Antibiotic misuse making bacteria resistant to drugs

The misuse of antibiotics is making bacteria resistant to the first line of drugs, necessitating the use of stronger, more expensive alternatives, statistics of the World Health Organisation have revealed.

Antibiotics, or anti-bacterials, are chemical drugs that stop the growth of bacteria. According to WHO figures, about 50% of all antibiotics that are prescribed and used are unnecessary and amount to overuse and misuse. Estimates by medical journals and studies conducted by medical colleges say that in India antibiotics account for anywhere between 40 and 80% of the drugs prescribed, mostly when not required.

Says S Chatterjee, senior consultant, internal medicine, Indarprastha Apollo Hospital, New Delhi, “Ideally, antibiotics are to be used for illnesses like pneumonia, typhoid, abdominal infections, etc, caused by bacteria. But they are getting used
for treating even sicknesses like viral fever, which need anti-virals.”

Also, stronger and more expensive antibiotics are prescribed even when illnesses can be cured by a first-line, less expensive anti-bacterial. “Minor fever can get cured by using the penicillin group of antibiotics,” says Chatterjee. “But a stronger anti-bacterial like meropenem is prescribed.”

The growing use of antibiotics is also reflected in the estimates by ORG-IMS, the market intelligence provider for the healthcare sector. In March 09, antibiotic brands like Taxim-O (rank 14, Alkem Labs), Augmentin (rank 7, GlaxoSmithKline), Cifran (rank 18, Ranbaxy) have gained in ranks among the top 20 medicine brands in the country.

This indiscriminate use is leading to a growing condition called “antibiotic resistance”, which is steadily becoming a major issue confronting the healthcare industry worldwide, more so India’s Rs33,000 crore domestic drug industry, says SM Sapatnekar, former administrator of the Maharashtra Medical Council and dean of the Clinical Research And Management Education Academy (Crema).

Antibiotic resistance is a phenomenon in which bacteria can defend themselves against an antibiotic, forcing the use of stronger, more expensive options. Chloramphenicol was earlier effective for the bacteria causing typhoid. But due to the drug’s irrational use, the bacteria became resistant to it, making it necessary to use a stronger antibiotic like ampicillin, says Srinagar-based Bashir Gaash, executive editor, Indian Journal for the Practising Doctor.

“But again, due to overuse and resistance, medication had to be switched to a stronger antibiotic like cephalosporins,” says Gaash.

Other than resistance, treatment becomes expensive as stronger antibiotics are costlier. According to KM Singh, consultant, internal medicine, Fortis Hospital, Noida, an expensive antibiotic like ceftum is used for bacterial infections of the throat, lung, and ear, as bacteria have become resistant to milder drugs like ciprofloxacin.

A strip of 10 tablets of ciprofloxacin costs between Rs60 and Rs130. Ceftum costs Rs600-700 for 10 tablets.

Industry experts say the reasons for overuse and irrational use of antibiotics range from impatient patients who seek quick relief to aggressive marketing by pharma firms to push their products. Says Sapatnekar, “As all drugs are freely available over the counter (OTC) despite being prescription-only, patients can buy any and every medicine, whether or not it is needed.”