Considering the fact that many cases of adverse drug reactions (ADRs) go unreported in the absence of a strong notification or investigation mechanism, Indian Medical Association (IMA) recently released guidelines on antibiotic resistance, multi-drug resistance and irrational usage of drugs.

"This would be a ready reckoner for over 2.5 lakh doctors across registered with the body to follow guidelines prepared for the first time in the interest of patient safety," says an official associated with the development.

The national level guidelines are meant to address issues related to adverse drug reactions and multi- drug resistance taking into account that as many as 85 lakh ADR cases were reported by WHO last year, of which one per cent were from India alone.

WHO's latest report on antimicrobial resistance reveals antibiotic resistance as a burgeoning problem in South East Asia as there is irrational usage of around 65 per cent antibiotics. It has therefore been mandated that the prescription should compulsorily bear the doctor's name and correct dosage regimen in accordance with the drug rules.

The Central government in September 2013 had amended the Drugs and Cosmetics (D&C) Rules to insert Schedule H1 to curb the indiscriminate use of antibiotics and some other vital drugs, by placing 46 antibiotics under this category.

Citing the WHO report, which focusses on antibiotic resistance in seven different bacteria responsible for common and serious diseases such as bloodstream infections (sepsis), pneumonia, urinary tract infections and gonorrhoea, experts inform that it also includes diarrhoea. That is why, it becomes imperative that right kind of dosage regimen needs to be adhered to. Echoing similar views, pharmacology expert Dr R P Agarwal has also recommended strict and exact adherence to dosage regimen of prescription medicines to tackle antibiotic resistance.

Argues a health activist, "It has been found that medical representatives appointed by drug companies in order to meet their targets promote antibiotics to unqualified allopaths and these in turn prescribe medicines to patients irrationally with the motive of getting hefty commissions. This has led to rampant quackery on one hand and disillusioned healthcare practitioners and patients on the other hand as drug usage most of the times is not backed by valid information on pharmacology."  

WHO’s report results show high levels of E. coli resistance to third generation cephalosporins and fluoroquinolones—two important and commonly used types of antibacterial medicine– in the South East Asian region. Resistance to third generation cephalosporins in K. pneumoniae is also high and widespread. In some parts of the region, more than one quarter of Staphylococcus aureus infections are reported to be methicillin-resistant (MRSA), meaning that treatment with standard antibiotics does not work.

Maharashtra accounts for Rs. 1500 per capita consumption of drugs as compared to the national average of Rs. 694. While talking about the existing scenario, an expert pinpoints that the country is currently facing a scarcity regime as no new drug class has been launched since 1987 to tackle infections caused by multi-resistant bacteria.

Guidelines are relevant with recent incidents of six children having developed severe drug reaction after being injected antibiotics in a BMC-run hospital in Vikhroli . Children aged between 1.5 and 12 years were being treated in the paediatric ward of Mahatma Phule Hospital, Vikhroli.  Drugs administered were ondasetron (an anti-vomitting drug), ranitidine, amoxicillin clavulinic acid, and a combination of cephaperazone and sulbactam (antibiotic injections).