Doctors in private sector over-prescribe antibiotics, finds study

Antibiotic prescriptions are highest for children in the age group of 0-4 years

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Indians are having more antibiotics than required, and doctors in private sector are to blame, according to a new study published in the journal PLOS One. 

In 2014, around 519 million antibiotic prescriptions were dispensed, which translates into 412 prescriptions per 1,000 persons per year, according to the study. Antibiotic prescriptions were highest for children in the age group of 0-4 years (636 prescriptions per 1,000 persons) and lowest in the age group 10–19 years (280 prescriptions per 1,000 persons).

Majority of the antibiotics dispensed were for diseases of the respiratory system (55 per cent); around 100 million prescriptions were dispensed for acute upper respiratory tract infections alone. Despite clinical guidelines that antibiotics should not be prescribed for common cold, non-specific upper respiratory tract infection, acute cough illness, and acute bronchitis, literature on antibiotic prescribing from India indicates high rate of antibiotic prescriptions for respiratory infections in primary care, authors of the study found. 

The study, first of its kind, has been done by researchers from the Public Health Foundation of India, and assumes importance in the wake of the country's battle against growing antibiotic resistance. Though the authors acknowledge that India has a high burden of infections and deaths due to diseases such as pneumonia and diarrhea (50 per cent) among children to justify the high usage of antibiotics in the country, they also state that “irrational use of antibiotics” can not be ruled out. 

The study also found that doctors in private health facilities were prescribing more, and expensive newer classes of antibiotics. One of the main reasons for this, they say, is because of the dominance of the private sector in “funding and provisioning” of health care in India – nearly 75 per cent of all outpatient visits and about 60 per cent of hospitalization episodes occurred in the private sector. Besides, people largely buy medicines “directly” from retail pharmacies as prescribed by the general practitioners in the private sector. Authors of the study acknowledge the government's interventions to deal with the problem of irrational use of antibiotics— treatment guidelines, surveillance, regulating the sale of third and fourth generation antibiotics —but say that the results of the efforts are yet to be "demonstrated".