All the patients admitted to the acute care ward of the Lala Lajpat Rai Memorial Medical College in Meerut, Uttar Pradesh, were given antibiotics, according to a recent survey by the National Centre for Disease Control (NCDC). In fact, in 13 out of 20 hospitals in which the survey was conducted between November 2021 and April 2022, more than 70% of patients were given at least one dose of antibiotic.
All the patients who were admitted to the ward for more than a day, regardless of the underlying cause for their hospitalisation, were part of this survey. Those who were admitted for day-care procedures were excluded from the survey and so were those who got admitted late on the day of the survey or were about to be discharged on that day.
The findings of the report are worrying as India is among the few countries where antimicrobial resistance is notably high. Such resistance develops when antimicrobials, which include antibiotics, are misused or overprescribed. According to the WHO, antimicrobial resistance was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. The WHO says, “as pathogens become resistant to the drugs that were used against them, making infections harder and more expensive to treat.”
Chart 1 | The chart shows the share of 9,652 patients surveyed in 20 hospitals who were on one, two, three and no antibiotic prescriptions.
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In total about 72% of the patients were on at least one antibiotic prescription, 25.3% were on two antibiotic prescriptions, and about 13% were on three. The survey said combining two antibiotics can increase the risk of adverse effects.
Chart 2 | The chart shows the share of patients on antibiotic prescriptions for preventing or treating a disease.
Among those who were given at least one antibiotic (6,944 patients), Chart 2 shows that 55% were given prescriptions for preventing the occurrence or spread of an infection and only the rest were to treat an infection or disease.
Chart 3 | The chart shows the share of antibiotic prescriptions based on the AWaRe classification.
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The WHO has also put some drugs on the “watch” list which are broader-spectrum antibiotics reserved for severe infections and on the “reserve” list which are last-choice antibiotics used to treat multidrug-resistant infections. Notably, 57% of antibiotics prescribed among the surveyed belonged to the “watch” category and 2% to the “reserved” category, (Chart 3). The NCDC survey expressed concern over the high use of “watch” group antibiotics. About 3% of the prescriptions were of the ‘not recommended by WHO’ group.
Chart 4 | The chart shows the share of antibiotic prescriptions with a stop/review date.
Chart 4 shows that there was a stop/review date in only 10.4% of the prescriptions. Moreover, only 52% of the prescriptions were compliant with India’s national policy developed to contain antimicrobial resistance (Chart 5).
Chart 5 | The chart shows the share of antibiotic prescriptions in compliance with India’s Antibiotic policy.
Chart 6 | The chart shows the choice of antibiotic drugs which were mostly prescribed in the hospitals surveyed.
Over 33% of antibiotic prescriptions were third-generation Cephalosporins which include drugs such as ceftazidime, ceftriaxone, cefoperazone and cefoperazone. This was followed by Imidazoles (Metronidazole, ornidazole, tinidazole) Aminoglycosides (amikacin, gentamycin, streptomycin) and Beta-Lactamase inhibitors (amoxicillin and clavulanate acid, piperacillin and tazobactam) which together form about 40% of the antibiotic prescriptions.
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Chart 7 | The chart shows the 20 locations where the survey was conducted and the share of patients who were given at least one antibiotic.
All the patients in Lala Lajpat Rai Memorial Medical College hospital in Meerut were given antibiotics. More than 90% patients were given antibiotics in at least four other hospitals surveyed.
UP-M: Lata Lajpat Rai Memorial Medical College, Meerut, U.P. | MP-I: Mahatma Gandhi Memorial Medical College, Indore, M.P. | BR-P: Indra Gandhi Institute of Medical Sciences, Patna, Bihar | MH-A: Government Medical College, Aurangabad, Maharashtra | UP-K: Ganesh | Shankar Vidyarthi Memorial Medical College, Kanpur, U.P. | UK-H: Government Medical College, Haldwani, Uttarakhand | CG-R: Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh | AS-G: Guwahati Medical College, Guwahati, Assam | JK-J: Government Medical College, Jammu | MH-P: BJ Government Medical College and Session General Hospitals, Pune, Maharashtra | WB-K: Calcutta School of Tropical Medicine, Kolkata, W.B. | MG-S: North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya | TN-T: K.A.P. Viswanathan Medical College, Trichy, T.N. | MP-B: Gandhi Medical College, Bhopal, M.P. | TR-A: Agartala Government Medical College, Agartala Tripura | CH-C: Government Medical College, Chandigarh | TG-H: Osmania Medical College, Hyderabad, Telangana | AP-G: Guntur Medical College, Guntur, Andhra | RJ-J: Nawal Man Singh Medical College, Jaipur, Rajasthan | HR-R: Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana
Source: Report of the First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22 published by the National Centre for Disease Control
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