at many places
Drug Quality and Monitoring
This figure is of a small part of the total medicines manufactured in the country, which reached the test, while a large quantity did not come under the purview of test. The result of this gap in investigation and monitoring was the incident in Chhindwara and Betul of Madhya Pradesh.
Similarly, regular recovery of fake and sub-standard medicines from states like Delhi, Uttar Pradesh, Uttarakhand and Himachal Pradesh is enough to expose the negligence of the system, apathy towards duties and government limitations.
Graphics created with the help of NoteBookLM artificial intelligence program.
According to ICMR and World Health Organization reports, every third bacterial infection in India has become drug-resistant. AMR causes approximately three lakh deaths each year directly and more than one million deaths from related cases.
Despite this, no integrated and concrete system regarding AMR surveillance has been made in the country till now. Human health, animal health and environmental monitoring and data are contained in separate departments. The ‘One Health’ policy is strong in documents, but its ground implementation is very weak.
Also read- Antibiotics are being sold in medical stores without rules and regulations, operators decide the dosage themselves.
To deal with the threat of AMR, there needs to be a very strong monitoring system of the entire chain of antibiotics from production to reaching the patient. Only then will we be able to make concrete efforts to control drug quality and antimicrobial resistance. It is not possible to stop AMR without strong regulations and strict monitoring on all three fronts – OTC sales, prescription by doctors and veterinary use.
Dr. Mahesh Verma, Vice Chancellor, IP University, New Delhi
In India, the rules regarding the use of antibiotics are not being strictly followed as they should be. Along with its strict compliance, there should also be a solid system for its effective monitoring. Sale of medicines without prescription from pharmacy and uncontrolled use of antibiotics in agriculture and animal husbandry continues. Without coordination between human, animal and environmental health departments and robust AMR surveillance, the crisis will worsen.
Dr. Rajneesh Atam, Joint Secretary, Indian Medical Association
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