Lokesh Sharma, Head – Public Health, Africa, Middle East and South Asia, IQVIA, in an interaction with Mansha Gagneja, discusses about how excess use of antibiotics result in increased resistance which can be a big public health challenge
Give a brief on the current consumption of antibiotics in India and how would you justify the under and over consumption in the country?
The bacterial disease burden in India is among the highest in the world. In 2010, India was the world’s largest consumer of antibiotics, measured by number of packs consumed. The antibiotic resistance we are seeing now is due to overuse and inappropriate use of antibiotics over the years. While antibiotics play a critical role in limiting mortality and morbidity caused due to bacterial infections, excess use results in increased resistance which can be a big public health challenge.
Based on IQVIA’s Total Sales Audit Data, the year-wise trend shows consistent increase in consumption patterns of number of packs consumed at national level. In 2016, India consumed Antibiotics worth Rs 150 billion. More than 2,600 million packs of antibiotics were consumed in 2016 alone. The consumption is continuously increasing.
What impact does the antibiotic resistance and associated diseases have on the economic growth of our country?
Antimicrobial resistance delay and hinder treatment which can result in complications. Patient may need more care, as well as the use of alternative and more expensive antibiotics, which may have more severe side effects as well. This would increase the cost of treatment and care and can even lead to increased mortality and morbidity.
It is an increasingly serious threat to global public health that requires immediate action. Globally, 480 000 people develop multi-drug resistant TB each year. According to a 2016 World Bank report, drug-resistant infections have the potential to cause global economic damage similar to 2008 financial crisis.
Are there any geographical demarcations where antibiotic consumption is steep and where there is a scarcity? Are there any specific patterns to the consumption?
The national average of pack consumption per 1000 population per day is roughly around 5.7 packs in the last 4 years, from 2013 to 2016. The year-wise trend shows consistent increase in consumption patterns of number of packs consumed at national level. The national average of Defined Daily Dose per 1000 inhabitants and per day consumption roughly averages around 134 in the last 4 years, from 2013 to 2016.
Also, we see a seasonal pattern in antibiotic consumption in the country. There is an increase in consumption of antibiotics from July to September where the average monthly consumption is higher compared to other months. The packs consumption per 1000 inhabitants and per day is highest in Goa with 10.5 packs. The national average of unit consumption per 1000 inhabitants per day is six packs, in 2016. It is followed by Delhi with nine packs and UP and Punjab each with 7.2 packs. The lowest number of packs consumed is from Himachal Pradesh with two packs per 1000 population per day and Jharkhand with 3.3 packs per 1000 population per day.
Suggest a plan and steps that could be put to use to tackle the antibiotic consumption and regulate it.
The government has come out with various programmes to tackle this problem but there are other initiatives that must be taken timely. For instance, it is essential to highlight the risks of misuse and irrational use of antibiotics through public campaigns. Also, the government must regulate the sales of antibiotics and bring in regulation on irrational fixed-dose combination drugs. It must also put restrictions on over the counter sales of commonly used antibiotics. There is a need for behavioural changes of pharmacists and physicians on irrational use/prescription of antibiotic drugs.