Who's selling OTC antibiotics in Chennai?

CHENNAI: It is not a difficult task to get antibiotics over the counter at pharmacies in the city. Schedule H drugs are sold without prescription at most of the pharmacies in any nook and corner of the city without a prescription.

Just by describing the symptoms to pharmacists, one can procure some of the most commonly used antibiotics like Amoxicillin, Azithromycin, Ciprofloxacin, and Nitrofurantoin and many other schedule H drugs.

Self-medication with antibiotics is a major cause behind the rising incidence of antibiotic resistance. While pharmacies provide antibiotics without prescription and action is taken against them for selling schedule H drugs without prescription in the State, it is unfair to place the entire blame on them.

Pharmacists say that after the pandemic, the use of antibiotics like Azithromycin and Amoxicillin became quite common among the people, as they became aware of treatment protocols. There is a need for awareness on antibiotic resistance. These are basic essential antibiotics so they are readily available and are the most commonly used ones as well," said S Ramachandran, former secretary of Tamil Nadu Druggists and Chemists Association.

He added that even if pharmacists deny giving medicines without prescription, consumers don't accept it or insist on being given the drugs. If one store denies them medicines, they can easily get it from some other one. "In some cases, consumers also use old prescriptions or bring other people’s prescriptions. It is important to track the use of medicines from the stage of manufacturing to the consumption to ensure that pharmacists and consumers both do not abuse or overuse antibiotics," said Ramachandran.

Antibiotics are not advised by medical practitioners for viral infections, as they should be used only if there is a bacterial infection. Former WHO Chief Scientist Soumya Swaminathan had pointed out that during the pandemic, the use of antibiotics for common cold and flu increased manifold and the resistance patterns surged since then. Doctors advise that people should avoid taking medicines for common cold and flu without a prescription as it can lead to increased risks of antimicrobial resistance. Experts also emphasise that there needs to be more research and innovation to understand which antibiotics work for a particular infection.

"People in India are not aware of how to use antibiotics. We cannot blame clinicians or pharmacists alone for the rising incidence of antibiotic resistance. People are directly approaching pharmacies and buying antibiotics over the counter. The lab tests for the bacterium are not done. Also, patients only buy half the course of antibiotics prescribed to them to save money. They only take limited doses and once they feel a little better, they discontinue the drugs, this leads to antibiotic resistance," says Dr Ramesh Nachimuthu, National Joint Coordinator IIMAR and a scientist working on Bacteriophage Research and Therapy.

He added that awareness needs to be across all stakeholders. Though the central government has a plan in place to prevent the surge of antibiotic resistance, the implementation of the same needs more awareness and education among the public.

Earlier this year, the Union Health Ministry had urged all doctors in medical colleges and medical associations to make it a mandatory practice to mention indications and reasons for prescribing antibiotics.

The Director General of Health Services Dr Atul Goel has also appealed to all pharmacists to strictly implement schedule H and H1 of the Drugs and Cosmetics Rules and stop over-the-counter sale of antibiotics and sell them only on the prescription of qualified doctors. The appeal highlighted that the misuse and overuse of antimicrobials are one of the main drivers in the development of drug-resistant pathogens.

Meanwhile, the Drugs Control Department has also taken action to prevent the sale of antibiotics without prescription.

A total of 48 sanctions of prosecution were made from January till November for sale of drugs without the supervision of a pharmacist,

119 for not maintaining proper prescription register, and 27 sanctions of prosecution were issued for not maintaining prescription registers and for the sale of Schedule H & H1 drugs without prescription of Registered Medical Practitioner or not in accordance with the prescription of Registered Medical Practitioner.

ACTIONS TAKEN:

*From January till November this year, the Drugs Control Department issued various sanctions for prosecution

*48 sanctions for prosecution for sale of drugs without the supervision of a pharmacist

*119 sanctions for prosecution for not maintaining proper prescription register

*27 sanctions of prosecution for not maintaining prescription registers and for the sale of Schedule H & H1 drugs without proper prescription