Over the years, Ganesh, a city-based pharmacist has observed just how his customers’ know-how on self-medication has evolved.
“Earlier, people would come to pharmacies and ask for Erythromycin for a throat infection. Today, they ask for a stronger antibiotic, Azithromycin. Since antibiotics are available over the counter and are fast-acting, people take them for anything – even a common cold or fever,” he said.
Experts say the city’s continuing indiscriminate use of antibiotics is a cause for concern, especially as an increasing number of antibiotic-resistant cases are being reported.
“People take antibiotics for ordinary fever or flu-like symptoms, which can be self-limiting. At times, diarrhoea too, can be self-limiting and oral re-hydration solutions are enough to treat it. But very often, anti-diarrhoeal drugs are prescribed. The use of antibiotics is rampant here, and there is no standard protocol for prescribing them. If giving antibiotics over-the-counter is wrong, then prescribing these medicines without knowing the actual cause of the illness — viral or bacterial — is also wrong,” said S. Elango, president of the Indian Public Health Association, Tamil Nadu branch.
The Central Drugs Standard Control Organisation has, time and again, laid emphasis on the rational use of antibiotics. In a note, it said that development and spread of antimicrobial resistance is commonly due to overuse, misuse and indiscriminate use of antimicrobials by doctors, nurses and pharmacists and self-medication by patients.
According to the note, an estimated 70 to 80 per cent of prescriptions for antibiotics are probably unnecessary. “But even more than the number of antibiotics prescribed is the amount bought by patients over the counter. Patients now know the names of medicines and straightaway buy them without consulting a doctor. In many cases, they produce an old prescription and get the antibiotics without even knowing the cause of their own illness,” said a government doctor.
To promote the rational use of antibiotics, the Indian Medical Association (IMA), Tamil Nadu along with other professional health bodies has approached the State health department to prepare a district-level Antibiogram – a test for the sensitivity of a bacterial strain to different antibiotics.
“The sensitivity of bacteria to drugs varies from place to place, as they constantly undergo mutations/genetic changes. It is better to identify common bacterial strains at a particular place as well as drugs to which they are sensitive. Hospital-level antibiotic policies can be formulated based on this antibiogram,” explained J.A. Jayalal, honorary State secretary of IMA-TN.
The practice of taking antibiotics for any and every ailment has seeped into villages too, he said.
“If a patient has an infection, a culture sensitivity test should be done to find out the cause of the infection. Otherwise, the irrational use of antibiotics will lead to bacteria turning resistant to drugs. For instance, Ciprofloxacin is prescribed for respiratory tract infections but studies have shown that 70 per cent of these infections are viral,” he said.
The Centre’s move to ban over-the-counter sales of 92 drugs, including antibiotics, will go a long way to curbing this practice, he added.
Dr. Elango said multi-drug resistant tuberculosis has become a major public health concern and was caused mainly because patients bought over-the-counter drugs for a cough without being tested for or even realising they had TB.
He reiterated the need for a drug prescription policy on antibiotics. “There should be a flowchart on when to prescribe antibiotics and what type, say for fevers with cough, fevers with rash, diarrhoea and eye infections,” he said.
N. Raj Ganesh, State president of Tamil Nadu Government Pharmacists’ Association said the government should first survey the sale of antibiotics at pharmacies for a certain period.
