The relative consumption of Watch antibiotics in India is nowhere close to Japan’s 83%, the highest clocked, but India’s 65% showing earned it the second spot in terms of indiscriminate consumption of these antibiotics.
The WHO considers antimicrobial resistance (AMR)—of which antibiotic resistance is a subset—a global health emergency. Indeed, AMR already kills nearly 700,000 people every year—230,000 die due to multi-drug-resistant (MDR) TB—and, in a business-as-usual scenario, could result in 10 million deaths annually by 2050. Now, a study by researchers at the Center for Disease Dynamics, Economics and Policy, published in The Lancet Infectious Diseases, says that global consumption of antibiotics registered a 40% increase between 2000 and 2015, on the back of a massive increase in consumption in low and middle-income countries (LMICs). The global per capita consumption of Watch antibiotics increased by 90.9% during the period—in 2019, the WHO had come up with the Access, Watch, Reserve (AWaRe) classification of antibiotics, based on resistance potential with Access being low-potential, Watch being high-potential and Reserve being ‘last-resort, restricted use’ antibiotics. India stands out sorely, as the world’s largest consumer of antibiotics—6.3 billion daily defined doses (DDD) of antibiotics consumed in 2015, compared with China’s 3.8 billion and the US’s 2.9 billion, respectively the second- and third-largest consumers of antibiotics.
Worryingly, India’s showing is largely on the back of an increase in consumption of Watch antibiotics—while its relative consumption of Access antibiotics (in the overall pool of antibiotics consumed) fell from 56.8% to 27.2%; together with China, it accounts for 6.6 billion DDDs of 15.2 billion of Watch antibiotics consumed in 2015. The relative consumption of Watch antibiotics in India is nowhere close to Japan’s 83%, the highest clocked, but India’s 65% showing earned it the second spot in terms of indiscriminate consumption of these antibiotics.
While access to life-saving drugs, including Access antibiotics, is a major concern for LMICs, including India, the Indian case also highlights its problem of antibiotic stewardship—or directing responsible use of antibiotics. The WHO sets a target of a 60% share for Access antibiotics in the overall pool of antibiotics consumed. A country like India, which already sees a high number of MDR TB cases, can hardly afford to lose control of antibiotic consumption. The good news is that India has taken significant steps over the past few years; it announced the National Action Plan on AMR in April 2017 and added a sixth pillar to the five pillars of the Global Action Plan—strengthening India’s leadership in the global fight against AMR. Kerala became the first state to adopt a state-level AMR action plan last year. India has also set up an AMR lab surveillance network, apart from laying down national guidelines on antimicrobial use. But, there are still many gaps—on the broader level, from clinical antibiotic abuse to abuse by poultry and dairy, from improper pharma effluent disposal to drug pricing policy’s impact on drug quality, it has to be a multi-front battle.