Govt study finds ‘remarkably high’ prevalence of antibiotic use by patients

A government study has found “remarkably high” prevalence of antibiotic use, with 71.9 per cent of surveyed patients at 20 tertiary care hospitals being prescribed it.

The findings of the study, conducted between November 2021 and April 2022, were released by the Union Health Ministry on Tuesday.

The study found that 45 per cent of the patients were being prescribed antibiotics for therapeutic indications and 55 per cent for preventive reason. It also showed that 4.6 per cent of the patients took four or more antibiotics.

The World Health Organization (WHO) included antimicrobial resistance (AMR) as one of the top 10 threats to public health in 2019.

Indiscriminate, excessive and inappropriate use of antibiotics has been a concern and over the years, India has taken many steps to deal with the challenge of antimicrobial resistance. One of the important strategies in the national action plan for antimicrobial resistance is the gathering information on antibiotic usage through surveillance mechanisms.

There is limited information on how antibiotics are prescribed and used at the patient level. For this, WHO has come up with the Global Point prevalence survey methodology to understand the prescribing patterns in hospitals, and repeated such surveys help compare antibiotic use over time.

There are only few studies that have been conducted in India using this methodology. The present study has been done in 20 tertiary care institutes across 15 states and two Union Territories.

The report also generates recommendations based on the findings to monitor antibiotic usage at the hospital level.

Over a period of six months, 9,652 eligible patients were surveyed out of 11,588 admissions.

“The prevalence of antibiotic use was 71.9 per cent. It showed wide variation between the sites ranging from 37 per cent to 100 per cent. Overall, there were 12,342 antibiotic prescriptions, 86.5 per cent of these were prescribed through parenteral route. Only six per cent of the patients were on definitive therapy with 94 per cent being empirical therapy,” the study found.

Besides, 45 per cent of the patients were being prescribed antibiotics for therapeutic indications and 55 per cent for prophylactic indications, the study report stated.

Out of 20, four institutes had more than 95 per cent prevalence of antibiotic use.

The study found that “watch group” antibiotics (57 per cent) were prescribed more frequently than “access group” antibiotics (38 per cent), with only two sites reporting higher prescription rates for access group antibiotics, the study found.

The high use of “watch group” antibiotics is of concern as these antibiotics have a higher potential to develop antibiotic resistance.

Access group antibiotics have a lower potential for the selection of antimicrobial resistance.

The study recommended that institutions should adhere to standard treatment guidelines and infection control practices to mitigate antibiotic resistance and that each institute should have a defined antibiotic policy which should encourage use of access group antibiotics.

Institutions should aim to keep the consumption of reserve group antibiotics at low levels and monitor the usage of reserve group drugs obtained from outside the hospital pharmacy.

Polypharmacy was observed in all the institutions. Combining two antibiotics can increase the risk of adverse effects and drug interactions.

Therefore, institutions are suggested to adopt standard treatment guidelines.

Institutions have been urged to avoid unnecessary double coverage with antibiotics for anaerobic bacteria and Gram-negative bacteria.

The use of antibiotics not recommended by the WHO has been observed in the study. Institutions should monitor the consumption of such drugs closely, the report stated.

Surgical prophylaxis should be limited to a single dose or one day before the surgical procedure, and treatment for post-procedure infections should only be administered after a diagnosis of infection