Long before superbug report,WHO warned India

Doctors and health experts said the study showed there was excessive and even dubious use of antibiotics in India.

With the Lancet study ringing alarm bells on anti-microbial resistance and global health experts gathering in Bangkok to discuss the drug-resistant superbug,it has now been pointed out that WHO had last year itself found excessive rates of antibiotic prescriptions and resistance developed to them by patients in India,based on a study conducted between 2002 and 2006.

Titled Community based Surveillance of Antimicrobial use and Resistance in Resource Constrained Settings,the study examined trends of antibiotic use in India and South Africa. Data was collected between 2002 and 2006 in Delhi,Mumbai and Vellore,and in Durban and Brits in South Africa.

The study found that resistance to Fluoroquinolones and third generation Cephalosporins was present in all areas,though the rates seemed to be much higher in India. Fluoroquinolones are used to treat urinary tract infections,gastrointestinal tract infections,skin and soft tissue infections and for some respiratory infections. Cephalosporins are used for respiratory tract infections such as pneumonia and bronchitis.

While the over-the-counter sales of antibiotics stood at 11.8 per cent in Durban,Mumbai reported 26.6 per cent and Delhi stood at 21 per cent meaning these percentages of antibiotics were sold without prescriptions. Surprisingly though,Vellore,for long a premier centre for healthcare in south India and considered conservative in terms of antibiotic prescriptions by doctors,was way ahead at 34.9 per cent.

Mumbai had the highest prescriptions of antibiotics with 48.6 per cent of all drugs prescribed at public hospitals being antibiotics while the number was 51.2 per cent for those by private doctors.

The study found that although Mumbai reported the highest rate of antibiotic prescriptions,Delhi was way ahead when it came to population resistant to the drugs. For instance,the study tested the efficacy of antibiotics Ampicillin,Gentamycin and Nitrofurantoin in treating E Coli infections.

It found that 41.7 per cent of the sample in Mumbai and 51.5 per cent in Delhi were resistant to Ampicillin,2.5 per cent in Mumbai and 30.1 per cent in Delhi were resistant to Gentamycin and 25 per cent in Mumbai and 20.2 per cent in Delhi were resistant to Nitrofurantoin.

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Doctors and health experts said the study showed there was excessive and even dubious use of antibiotics in India. The problem has long been a time bomb ticking away,but there is constant denial in acknowledging its presence, said Dr Chand Wattal,who steered the research at Sir Ganga Ram Hospital,the site of the WHO study in Delhi. The researchers add that with the spurt in infectious diseases in both Delhi and Mumbai,use of antibiotics has increased exponentially.

The Health Ministry reacted strongly to the New Delhi Metallo-beta-lactamase NDM-1,because foreigners caught the bug,which in turn instigated the references to medical tourism in India, said Dr Renuka Munshi,who monitored the statistics at BYL Nair Hospital,the study site in Mumbai. We have approached WHO for funds to conduct a fresh study to enumerate antibiotic use.

Dr Ramanan Laxminarayan,Professor of Medicine at Princeton University and Project Director for the Global Antibiotic Resistance Partnership,said: Resistance rates in India have been low compared to developed countries that have a much longer history of intensive antibiotic use. However,that picture is changing fast with high levels of resistance emerging in the metros,largely because of excessive antibiotic use.

The need for the inclusion of an antibiotic policy in the National Health Programme has been raised consistently by Dr Kathleen Holloway,the main author of the WHO study. While Holloway was not available for comment,her co-authors said they had submitted a fresh proposal about the need for an antibiotic policy to the Union Health Ministry along with the results of the WHO study.