Concerns regarding a build-up of resistance to antiviral drugs used to treat swine flu are surfacing, after two such drugs — Oseltamivir and Zanamivir — were taken off the restrictive Schedule X of the Drugs and Comestics Rules. Now under Schedule H1, the drugs can be stocked by all chemists.
Central health authorities have also advised doctors to prescribe the drugs based on strong symptoms, without opting for the swab test. Medical experts say these decisions could lead to misuse and eventually, severe drug resistance.
Oseltamivir and Zanamivir are antiviral drugs that block the actions of influenza virus types A and B in the body. While Oseltamivir is available as tablets, Zanamivir comes in powder form.
Dr. Vasant Nagvekar, a Mumbai-based infectious diseases expert, said, “We are already witnessing antibiotic resistance and related hazards. Resistance built up only because antibiotics were easily available and even sold over the counter. Now, we seem to be going the same way with antiviral drugs.”
His reaction to the government’s decision was mixed. “It is good, because when H1N1 cases are on the rise, the drug will be available to patients easily. However, it could backfire because in India, we don’t use caution. The doctors will prescribe these drugs so widely that eventually it will stop working.”
Restrictions in place
Drugs under Schedule X require three copies of prescription for the doctor, patient and chemist, and can be sold by a chemist who holds a special Schedule X licence. Also, the chemist has to preserve the prescription copy for up to three years. In Schedule H1, only one copy of the prescription is required, and drugs in this category can be sold by all chemists.
Hakim Kapasi, a chemist and wholesaler from Andheri, said, “Chemists will still need a prescription to sell the drug. The only difference is, the drug will be widely available. It all depends on doctors now. If they prescribe the drug with caution, there won’t be misuse.”
Till date this year, India has recorded over 11,700 H1N1 cases and 561 deaths.
Dr. Khusrav Bajan, a physician and intensivist at Hinduja Hospital, said, “Bacteria mutate much faster than viruses, so I don’t think resistance should be a cause of concern when there is a spurt in H1N1 cases.”
