One of the world's most pressing public health problems today is the
growing antibiotic resistance due to its irrational use over the years.
Confirming a bacterial infection, selecting the appropriate antibiotic
for the infection and educating patients about the importance of taking
therapy as prescribed by physicians are considered critical in treating
infectious diseases. Bacteria can become resistant in several ways and
all of which involve changes in their genetic material or genes. These
altered genes enable the bacteria to either destroy the antibiotic or
block its ability to inhibit bacterial growth. The laws of natural
selection suggest that all bacteria will eventually become resistant to
antibiotics at some point. Repeated and improper use of antibiotics are
two main causes for increase in resistant bacteria world over. It is
estimated that up to 50 per cent of antibiotic prescriptions given in
the community settings are not actually needed. Patients too contribute
to antibiotic resistance by requesting physicians to prescribe
antibiotics even if they do not have a bacterial infection.
Noncompliance of patients to the antibiotic treatment regimen is another
contributory factor for resistance which has become a significant
patient safety concern today.

In India, scientific debate on
antibiotic resistance has taken a serious turn in the wake of a recent
controversy over a reference made in the medical journal, Lancet,
regarding the superbug called New Delhi metallo-beta-lactamase 1
(NDM-1). The superbug is stated to be resistant to the most powerful
antibiotics and the circulation of the Lancet report did hit the image
of India as a destination for medical tourism and cheaper treatment
facilities. Scientific community in the country did take objection to
the reference of New Delhi in the name, NDM-1, as it can give a wrong
impression that it originated from India. What is, however, more
important now is how to bring a control on the antibiotic resistance in
the country. And it is creditable that the Union health ministry swung
into action and set up a task force to review the current situation
regarding manufacture, use and misuse of antibiotics in the country and
also to initiate studies documenting prescription patterns and establish
a monitoring system for the same. The report has been already placed
before the Drug Consultative Committee a few weeks ago. Now, DCGI
decided to introduce a set of new rules to regulate the sale of
antibiotics and add a separate schedule under the Schedule H of the
Drugs & Cosmetics Act. The new Schedule, HX, is expected to be
added to the D&C Act to make it compulsory for patients to carry
duplicate prescriptions for buying antibiotics from the chemist shops.
One copy of the prescription has to be kept by the chemists for audit up
to one year. These are all highly desirable initiatives from the health
ministry and not many developing countries have taken such steps to
counter this new threat. What is to be seen now is how effectively and
fast the health ministry and drug control machinery of the country will
be enforcing these critical regulations.