Justifying antibiotics prescription can help rationalise use: Experts

With the Union Health Ministry urging doctors to mandatorily mention indications and reasons for justification while prescribing antibiotics, infectious disease specialists say the initiative can help in rationalising antimicrobial usage and avoid indiscriminate consumption.

The practice could also help further an evidence-based approach in medicine, along with improving patient outcomes, and curbing treatment costs and unwarranted side effects, they said.

"Prescribers have to think and document the rationale before prescribing antimicrobials... This will help in the rational prescribing of antimicrobials and avoiding injudicious, indiscriminate usage," infectious disease specialist and senior consultant at the Yashoda Super Speciality Hospital in Kaushambi Dr Chhavi Gupta told PTI.

In a letter to all doctors in medical colleges and medical associations on January 1, Director General of Health Services Dr Atul Goel urged them to make it a mandatory practice to write indications, reasons or justifications while prescribing antimicrobials.

He also appealed to all pharmacists to strictly implement Schedule H and H1 of the Drugs and Cosmetics Rules and stop the over-the-counter sale of antibiotics and sell them only on the prescription of a qualified doctor.

Asked about the move, Dr Mahua Kapoor Dasgupta, director of medical affairs at HaystackAnalytics, a genomics-based diagnostics solutions provider incubated at IIT-Bombay, said it will enable the healthcare ecosystem to design strategies aimed at improving diagnostics, allowing a caregiver to justify the prescribed antimicrobial.

Regular audits and checks will still be necessary to scrutinise the justifications provided, Gupta added.

Antimicrobial resistance (AMR) is one of the top global public health threats facing humanity, the director general of health services said in the letter addressed to all doctors of medical colleges and all medical associations.

AMR happens when drugs designed to kill infectious bacteria and fungi are rendered ineffective because the microbes have evolved and developed an ability to defeat these drugs.

"With few new antibiotics in the research and development pipeline, prudent antibiotic use is the only option to delay the development of resistance," Goel wrote.

According to the World Health Organization, "bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths". AMR can also have significant economic costs, in terms of additional healthcare costs and GDP losses, it said.

Studies have shown that air pollution too could be driving antibiotic resistance, with the association between particulate matter (PM2.5) air pollution and an increase in antibiotic resistance becoming more pronounced recently.

A recent report by the National Centre for Disease Control (NCDC), Directorate General of Health Services, found the prevalence of antibiotic use was about 72 per cent although site-specific variation ranged from 37-100 per cent.

The report evaluated antibiotic consumption across tertiary care institutes in 15 states and two Union territories from November 2021 to April 2022. It included 9,652 participants and was released on Tuesday.

The findings reiterated the need to take action for the judicious use of antibiotics especially in the context of high use in prophylactic (preventive) settings, the report said.

An international group of researchers, including those from the Indian Council of Medical Research, called for tackling AMR through genomic surveillance in a November 2023 study published in the journal The Lancet Microbe'.

Genomic surveillance was widely employed during the COVID-19 pandemic to inform scientists and authorities about the spread of the viral infection and its variants of concern, among others.

The study said the potential of surveillance could be higher for AMR pathogens as the genome data could track outbreaks and predict an effective antibiotic treatment.

Dr Chhavi Gupta, who was formerly associated with the All India Institute of Medical Sciences (AIIMS), New Delhi, said genomic AMR surveillance helps in defining local epidemiology of drug-resistant bugs and their patterns.

"Thus, (the tool helps) define the scope of the resistance problem, develop interventions that improve the appropriate application of antimicrobial agents, and decrease resistance selection pressure," she added.

Such powerful genomic tools provide a high-resolution picture of the antimicrobial resistance profile of the disease-causing organisms, impacting an individual patient's therapy and also helping in informed decision-making in hospital infection control, according to Dasgupta.

"These solutions also have the potential to map transmission dynamics, pathogen evolution, lineage mapping, outbreak linkage, predict the capacity of the spread of AMR and pandemic preparedness," she added.

However, there are challenges in making the technology accessible and cost-effective, addressing supply chain issues, pricing models, moving from a hub-and-spoke model to democratisation, automation of bioinformatics, data privacy and governance, Dasgupta said.

India's genomic surveillance capabilities are a work in progress, even as many diagnostic tools studying drug-resistance patterns at the genetic level are available, Gupta said, adding, "Many diagnostic centres and hospitals now have access to such tools that may define local epidemiology of AMR in India and help in personalised treatment.