When it comes to antibiotics use, India faces a twin challenge. A ‘skewed’ ground reality that requires it to control overconsumption of antibiotics and the risk of drug-resistance that comes with it, even as the country seeks to improve access to antibiotics among its poor and vulnerable populations.

In 2016, India consumed more than 260 crore packs or ₹15,000 crore worth of antibiotics, a statistic that puts it among the world's largest consumers of antibiotics. And in this worrisome pecking-order Goa, Delhi, Uttar Pradesh, Punjab and Kerala top the list of antibiotics consumers in the country, with consumption patterns higher than the national average of about 6 packs per 1000 people per day.

The data culled by healthcare analytics company IQVIA will be submitted to the World Health Organisation by the year-end to help develop a country and State profile on the use of antibiotics, so interventions can be developed, Lokesh Sharma, IQVIA's Head- Public Health (Africa, Middle East and South Asia), told BusinessLine . (IQVIA was formerly IMS Health before it merged with Quintiles and became QuintilesIMS.)

Explaining the high numbers, Sharma said the ground reality is skewed as some parts show overuse of the antibiotic, while there are other regions that could do with greater access of antibiotics to vulnerable populations. Even the high number regions, he says, could be either repeated use by the same population or increasing use by a fresh population.

Last week was WHO’s Antibiotic Awareness week. The multilateral agency, in its 2014 surveillance report, had cautioned Governments across the world that antimicrobial resistance (AMR) was everywhere and had the potential to affect anyone, of any age, in any country.

AMR occurs when microorganisms (such as bacteria, fungi, viruses, and parasites) change on excessive or irrational exposure to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). And these changed microorganisms then become resistant to the drug. As a result, an antibiotic for example, used to treat an infection would have no effect on the person, increasing the threat to the individual's life and also the risk of passing on the infection.

Drug resistance The worrying phenomenon of drug resistance is being seen in a range or treatments from flu to malaria, tuberculosis and HIV. According to the WHO, “Colistin is the last resort treatment for life-threatening infections caused by Enterobacteriaceae which are resistant to carbapenems. Resistance to colistin has recently been detected in several countries and regions, making infections caused by such bacteria untreatable.”

Explaining why it was necessary to have targeted interventions at the State and Central level to control the use of antibiotics in India, Sharma points to the weak research pipeline for new antibiotics.

The WHO is working with different countries along with other agencies handling food and animals to stop the indiscriminate use of antibiotics.

India has shown a 20 per cent growth in the last four-five years in the antibiotics segment, says Sharma, calling for a multi-pronged approach to curb use. Children exposed to antibiotics now could develop resistance by the time they grow up, he says, calling for school awareness programmes, besides other interventions among corporates etc.

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