Indians popping more antibiotics than ever: Study

There has been a six-fold increase in the number of antibiotics being popped by Indians. This includes the retail sale of Carbapenems -- powerful class IV antibiotics, typically used as a "last resort" to treat serious infections caused by multi-drug resistant, gram-negative pathogens.

Research by the Centre for Disease Dynamics, Economics and Policy, Washington DC, has found that retail sale of carbapenems increased six times -- from 0.21 units per million in 2005 to 1.23 in 2010, raising serious fears of resistance to these drugs.

The Centre said that based on pharmaceutical audit data from IMS Health's Multinational Integrated Data Analysis System ( MIDAS), the size of the carbapenem retail market in India was $27.4 million (Rs 119.4 crore) in 2010 which is actually a small share of the $1.7 billion (Rs 7,953 crore) anti-infectives market, and $10 billion (Rs 46,787 crore) total pharmaceutical market.

India consumes fewer carbapenems per capita than Pakistan. In 2010, a total of 1,753,740 units of carbapenem antibiotics -- usually dispensed in 1g vials -- were retailed in pharmacies throughout India and Pakistan (1,457,246 and 196,494 in each, respectively). When adjusted for population, Indian per capita consumption in 2010 was 27% lower than that of Pakistan: 1.25 units per million population versus 1.7.

CDDEP research analyst Nikolay Braykov told TOI from Washington. "Indian carbapenem consumption grew at more than twice the pace of Pakistan between 2005 and 2010: there was nearly a six-fold increase. In Pakistan, the same market grew 2.5 times, from 0.68 to 1.7 units per million population. The data covers the retail pharmacy channels, estimated to account for 80% of the total pharmaceutical market in both India and Pakistan."

CDDEP said the highly competitive domestic pharmaceutical industry in India could play a role in the rapid growth of carbapenem overuse. Based on search of the CIMS, there are over 55 brand names of carbapenem antibiotics retailed on the Indian market.

"This is a lot, considering carbapenems are a relatively new antibiotic class with only four drugs: meropenem (most popular in India), imipenem/cilastatin, ertapenem and doripenem (the newest and most expensive one). By comparison, there were only six product names in Pakistan and five in the US," Braykov said.

The health ministry too has been worried about India's overuse of antibiotics. India had made plans to ban the availability and over-the-counter sale of the latest generation of antibiotics from general pharmacies in a bid to end the country's obsession with popping pills. However the plans were shelved.

Just days before the drug controller general of India was to notify Schedule H1, the health ministry decided that a "broader consensus was required" and withheld its notification. As many as 90 antibiotics would have been brought under the new schedule. There would have been strict curbs on the sale of these antibiotics.

The schedule would have had two parts -- Part A having 16 drugs and antibiotics that would be sold directly by drug manufacturers to the tertiary care hospitals. These drugs would have a label with a red box and would be marked as for use in tertiary care hospitals only. Part B had 74 drugs and formulations that would carry the warning, 'It is dangerous to take this preparation except in accordance with the medical advice', and 'Not to be sold by retail without the prescription of the doctor'.

Part A included drugs like Moxifloxacin, Meropenem, Imipenem, Ertapenem, Doripenem, Colistin, Linezolid and Cefpirome. Part B included drugs like Gentamicin, Amikacin, Pencillin, Oxacilin, Zolpidem, Cefalexin, Norfloxacin, Cefaclor and Cefdinir.

Even director of Centres for Disease Control Atlanta chief Dr Thomas R Frieden, who was recently in India, told the TOI in an exclusive interview that drug resistance due to irrational use of antibiotics will increase in the future. "It is very important that India came out with a policy to control irrational use of antibiotics. Superbugs like NDM1 and drug resistance are definitely major threats," Dr Frieden said.

The World Health Organization has also warned that the world is staring at a post-antibiotic era, when common infections will no longer have a cure. WHO director general Dr Margaret Chan said when antibiotics were first introduced in the 1940s, they were hailed as wonder drugs. "Widespread infections that killed millions could be cured. Major diseases, like syphilis, gonorrhoea, leprosy and tuberculosis lost much of their sting. However today, the message is clear -- the world is on the brink of losing these miracle cures," Dr Chan sai

Similar Threads: