NCDC Survey On Antibiotic Use: Overprescription, Polypharmacy, and Urgent Calls for Action

Context:

The National Centre for Disease Control (NCDC) has carried out a survey on the trend in the prescription of antibiotic use in India.

Usage Trends at 20 NAC-NET Sites and Addressing Critical Data Gaps about Antibiotics Use

• It is the first multicentric point prevalence survey of antibiotic use at 20 NAC-NET sites. 
  • NAC-NET or National Antimicrobial Consumption Network, is a network comprising 35 state medical colleges across India.
• Present Data: Currently, there is no data related to the usage of antibiotic use in food, animals and crops. This survey fills that gap. 
• As of 2019, the WHO placed AMR in the top 10 public health hazards. 

Methodology of Survey:  Understanding Access, Watch, and Reserve Categories in Prescriptions

• The antibiotic prescriptions were classified based on AWaRe categories developed in 2017 by the World Health Organization (WHO)  
• Access, Watch and Reserve (AWaRe) takes into account the impact of different antibiotics and antibiotic classes on antimicrobial resistance.
• The categories are 
  • Access: These are antibiotic drugs with a lower potential for misuse that are widely available and are used to treat a wide range of infections.
  • Watch: This group has a higher potential for misuse and a higher potential to develop antibiotic resistance.
  • Reserve: This group is used to treat severe infections caused by multidrug-resistant pathogens however, their use should be restricted and as last resort. 

Key Findings of the Survey: 

• Classification: 

  • 57 % of antibiotic drugs belong to the “watch” group. 
  • 38 % of prescriptions belonged to the “access”  group. 
  • About 2 % of antibiotic drugs prescribed belonged to the “reserve” group 

• Average: The average antibiotic prescription per patient was 1.8. 

  • The overall antibiotic use was recorded maximum in the Intensive Care Units and surgical wards. 

• Most commonly prescribed antibiotics Use: 

  • Third-generation cephalosporins was the most commonly prescribed class of antibiotics (33.1 per cent)  
  • Aminoglycosides was the second most prescribed antibiotic (12.1 per cent) in the survey. The commonly prescribed antibiotic use identified in this class was amikacin. 

• Use of Critically Important Antimicrobials (CIAs) in food-producing animals in India: 

  • Ceftriaxone was found to be used in the Indian dairy sector. 
  • Aminoglycosides, including amikacin, were reported in the Indian poultry sector. 
  • These antibiotics were being used to prevent, control, or treat diseases in animals. 
• Antibiotic Policy: Only eight out of 20 institutes have an antibiotic policy in place

Major Concerns Raised by Survey: 

• Prescription for Prevention: Over 55% of the patients were prescribed antibiotics for preventive purposes rather than to treat existing infections. 
  • This raises growing concerns regarding the increasing risk of antimicrobial resistance (AMR).
• Over Prescription: There is a rampant polypharmacy, the practice of handing out five or more medications to treat infections. 
  • This increases the risk of adverse effects and drug interactions. 
• Overuse: Overall, 53 % of the patients on antibiotics were on more than one antibiotic. About 4.6 percent of patients got four or more antibiotics.  
• There is a trend of increasing resistance towards CIAs, including third-generation cephalosporins and aminoglycosides. 

• Recommendations: 

  • Institutions are suggested to adopt standard treatment guidelines.
  • The hospitals should adopt standard treatment guidelines and have well-defined antibiotic policies in place. 
  • Timely review of the antibiotic prescription should be undertaken to reduce risk of polypharmacy. 

Additional Reading: Antimicrobial Resistance (AMR)

Source: DTE

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