India mandates justification for antimicrobial prescriptions in Medical Colleges

Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them

The Health Ministry has mandated that doctors in medical colleges must mention the justification while prescribing antimicrobials. In a letter dated January 1, the Director General of Health Services, Dr. Atul Goel, appealed to doctors at all medical colleges in India.

“Doctors in medical colleges [are] to mandatorily mention the exact indication/reason/justification while prescribing antimicrobials,” the letter said. “Misuse and overuse of antimicrobials is one of the main drivers in the emergence of drug-resistant pathogens,” it added.

Antimicrobial resistance (AMR) is one of the top ten public health threats to human beings, according to the World Health Organization (WHO). According to the US CDC (Centers for Disease Control), antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them.

The letter cites estimations that bacterial AMR directly caused 1.27 million deaths worldwide in 2019, with an additional 4.95 million deaths associated with drug-resistant infections.

A recent government study titled "The First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22," conducted by the National Centre for Disease Control (NCDC) under the Union Health Ministry, found that antibiotic use was very high in India.

The survey indicates that, on average, "watch" group antibiotics were prescribed more frequently (57 percent) than those categorized under "access" (38 percent) at the surveyed sites.

"Watch" antibiotics, known for their higher potential for antimicrobial resistance, are commonly administered to sicker patients in medical facilities. Notably, 4.6 percent of patients were found to have taken four or more types of antibiotics.

The Director General's letter emphasizes that AMR not only jeopardizes the advancements in modern medicine but also poses a threat to effective infection prevention and treatment. It warns of prolonged illnesses, increased risk of death, extended periods of infectivity, and prohibitive costs associated with second-line drugs.

The directive underscores the importance of this measure in medical colleges, which serve not only as providers of tertiary healthcare but also as crucial centers for educating the next generation of doctors.

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