ICMR issues new guidelines to curb antibiotic misuse in India, aiming to reduce antimicrobial resistance and promote responsible healthcare practices.
The Indian Council of Medical Research (ICMR) – a government body – has begun a massive campaign to reduce the misuse of antibiotics especially for common ailments such as upper respiratory tract infections, fever, and community-acquired pneumonia. These conditions usually result in the administration of antibiotics where they are not required further for public health concerns of antimicrobial resistance.
Another significant problem has been the overuse of antibiotics, which has only worsened during the pandemic due to the administration of such medication as azithromycin in cases where they are not warranted. This misuse together with increased accessibility of antibiotics without prescription has acted as a catalyst to the development of AMR. AMR has been directly responsible of over 297000 deaths in India in 2019, making it an issue of high concern and priority for health ministries.
The guidelines issued by the ICMR will cover the empirical usage only of antibiotics—those that are administered before the identification of the specific pathogen causing an infection. Such empirical treatments sometimes lead to the prescription of antibiotics more often for viral ailments such as the upper respiratory tract infections in which antibiotics are not beneficial. For instance, 95% of these infections are viral, while antibiotics are often administered hence requiring a better direction from the clinicians.
The guidelines will help healthcare providers make evidence-based decisions on when to start, stop, or switch antibiotics, with a focus on using narrow-spectrum antibiotics from the WHO's "Access" group, which are associated with fewer side effects and a lower risk of resistance.
The aim of these guidelines is to facilitate evidence-based decisions for healthcare providers on when to start, stop, or switch antibiotics, with reference to the WHO “Access” category of narrow-spectrum antibiotics that cause minimal side effects and possession of lower levels of resistance.
In contrast to the healthcare settings of developed countries like that of the USA where the physicians use algorithms for suggesting suitable antibiotics, India has certain limitations because of the absence of rapid diagnostic kits for outpatients. The lack of these diagnostics results in the use of antibiotics that can be deemed unnecessary. This is where the new guidelines come into play, as they give physicians a framework for prescribing antibiotics since they may not necessarily be able to conduct rapid tests.
The World Health Organization (WHO) categorizes antibiotics into three groups:
Access: These are antibiotics that are more specific in that they only affect certain pathogens, and hence are less likely to be resisted.
Watch: Medications that are administered in somewhat severe illnesses, with chances of resistance comparatively higher.
Reserve: Specific antibiotics are used in cases when the disease is caused by bacteria that are resistant to other antibiotics.
In most cases, the ICMR’s recommended guidelines suggest the use of “Access” antibiotics in order to prevent the unnecessary use of stronger drugs. Through promoting the right use of these drugs, the guidelines are well intended to help mitigate the increasing cases of AMR.
A significant barrier to curbing antibiotic overuse is the unavailability of fast diagnostic tests. Physicians, especially those working in rural or outpatient facilities often prescribe empirical treatments since they do not have access to prompt and comprehensive tests to identify the cause of the infections. This often leads to the prescription of unnecessary antibiotics, especially for diseases such as dengue, which require supportive management as the recommended treatment.
It can be said that the guidelines have been issued by ICMR at the right time as India ranks second in antibiotic resistance in the world. These guidelines will provide busy clinicians with clear, evidence-based guidance to help reduce the use of unnecessary antibiotics and ultimately help tackle AMR. This way, the ICMR hopes that more rational prescriptions of antibiotics will emerge across the country, both in the private and public sectors.