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Prescribing Antibiotics : DGHS mandates doctors to write indication; Appeals to Pharmacists to sell

antibiotics only on prescription

New Delhi: Deeply concerned on reports of misuse and overuse of drugs which is gradually leading to antimicrobial resistance, the Director General of Health Services (DGHS) as per the directions of the Union Health and Family Welfare Ministry has asked all doctors across the country to mandatorily list the exact reasons while prescribing medicines. According to a notice issued by the Director General of Health Services (DGHS) Dr Atul Goel, written on 1 January, misuse and overuse of anti-microbials is one of the main drivers in the emergence of drug resistant pathogens. “It is an urgent appeal to all the doctors in medical colleges to mandatorily mention exact indication/ justification/ reason while prescribing antimicrobials,” the notice read. Calling antimicrobial resistance (AMR) one of the top global public health threats, the DGHS has also written to all the pharmacist associations in India to stick to the Drugs and Cosmetic Rules in the sale of antibiotics.

“While pharmacists are being reminded to implement the schedule H and H1 of the Drugs and Cosmetic Rules and sell antibiotics only on valid prescriptions, it is important that doctors mention exact indication on their prescriptions while prescribing antimicrobials,” the notice mandates.

The DGHS has also emphasised the need for judicious use of anti-microbials for doctors of all medical colleges so that the pathogens don’t mutate at a faster rate. “With few new antibiotics in the research and development pipeline, prudent antibiotic use is the only option to delay the development of resistance. The medical colleges not just provide tertiary healthcare in the country but also are hubs for education of the younger generation of doctors. This makes it important that the doctors of all medical colleges set example of judicious use anti-microbials for the next generation of doctors who will face this crisis in a much more severe form,” the notice read.

Under the Drugs and Cosmetics Rules 1945, antibiotics are included in the list of drugs specified under Schedule H, which are required to be sold by retail on the prescription of a registered medical practitioner (RMP) only. Some high end antibiotics are included in list of H1 drugs. “This is an urgent appeal to all the pharmacists in the country to strictly implement schedule H and H1 of the Drugs and Cosmetics Rules and stop over the counter sale of antibiotics and sell them only on prescription of a qualified doctor,” it added.

As per the NCDC’s (National Centre for Disease Contro) recent report on use of antibiotics which stated that 3rd Gen Cephalosporines was the most commonly prescribed antibiotic, followed by Imidazoles, and Aminoglycosides. Amongst most commonly prescribed antibiotics are Ceftriaxone, Metronidazole and Amikacin followed by Piperacillin and Tazobactam. According to the World Health Organization, it is estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 while 4.95 million deaths were associated with drug resistant infections. AMR puts many of the gains of modern medicine at risk. It threatens the effective prevention and treatment of infections caused by resistant microbes, resulting in prolonged illness and greater risk of death. Treatment failures also lead to longer periods of infectivity and prohibitive high cost of the second line drugs may result in failure to treat these diseases in many individuals.