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India was the largest consumer of antibiotics in the world until 2010. Evidence suggests that countries with higher per-capita antibiotic consumption have higher rates of Systematic antibiotic resistance(SAR).

 To control Systemic antibiotic resistance- SAR drug resistance, Required not the only reduction in antibiotic consumption, socio-economic factors like access to clean water and proper sanitation, stringent regulation of the private healthcare sector, and better governance are equally important.

The key objective of the research conducted by  Habib Hasan Farooqui was to investigate the five-year trends in consumption of major classes of antibiotics in India and compare them with European Surveillance of Antimicrobial Consumption Network (ESAC-Net) countries data.

Where the antibiotic use was plotted and reported by year and antibiotic class. Their main findings were—per-capita antibiotic consumption in the retail sector in India has increased from 13.1 DID in 2008 to 16.0 DID in 2012—an increase of ~22%; use of newer class of antibiotics like carbapenems, lincosamides, glycopeptides, 3rd generation cephalosporins  and penicillin’s with beta-lactamase inhibitors has risen; and antibiotic consumption rates Drugs ACR in India.

They concluded their  studies by  providing  the first reliable estimates of antibiotic use in the retail sector in India vis-à-vis ESAC-Net countries.

India was the largest consumer of antibiotics in 2010 in the world. Evidence suggests that countries with high per-capita antibiotic consumption have higher rates of antibiotic resistance. To control antibiotic resistance, not only reduction in antibiotic consumption is required, socio-economic factors like access to clean water and sanitation, regulation of the private healthcare sector, and better governance are equally important. The key objective of this research was to investigate the five-year trends in the consumption of major antibiotic classes in India and compare them with the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) countries. We used Intercontinental Marketing Statistics (IMS) Health (now IQVIA) medicine sales audit data of antibiotic sales in the retail private sector (excluding the hospital sector) in India. We then standardized dosage trends and assigned defined daily dose (DDD) to all formulations based on the ATC/DDD index. We expressed our data in standardized matrices of DDD per 1000 inhabitants per day (DID) to compare antibiotic use in India with ESAC-Net countries. The antibiotic use was plotted and reported by year and antibiotic class. Our main findings are—per-capita antibiotic consumption in the retail sector in India has increased from 13.1 DID in 2008 to 16.0 DID in 2012—an increase of ~22%; use of a newer class of antibiotics like carbapenems (J01DH), lincosamides (J01FF), glycopeptides (J01XA), 3rd generation cephalosporins (J01DD) and penicillin’s with beta-lactamase inhibitors has risen; and antibiotic consumption rates in India are still low as compared to ESAC-Net countries (16.0 DID vs. 21.54 DID). To conclude our study has provided the first reliable estimates of antibiotic use in the retail sector in India vis-à-vis ESAC-Net countries. In addition, our study could provide a reference point to measure the impact of interventions directed towards reducing antibiotic use.

India was the largest consumer of antibiotics in 2010 in the world. Evidence suggests that countries with high per-capita antibiotic consumption have higher rates of antibiotic resistance. To control antibiotic resistance, not only reduction in antibiotic consumption is required, socio-economic factors like access to clean water and sanitation, regulation of private healthcare sector and better governance are equally important. The key objective of this research was to investigate the five year trends in consumption of major antibiotic classes in India and compare them with European Surveillance of Antimicrobial Consumption Network (ESAC-Net) countries. We used Intercontinental Marketing Statistics (IMS) Health (now IQVIA) medicine sales audit data of antibiotic sales in the retail private sector (excluding the hospitals sector) in India. We then standardized dosage trends and assigned defined daily dose (DDD) to all formulations based on the ATC/DDD index. We expressed our data in standardized matrices of DDD per 1000 inhabitants’ per day (DID) to compare antibiotic use in India with ESAC-Net countries. The antibiotic use was plotted and reported by year and antibiotic class. Our main findings are—per capita antibiotic consumption in the retail sector in India has increased from 13.1 DID in 2008 to 16.0 DID in 2012—an increase of ~22%; use of newer class of antibiotics like carbapenems (J01DH), lincosamides (J01FF), glycopeptides (J01XA), 3rd generation cephalosporins (J01DD) and penicillin’s with beta-lactamase inhibitors has risen; and antibiotic consumption rates in India are still low as compared to ESAC-Net countries (16.0 DID vs. 21.54 DID). To conclude our study has provided the first reliable estimates of antibiotic use in the retail sector in India vis-à-vis ESAC-Net countries. In addition, our study could provide a reference point to measure the impact of interventions directed towards reducing antibiotic use.

