The drug habit

The dilemma about antibiotics is simple: the more you use them,the more you lose them. Indiscriminate use blunts their efficacy by encouraging mutant microbial strains that can withstand them. When the New Delhi Metallo-1 superbug was identified by a Lancet study as being a side-effect of Indian surgeries and transplants,the medical community here was livid. But theres no dodging the fact that the profligate use of such medication,even for mild infections,is an all-too-common failing in India. Some doctors are encouraged by pharma reps; in other cases,feeble regulation means even pharmacies can get away with shilling antibiotics without prescriptions. On the other hand,we have patients who are convinced their illness is being ignored or insufficiently treated if they dont get a full regimen of antibiotics. The fact that doctors tend to concentrate on helping the person under their care rather than thinking of the larger public health dimensions of the matter also contributes to India being awash in unnecessary antibiotics. We are not alone Kenya,South Africa,Vietnam and China are also particularly culpable,according to a recent WHO study.

But that much-maligned Lancet study seems to have some welcome effect,as a group of public health experts is now ready to institute guidelines for government hospitals on appropriate antibiotic use. Rather than piling on the meds at a doctors discretion,there will now be clear distinctions between antibiotics based on the gravity and intensity of the illness. Strong and high-end antibiotics will be restricted to those under intensive care,and others out-patients and cases of emergency will be given milder,simpler antibiotics. Also,an infection surveillance mechanism will be mandatory,and hospitals will have to form teams to exclusively focus on containing infection by checking for cleanliness standards,hand-washing,careful use of catheters and other instruments,the isolation of infectious patients,etc.

The guidelines couldnt have come any sooner but are they enough? Private hospitals are still left out of their purview,and are harder to monitor. The sad truth is that resistant microbial populations respect no cordons,and unless antibiotic misuse is tackled thoroughly,with an impregnable regulatory shield and strict consequences for any violations,the problem will always be with us.