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Resource centre on India's rural distress
 
 

Patients looking for quick fixes, chemists & quacks spur antibiotics resistance -Roli Srivastava
-The Times of India

PUNE: Family physician Dr Kumar Mandhare has been practising for 27 years in Koregaon Park in Pune, treating a wide variety of patients. Over the last few years, however, he has observed a new set of patients - on whom once-effective antibiotics drugs don't work.

He pegs their number at 30 to 40% of the patients he gets, usually people who have found a quick fix solution to their illnesses - walking to the nearest pharmacy and popping a readily available antibiotic. No questions asked or prescription demanded.

It is this brazen pill popping which shows up as extraordinary resistance to even second or third generation antibiotics among many self-medicated patients when they seek treatment for more serious medical conditions.

In Delhi, at Sir Ganga Ram Hospital, doctors have been recording a similar trend. "We have seen cases of resistance to gentamycin used to treat urinary tract infection. This antibiotic is not available as a tablet, but only as an injection," said Dr Chand Wattal, head of department of microbiology, Sir Ganga Ram Hospital, Delhi -an indicator that even an antibiotic administered intravenously is available over the counter widely enough to breed resistance.

Dr Wattal's counterpart at Max Healthcare in Delhi, Dr Bansidhar Tarai, strikes another worrisome note- the resistance surfacing among patients from small towns and rural parts. "We see patients from UP, say cities like Kanpur or even smaller cities, who have been to nursing homes and by the time they come here, they are multi-drug resistant," Dr Tarai said.

At Sassoon General Hospital in Pune, head of department of microbiology Dr Renu Bharadwaj, pegs the resistance to antibiotics among out-patients at around 15%. Her colleague, Dr D B Kadam, who heads the department of medicine at the hospital, says community-acquired resistance is still uncommon, but does note that by the time people reach a tertiary-care facility they have been exposed to some or the other antibiotic.

It was this pattern that led Dr V Balaji, head of microbiology at Christian Medical College, Vellore, to embark on research in both urban and rural parts to study the reason for resistance.

"We interviewed people in both rural and urban parts. Urban pharmacists said they were giving out drugs because of competition and also the steep rentals they had to pay for their shops in prime areas. Another chemist said that medical representatives gave them free medicines, so they promoted it among patients," Dr Balaji said.

What he found in rural areas was more alarming: it wasn't doctors prescribing antibiotics in many cases, but quacks. "Not only were people taking the inappropriate drug, but also in wrong dosage and for a wrong duration," he said.

Almost 30% of the cases that come to CMC Vellore are from the northeast and the resistance pattern among those patients is much the same, said Dr Balaji, who is also heading the antimicrobial stewardship and infection control and prevention at Indian Council of Medical Research.

The result of this arbitrary use of antibiotics is doctors leaning on stronger antibiotics to cure even routine ailments.

"Chemists give azithromycin for cough and cold and norflox for diarrhoea and urinary tract infection and now both the drugs are out (of use)," says Dr Mandhare. He attributed the pill popping trend to a cocktail of factors mainly the restlessness among patients to get cured, and doctors putting them back on their feet in two to three days with strong antibiotics being deified.

"Earlier, we did not give antibiotics for the first three to four of days of fever, and waited for the blood test report before administering any antibiotic. And then too we used the basic antibiotics," he said.

The resistance to higher antibiotics is much higher in urban areas - as patients can afford high-end drugs that are also more expensive. There is no measure really to map the restlessness among patients, but data from diagnostic labs does illustrate this concern in numbers.

Diagnostic laboratory chains find a 35 to 40% rise in antibiotic resistance among people who have been referred to undergo these tests by their physicians - which means people being tested for antibiotic sensitivity after they fail to react to the drugs their doctor is treating them with.

The Pune laboratory of SRL in Wakdewadi carries out an average of 60 to 70 antibiotic sensitivity tests every month, 'of which just two are found to be resistant to all drugs', as indicated in the data of the past months. Pathologists here point out that 40% of the cases tested here are those of out-patients.

"There is a manifold rise in resistance to antibiotics over the years mainly due to misuse or overuse of antibiotics. Today, we have reached a stage where we have limited new antibiotics and we find resistance to most of the antibiotics available to us," says Dr Nita Munshi, head of department of pathology, Ruby Hall Clinic in Pune.

Experts said judicious use of antibiotics is much needed, but rue that patience is a rare virtue in these times when people medicate themselves, and undergo tests even before they consult the doctor.