Watch for the red line on pack of antibiotics next time before consuming

It is generally believed that availability of antibiotics over the counter and lack of awareness about using antibiotic drugs results in inappropriate use of antibiotics. 

As per a recent report (2015) released by Global Antimicrobial Resistance Partnership (GARP), it is reported that resistance among common pathogens is increasing worldwide though regional patterns of resistance vary. Common bacterial pathogens becoming resistant to antimicrobials are Staphylococcus aureus, Enterococus, S. pneumoniae, N. gonorrhoeae, N. meningititidis, E.coli, Klebsiella pneumoniae, Typhoidal Salmonella, Shigella species, Vibrio cholerae, Mycobacterium tuberculosis and in other diseases such as Malaria, Kala azar, HIV etc.

The consequences of increased prevalence of antimicrobial resistance are best illustrated in the case of neonatal sepsis. According to a study carried out by the All India Institute of Medical Sciences (AIIMS), the number of neo-natal deaths caused by sepsis accounts to about 58,000 as per 2013 statistics. The study was mainly conducted to ascertain, the impact of excess of use of antibiotics in India. 

Looking towards the growing problem of antibiotic resistance, a much-needed public awareness campaign to highlight the dangers of misuse and irrational use of antibiotics was recently launched by the Ministry of Health and Family Welfare. Called 'Medicines with the Red Line', it comes at a time when the consumption of antibiotics in India has increased sharply while the effectiveness of these drugs to treat bacterial infections has been steadily declining. 

The Drug Control General of India (DCGI) has directed all the pharmaceutical companies manufacturing antibiotics to mark a red line on the strips of the capsules and syrups to differentiate them from normal medicines. 
 
Previously, to regulate the sale of antibiotics, the Government of India, in the year 2013, amended the Drug and Cosmetics Rules, 1945 to incorporate a new Schedule H1 containing 46 drugs which also includes IIIrd and IVth Generation antibiotics and anti-TB drugs for a strict control over the sale of these drugs. The Drugs falling under Schedule H1 are required to be sold in the country with the following conditions:
(1)   The supply of a drug specified in Schedule H1 shall be recorded in a separate register at the time of the supply giving the name and address of the prescriber, the name of the patient, the name of the drug and the quantity supplied and such records shall be maintained for three years and be open for inspection.
 (2)   The drug specified in Schedule H1 shall be labeled with the symbol Rx which shall be in red and conspicuously displayed on the left top corner of the label, and shall also be labeled with the following words in a box with a red border:
“Schedule H1 Drug-Warning:

-It is dangerous to take this preparation except in accordance with the medical advice.
-Not to be sold by retail without the prescription of a Registered Medical Practitioner.”

 
An insertion has been made in the Drugs and Cosmetics Rules, 1945 to specify the withdrawal period of antibiotics in case of egg, milk, poultry and fish before these enter the human food chain. The Department of Animal Husbandry, Dairying and Fisheries has also issued Advisories in 2014 addressed to all States and Union Territories regarding judicious use of antibiotics to prevent AMR.

But, though there were steps taken on Government font to curb misuse of antibiotics, the rampant sale of such therapeutic drugs remained unstoppable. Therefore at present, the latest move on antibiotics of MOHFW was much required and therefore welcomed by all medical forums.

 Indian healthcare experts, professionals and researchers are also advising that to ensure sustainable access and consumption of antibiotics, firstly, people should be made aware that stopping antibiotics midway, missing doses, taking suboptimal dosages, or consuming antibiotics for cold and other viral infections, makes them resistant to antibiotics; when ill the next time and then their only recourse will be more expensive drugs. There is also need to check doctor’s practice on prescribing antibiotics on patient demand for quick relief due to lack of antibiotic guidelines besides incentives from drugs companies and chemists to push certain products. Not just by the doctors, the antibiotics are increasingly sold by the pharmacy stores without proper prescriptions. Over the counter sales of antibiotics is a big concern as there is no proper surveillance mechanism to control excessive sales of antibiotics by the drug stores and similarly is the case with the patients. Therefore, together the patients, doctors and the drug store owners must be made aware of the negative repercussions of excessive use of antibiotics on human health.

The problem exists even at hospitals. Too many antibiotics are administered to the patients in intensive care units. There is no proper monitoring nor is the use of antibiotics reported. For this reason, there is a strong need to create a surveillance mechanism whereby the misuse of antibiotics can be controlled.

Secondly, government with top priority action should crack down on drug companies manufacturing irrational fixed-dose combination drugs. The government should also urgently regulate drug companies discharging antimicrobial waste into the environment and regulate the use of antibiotics in animal feed to combat antibiotic resistance and obtain healthier animal products. Better sanitation and effective infection control measures in health-care settings will also drastically cut the spread of drug-resistant strains.

The only way to achieve this objectives are by ensuring that all stakeholders - government, patients, veterinarians, doctors, pharmacists, pharmaceutical companies and health-care facilities - play their respective roles more responsibly.

We at PSM- India, also urge all patients/consumers to follow restrictions imposed on antibiotic consumption and properly study packaging labels before consuming pills. Each one of us should be alert and stop others from following such habits too, so that further complication and rise of antimicrobial resistance can be decreased in patients and coming generations.