Subject: Science & Technology

The emergence of Antimicrobial Resistance (AMR) has become a critical public health challenge, with India being particularly vulnerable due to widespread antibiotic misuse. A recent study in Bengaluru revealed that 174 out of 261 pharmacies dispensed antibiotics without prescriptions, highlighting the severity of this issue.

Link Between Overuse and Drug Resistance

• Indiscriminate Usage: Over-the-counter availability leads to self-medication and inappropriate dosing, accelerating bacterial mutations and resistance development.

• Economic Factors: Easy availability and relatively low costs make antibiotics accessible without proper medical consultation, leading to their misuse in both urban and rural areas.

• Scientific Evidence: The 2023 ICMR report shows decreased susceptibility to crucial antibiotics like piperacillin-tazobactam and amikacin in common bacteria like E. coli and K. pneumoniae.

Monitoring and Control Mechanisms

• Legislative Framework:

  • The Drugs and Cosmetics Act, 1940 categorizes antibiotics under Schedule H as prescription-only medications.
  • The 2014 amendment introduced Schedule H1, mandating separate registers for antibiotic sales.

• Surveillance Systems:

  • National Antibiotic Consumption Network (NAC-NET) monitors antibiotic consumption patterns.
  • The 2022 NAC-NET report revealed high consumption of 'Watch' antibiotics and concerning use of 'Reserve' antibiotics.

Critical Issues and Challenges

• Implementation Gaps:

  • Weak enforcement of existing regulations at retail level.
  • Limited awareness among healthcare providers and public.

• Healthcare System Challenges:

  • Inadequate access to qualified medical professionals.
  • Lack of diagnostic facilities leading to empirical antibiotic prescription.

• State-level Initiatives:

  • Kerala became the first state in 2024 to enforce strict regulations against OTC antibiotic sales.

The emergence of drug-resistant diseases due to antibiotic misuse requires a multi-pronged approach involving strengthened regulations, improved surveillance through initiatives like Indian Council of Medical Research's AMR surveillance network, and enhanced public awareness about responsible antibiotic use. The success of Kerala's model in restricting OTC sales could serve as a template for other states to follow.