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Doctors should not prescribe antibiotic cover or prophylactic antibiotic without a high degree of clinical suspicion.
Alarmed over the growing antibiotic resistance that has made it difficult to treat many bacterial infections, the Indian Medical Association (IMA) has advised doctors to follow strictly guidelines while prescribing antibiotics.
Despite the Indian Council of Medical Research (ICMR) setting up the National Anti-Microbial Resistance Research and Surveillance Network (AMRRSN) to enable compilation of data of such resistance at different levels of healthcare and publishing of treatment guidelines for anti-microbial use in common syndromes, the problem of multi-drug resistance due to widespread and indiscriminate use of antimicrobial and antibiotic drugs continues unabated in the country.
To address this issue, the IMA, at the Antimicrobial Resistance Conference held in New Delhi last month, advised its members to mandatorily restrict the usage of antibiotics for treatment of proven bacterial infections. It also came out with a policy on anti-microbial resistance.
No refill without consent
IMA national president K.K. Aggarwal told The Hindu that doctors should henceforth write the antibiotic in a box to differentiate it from other drugs in the prescription.
“When prescribing antibiotics, clear instructions should be given to the patient about no refill of antibiotic prescription without the signature of the doctor. The role of antibiotics should be discussed in an informed consent,” he said.
Expressing concern over irrational antibiotic usage, Dr. Aggarwal said: “As per our policy, doctors should not prescribe antibiotic cover or prophylactic antibiotic without a high degree of clinical suspicion. No antibiotics should be prescribed for small bowel diarrhoea, fever with cough and cold, dengue, chikungunya, malaria and fever with rashes. However, early initiation of antibiotics is the rule in suspected sepsis bacterial pneumonia meningitis and confirmed tuberculosis cases.”
B.R. Jagashetty, former Drugs Controller of Karnataka and former National Adviser to the Union Ministry of Health and Family Welfare, said the government should conduct random “prescription audits” in both private and public sectors to improve medication safety.
This has also been included in the National Health Policy and Karnataka Public Health Policy prepared by the Knowledge Commission. The Karnataka Health Policy — that is yet to be implemented — also recommends that the State Health Ministry should also have its own antibiotic policy.
Attributing the growing antibiotic resistance to self-medication by most people, Dr. Jagashetty said: “Many people go to a chemist and ask for medicines for their health problem without visiting a doctor. Buying medicines over the counter is a major reason for misuse. Moreover, some doctors too prescribe higher antibiotics due to the impatience shown by their patients in getting well soon.”
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