Antibiotics are so over-prescribed that a Kochi hospital managed to cut down the use of restricted antibiotics — considered the last-resort medicines for seriously ailing patients — by as much as 86 percent over the past two years with no adverse effect on the number of deaths. Doctors at Hinduja Hospital, Mumbai, ask patients to take antibiotics for only one day prior to surgery against the previous practice of taking them for a few days. In a handful of tertiary-care hospitals across Mumbai, every time a restricted antibiotic is prescribed, a team of doctors, including a pharmacist, check on the patient’s file looking for justification. Antimicrobial medicines, especially antibiotics, have been so widely prescribed that the micro-organisms have developed resistance to them — posing one of the biggest health problems.
A 2016 World Health Organization study had estimated that seven lakh deaths across the world every year could be attributed to antimicrobial resistance and the toll could rise to 10 million in 30-odd years if no corrective measures are taken. On the bright side, there is a slow but clear change in the prescribing habits of doctors across the country. Experts, though, fear that this could be a case of too little too late. The WHO, in fact, observes an antimicrobial resistance awareness week to focus on this problem as patients’ recovery could be delayed or, in a worse case, fatalities could increase. The Indian Council for Medical Research, too, started a pilot project a couple of years ago in which doctors of Hinduja Hospital and five others in Delhi, Chennai and Kolkata were told to provide justification within two days for giving restricted antibiotics to a patient.
“We do this in a few chosen hospitals across the country so that we can frame guidelines as per the feedback,” said ICMR’s Dr Kamini Walia. She wants to ensure reduction in the use of broad-spectrum antibiotics and boost the use of targeted antibiotics that work on specific organisms. The Kochi hospital, Amrita Institute of Medical Sciences, started its antimicrobial stewardship program two years ago to ensure appropriateness of medicines and has published its “positive” findings in Oxford University Press’s Open Forum Infectious Diseases journal earlier this month. Dr Sanjeev Singh, who is in charge of the hospital’s program, said it has not only cut down the use of restricted antibiotics by 86 percent but reduced deaths by 24 percent and even saved Rs 2.3 crore per year. As antimicrobial resistance is still a big worry, ICMR’s Dr Walia said there is an urgent need to change the manner in which antibiotics are prescribed. “If doctors realize their treatment is being monitored, they may be a bit more prudent in prescribing them.” – TOI