Doctors in Mangalore had varying thoughts on the proposal to evolve a new policy on antibiotics. Suggestions include restricting the sale of over the counter (OTC) antibiotics to a specified list, setting up of a national antibiotics surveillance system, and training doctors on the use of antibiotics.
Associate Professor and Unit Head of Father Muller Medical College (FMMC) Rakesh Rai said resistance develops in people due to inappropriate dosage, under-dosage or if the course is discontinued. The key word is “evidence”, which refers to the microbiological culture, based on which the antibiotic should be given. A patient must not be given an antibiotic for a viral infection.
He said, “OTC sale of antibiotics is random and irrational.” Patients must get signed prescription with the number of days specified, to buy antibiotics. Only tertiary centres should be allowed to sell antibiotics under the surveillance of a physician. The pharmacist should be educated not to sell without the prescription.
Such a system is possible if all major hospitals and referral hospitals participate, he said. Hospitals should monitor cases of resistance to bugs and send that to a common registry. FMMC is training interns and postgraduates on use of antibiotics, he said.
Senior Specialist at Lady Goschen Hospital Ramesh Kawari said regulating OTC sale of antibiotics is necessary because they are prescribed incorrectly and often unnecessarily. Some antibiotics must not be given to children and pregnant women.
Some doctors said prescribing antibiotics based on the microbiological culture is good in principle but impractical in India. Deputy Medical Superintendent of Kasturba Medical College (KMC) at Mangalore, Anand Venugopal, said, “It’s easy to say but with our population, we can’t just ape the West.”
Treating with proper antibiotics based on microbiological culture is good as there is clear-cut over-usage now with doctors “bombarding a small health problem with the highest antibiotics due to patient demand”.
However, he said, “That is a long way off. By the time the culture comes – four to five days – the patient will be dead.” Abroad, the number of patients is low and they go from primary to a referral hospital. In India, doctors treat patients with knowledge of local diseases and conditions. For a start, he said, “Train doctors immediately, at the MBBS level. Expose them to antibiotics policy; they should be sensitised.” KMC is working towards a hospital protocol on use of antibiotics. A team monitors resistance and wherever possible, the microbiologist says which antibiotic should be used.
He said, “We should be doing this at least in closed centres such as the ICU. That is definitely a way forward.”
