In the Data Point published last week (“Over 38% patients on more than one antibiotic”, January 17), results from a government survey showed that an overwhelming number of inpatients are prescribed antibiotics by hospitals across India. Findings also showed that many patients were on more than one antibiotic. Further, the data showed that over 55% of such antibiotic prescriptions belonged to the “Watch” group as classified by the World Health Organization (WHO), i.e., medicines reserved for only severe infections.
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Data show that resistance among Indian patients to certain types of antibiotics is among the highest in the world. In India, for many antibiotic-bacterium combinations, over 75% of infections were from resistant bacteria. For instance, in the ceftriaxone antibiotic-Klebsiella pneumoniae bacteria combination, over 87.4% of infections were from resistant bacteria as shown in Table 1.
Table 1 | The table lists the antibiotic-bacterium combinations, the broader antibiotic group these drugs belong to and the best and the worst countries in terms of resistance to various antibiotic-bacterium combinations. For instance, the ceftriaxone antibiotic belongs to the group called third-generation cephalosporins.
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It is telling that the resistance proportion among Indian patients was among the highest for drugs in the third generation cephalosporins group, as can be seen in Table 1. As noted in the Data Point last week, over 33% of antibiotic prescriptions in India — the highest among all types — that featured in the government survey in 2021-22, were also from the third generation cephalosporins group, which include antibiotics such as ceftriaxone, ceftazidime and cefotaxime. So, the most used antibiotic is also the most resisted.
Also read: Are antibiotics over-prescribed in India?
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There is also a clear divide between countries with high resistance and low resistance. As shown in Table 1, responsible antibiotic usage has resulted in low antibiotic resistance among developed countries such as Norway, Finland, Netherlands and the U.K.. In contrast, along with India, patients in Russia, Egypt and Pakistan have developed high antibiotic resistance. Chart 2 explains this relationship further.
Chart 2 | The chart shows the consumption (%) of “Watch” group antibiotics among AWaRe categories in select countries as of 2015-17.
AWaRe was developed by WHO based on the impact of different antibiotics on antimicrobial resistance so that they can be used appropriately. It broadly categorises antibiotics into “Access”, “Watch”, and “Reserve”. The “Access” group is the most advised as it minimises the potential for resistance. “Watch” group antibiotics are only for specific and limited use, and result in increased antibiotic resistance. The “reserve” group should only be used in life-threatening conditions. According to WHO, 60% of total antibiotic consumption in a country should be from the “Access” group. It is a worry that in India, the opposite is true. About 59% of total antibiotic consumption in the country in 2022 was from the “Watch” group. This share went up to 64% during the pandemic years.
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Chart 2 shows the “Watch” group share as of 2015-17, a year for which comparison data with other countries was available. Clearly, India stood out that year, with 56% of all antibiotics that were prescribed from the “Watch” group. Russia was a distant second. On the other hand, Norway, Finland, Netherlands and the U.K. — which featured among nations with low antimicrobial resistance — also had low “Watch” group proportion in consumption. “Watch” group antibiotics formed less than 20% of the total consumption in these countries.
vignesh.r@thehindu.co.in, rebecca.varghese@thehindu.co.in
Source: WHO Report on Surveillance of Antibiotic Consumption and WHO’s Global AMR data
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