India was the largest consumer of antibiotics in 2010 in the world. Evidence suggests that countries with high per-capita antibiotic consumption have higher rates of antibiotic resistance. To control antibiotic resistance, not only reduction in antibiotic consumption is required, socio-economic factors like access to clean water and sanitation, regulation of private healthcare sector and better governance are equally important. The key objective of this research was to investigate the five year trends in consumption of major antibiotic classes in India and compare them with European Surveillance of Antimicrobial Consumption Network (ESAC-Net) countries. We used Intercontinental Marketing Statistics (IMS) Health (now IQVIA) medicine sales audit data of antibiotic sales in the retail private sector (excluding the hospitals sector) in India. We then standardized dosage trends and assigned defined daily dose (DDD) to all formulations based on the ATC/DDD index. We expressed our data in standardized matrices of DDD per 1000 inhabitants’ per day (DID) to compare antibiotic use in India with ESAC-Net countries. The antibiotic use was plotted and reported by year and antibiotic class. Our main findings are—per capita antibiotic consumption in the retail sector in India has increased from 13.1 DID in 2008 to 16.0 DID in 2012—an increase of ~22%; use of newer class of antibiotics like carbapenems (J01DH), lincosamides (J01FF), glycopeptides (J01XA), 3rd generation cephalosporins (J01DD) and penicillin’s with beta-lactamase inhibitors has risen; and antibiotic consumption rates in India are still low as compared to ESAC-Net countries (16.0 DID vs. 21.54 DID). To conclude our study has provided the first reliable estimates of antibiotic use in the retail sector in India vis-à-vis ESAC-Net countries. In addition, our study could provide a reference point to measure the impact of interventions directed towards reducing antibiotic use.

But  since the discovery of Antibiotics in 1928, nearly ninety two years  ago,  we used  antibiotics, to prevent  a simple cut or wound that kills because of a bacterial infection. Antibiotics changed that scenario. These remarkable drugs or “Magic Bullets”are capable of killing the biological organisms or pathogens  in our body without harming us. Under this illusion that making antibiotics is essential for every sneeze and cold (which by the way, are unaffected by antibiotics), and we have collectively overused antibiotics. 

There is the reason when these are meant to be sold only under a registered doctor’s prescription. Primarily, because using such antibiotics are unnecessarily can expose us to unnecessary side effects. Secondly, because each time we use this magic drugs or antibiotics, we allow the few superbugs—bacteria that are able to survive the antibiotics and making those specific bacteria’s  resistant to drugs SAR or antibiotic resistance.  Over the time, the entire population of  bacteria is made up only of these superbugs and our antibiotics no longer work or made it drugs SAR or antibiotic resistance.
Various reports and studies have been conducted over years which sounding the alarm that we have placed ourselves at risk for a world without antibiotics as new class of antibiotics drugs are not getting discovered and existing class of antibiotics drugs are unable to work due to drugs SAR or antibiotic resistance with excessive overuse of these drugs .  The most recent study was released by the World Health Organization (WHO) in 2015 that reported data from 114 countries across all WHO regions. Which clearly shows every country and region, drugs SAR or antibiotic resistance is a problem but is very much worse in those where restrictions on use of antibiotics are not stringent.

SAR- Systematic Antibiotic Resistance now a global pandemic

Even if drugs SAR or antibiotic resistance of some antibiotic drugs emerges in one country, it can spread fast & easily to other countries and put other countries at risk even if they have never taken any course of antibiotics.  What was also disturbing about the WHO report was that very little drugs SAR or antibiotic resistance drugs data were available from important countries like India.

India does not have any organizational standardized national drugs SAR or antibiotic resistance drugs data on resistance rates and everything we know about drugs SAR or antibiotic resistance data comes from a few reports from hospitals and communities. From all these studies in India with 30 drugs isolates or more, drugs SAR or antibiotic resistance rates of E coli to third-generation cephalosporins (new powerful drugs) were 82 percent and to fluoroquinolones was 86.4 percent.  In other words we can say, the next time we need an antibiotic for a urinary tract infection or upper respiratory tract infection, the antibiotics we take normally are not going to work most of the time.

Where Indian  Drugs SAR is going Wrong?

India’s response to the threat of  Drugs SAR or antibiotics drugs resistance  has been unfolding ever since the NDM-1 strain was discovered in a patient who had been hospitalized in New Delhi.  Although much of the media attention  was focused on controversies over this strain which being named New Delhi metallo-beta lactamase (NDM 1), which is frankly speaking is irrelevant (the most common strain of community associated methicillin-resistant Staphylococcus aureus is called USA 300, for example), very little attention was paid to the fact that patients in India were suffering from infections that are now essentially untreatable due to drugs SAR or antibiotic resistance.

Why is Drugs resistance or Drugs SAR getting worse in India? 

The use of antibiotics is increasing across the states .It can be seen that between 2005 and 2009, 40 per cent more units of antibiotics were sold.  Powerful drugs like newer generation cephalosporins are sold far more frequently for no apparent reason and also illegally without doctors prescriptions —between 2005 and 2009, sales of cephalosporins increased 60 per cent.

What about drug use in livestock?

Antibiotics are also used in animals and a significant proportion of drugs SAR or antibiotics resistance is due to its over use in animals. India is one of the major exporter animal food products and 160,000 livestock animals were reported to have been affected by bacterial infections in 2009.   Antibiotics are used in animals to treat infections, for growth promotion using sub-therapeutic antibiotics levels, and for prophylactic purposes to prevent disease. There is high levels of drugs SAR antibiotic resistance in veterinary sectors. Resistant bacteria in animals can spread to humans in several ways like, consumption of animal products, exposure to raw meat products, and direct contact between animals and humans as the main modes of transfer.  Currently Indian laws was laid down to regulate antibiotic use in animals but both these new laws and stronger enforcement of existing laws could slow the spread of drugs SAR or antibiotic resistance in animals and, therefore, humans


WHO report on antimicrobial drugs SAR or drugs resistance skips some obvious truths

We have a serious problem that each of us will face when we or our loved one gets an infection that will simply not go away. It has been a long time since people died of untreatable bacterial infections and the prospect of returning to that world is worrying for the mankind. 

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