Saturday, 27 February 2016

Draft IMA Antibiotics Policy

Draft IMA Antibiotics Policy

Dr KK Aggarwal

In a survey conducted by IMA, it was revealed that 50% of the healthcare providers felt that costlier medicines are stronger and better; 70% felt that newer drugs are better and stronger; 87% felt that minimum 2 antibiotics are required for fever; 80% co-related cough with necessity of antibiotics; 90% used Lerofloaxem  for Respiratory Tract infections and 50% were not aware with the terminology called Healthcare associated infections.  70% of them felt that it is cheaper to give an antibiotic than to investigate a patient in an overcrowded OPD.

Most practitioners were also afraid of legal and Consumer Protection Act implications.

Recently a case was filed against a Pediatrician under IPC 269 & 270 where he was charged criminally negligent as the neonate development hospital acquired septicemia

Central Government Act
Section 269 in The Indian Penal Code
269. Negligent act likely to spread infection of disease danger­ous to life.—Whoever unlawfully or negligently does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

Section 270 in The Indian Penal Code
270. Malignant act likely to spread infection of disease danger­ous to life.—Whoever malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.”

MCI Ethics Regulations 2.4 talks about that a patient should not be neglected. Also MCI Regulation 3.1.2 warns not to do investigations in a routine manner.  On the contrary,  2002 Judgement of Supreme Court by Justice M. Kartzoo said that one should not  rely only on clinical history but also go for investigations when indicated.

“MCI Ethics Regulations
2.4 The Patient must not be neglectedA physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient or patients from necessary medical care.

1.1.2        Consulting pathologists /radiologists or asking for any other diagnostic Lab investigation should be done judiciously and not in a routine manner.”

We have not come across on any legal case against a doctor for using Antibiotics. In most of the cases, cases for filed for not using antibiotics. 
Medical profession is often blamed of over prescribing, writing newer drugs when older drugs are equally affected. British Media, especially BMJ & Lancet, has been writing that development of bacterial resistance in India is because of corruption and over use of antibiotics. 

Most doctors in India work in adverse situations which is the major factor for development of drug resistance.

Drug General Controller of India does not inform the introduction of newer drugs or banning of a drug to each & every doctor on a regular basis.  Just putting the information in a newspaper or on the website is not the answer, as 50% of the doctors even today are not digital friendly.

As per MCI 1.2.3 Regulation, medical graduates needs to update their knowledge on a regular basis but the Council has not made it mandatory for the medical colleges to hold annual review programme on an yearly basis.  Most of the medical updates are pharma sponsored and the information, a practitioner gets, is often biased.

Price variations are allowed in the country. In a recent IMA Survey, it was found that the drug Meropanam (with equivalent salt)  can be available at Rs. 500/- as well as at Rs.2,800/-.

Multiple brands in the country will invariably allow practices to lure doctors.

The list of drug prices is also not available on a centralized Govt. website.

A General practitioner has no access to anti biogram or recommendations from Infection Control committee. Even NABH does not enlist that information.  

Even the Govt. Policy of intermittent regimen for treatment for TB and now shifting to daily  regimen has created more confusion than right answer.

Govt. has opened Jan Aushadhi Kendras but most of the essential drugs are not available there.

Most of the doctors fear prescribing Pencilin and Septron though pencilin still has no resistance to any antibiotics.

No regulation against quacks, AYUSH doctors, chemists and Nurses to prescribe allopathic antibiotics also ends up in over and irrational prescriptions.

UN-checked use of antibiotics in animals  husbandry & agriculture use adds to the existing problems.

IMA Contribution:

·         IMA is compiling 10 Points which every doctor must know about antibiotics ·         IMA is appointing an Independent Infection Control Committee at National/State and Branch level. ·         IMA is conceptualizing Trade Tendering for vaccines so that they are available at a cheaper cost to the patients. ·         IMA is compiling a book on “ when not to use antibiotics”.

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