Plugging the breach with finger!

The World Health Organisation (WHO) has recently published a report titled, ‘Antimicrobial Resistance - Global Report on Surveillance’ in which it said, 50 per cent of the patients are not cured by drugs commonly used against some micro organisms which has become superbugs. For example it pointed out, ‘half the patients treated for sepsis caused by K.pneumoniae don’t respond to even newer antibiotics like carbapenem antibiotics’. It also raises an alarm that ‘common microbes such as E.coli are posing a major emergency in intensive care units (ICU) across the world’. ‘People with MRSA [Methicillin Resistance Staphylococcus Aureus] are 64 per cent more likely to die than people with non-resistant form of the infection’, it warns.

Killing antibiotics
Well, enough has been written in the past few years about antibiotic resistance, but we doubt the message has not reached even the authorities with all its seriousness, leave alone the poor public and others. As a result of their negligence or half hearted measures, day by day, we are killing not the microorganisms but the antibiotics! Dr. Keiji Fukuda of World Health Organisation has rightly pointed out “Without urgent coordinated action by many stakeholders, the world is headed for a post antibiotic era in which common infections and minor injuries which have been treatable for decades can once again kill”.

Red alert
It is worth to point out here; research by Pharma Sector for discovering new antibiotics, in the last few decades has been rather slow and lethargic, due to the fact that, these researches does not yield a better antibiotic than the existing ones. So the huge money spent on these researches goes waste and quite naturally no one wants to take the risk. It is because of this pathetic situation in the research front, as and when some promising new molecule is invented it is approved in haste by Governments, even without completing Phase III trial of it using large number of patients across the world. For example the new anti TB drug ‘Bedaquiline’ was approved after Phase II trial only without verifying its potential side effects and now even for this drug there are resistant TB cases because of misuse. Similarly, there are thousands of cases of Malaria, resistant to the most effective new drug Artemisinin in South East Asia alone. Have the people concerned understood the gravity of the situation?

No doubt, Indian government took some measures to control the use of antibiotics such as bringing Schedule HX to Drugs and Cosmetics Act, etc. At the most these measures can be equated to plugging the breach of a dam with finger, because the problem is much bigger and the Government is not seeing it in its entire perspective. As pointed out by this author earlier in these columns, two and half years back exactly [‘Antibiotic Resistance - Real Reasons and Remedies’ ‘Pharmabiz’ 20th Oct 2011] there are many reasons for antibiotic resistance but some of them are simply ignored. For example, non availability of full time pharmacists in community pharmacies, Socio economic reasons like poor patients not purchasing and using full course of antibiotics and above all absence of patient education and counselling by graduate clinical pharmacists, etc, are not addressed by authorities. Whether they think these suggestions are selfish, we don’t know.

In that case, they must prove, the duties performed by clinical pharmacists in developed countries like, Conducting patient’s medication history interview, Prescription auditing, Therapeutic drug monitoring and Patient counselling are not the tools to detect antibiotic misuse, resistance and prevention. Also they should prove these duties can be carried out by people other than a clinical pharmacist who is academically prepared for the task, as mentioned in the above article.

However, it is obvious that the hole in the system is in the unregulated and unattended area and hence the measures now announced by Government are not going to solve the problem, we can vouch and warn.

Shutting the eyes to glaring lies
The lower level bureaucracy tends to lie always to hide its inefficiency and corrupt practices. As per Government records there is full time pharmacists in all [100 per cent] pharmacies [medical shops] of India! But general public cannot be fooled; they know how much percentage of truth is there in this statement. Actually the cat is out of bag, when duty conscious Maharashtra drugs controller took action against the pharmacies without pharmacist. How the Government of India is going to prevent misuse of antibiotics without the services of pharmacist - the poor chap who is supposed to be the custodian of drugs? Why remedial measures like appointing inspectors by State Pharmacy Councils and giving prosecuting powers to them is not implemented?  Then what for or to cheat whom wonderful statements are released by Government authorities?

Remedies
While appreciating the actions already taken, we once again demand and emphasize the following actions by Government:

As ignorance of the patients is the major reason for antibiotic resistance, educate the patients continuously, convincingly and consistently about the danger of Antibiotics resistance by appointing clinical pharmacists in hospitals and graduate pharmacists in other places as in developed countries.

Strictly monitor prescriptions by doctors as the above World Health Organisation report has correctly blamed “poor regulation in the medical sector with respect to prescriptions in India”

Appoint more drug inspectors, proportionate to drug licences issued and to effectively implement the new Schedule HX.

Make available all antibiotics free of cost in all Government hospitals in sufficient quantities and see to that it reaches the poor needy patients.

As a short time measure till clinical pharmacists are appointed, advertise frequently about antibiotic misuse and consequent danger in all print and visual media especially in T.V. and cinema which has tremendous reach to poor uneducated people. Will the Government heed? Let us hope, as life is revolving only on the axis of hope!