Antibiotics to group into categories to combat misuse: Experts

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Medicine
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In a bid to combat the problem of overuse and underuse of antibiotics in India, experts are mulling if antibiotics can be grouped into categories with recommendations when each category should be used. In a revision of the antibiotics section in the National List of Essential Medicines (NLEM) public health experts that met today are deliberating if the WHO’s action plan on antimicrobial resistance which aims to ensure the best use of antibiotics-can be replicated in India.

The WHO in its revision exercise of antibiotics have grouped them into three categories– access, watch and reserve. WHO recommends that antibiotics in the access group be available “at all times” as treatments for a wide range of common infections. While the “watch” group includes antibiotics that are recommended as first- or second-choice treatments for a small number of infections. The third group-reserve includes antibiotics such as colistin and some cephalosporins that should be considered last-resort options.

“All recommendations are taken into consideration. We are studying the WHOs recommnendations,” sources told ET.

The government’s Standing National Committee on medicines which has been tasked to shortlist essential medicines list met the stakeholders today to examine their recommendations before the list is updated and finalised for NLEM 2019.The committee on the National List of Essential Medicines (NLEM) headed by Balram Bhargava, secretary, department of health research and director-general of the Indian Council of Medical Research will decide on those medicines that should be available in adequate numbers and assured quality. “The committee is looking at the inclusion and deletion of those medicines from the NLEM which have become resistant,” added sources. 

The revision of NLEM aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections.

Major pharma lobby groups like Indian Drug Manufacturers’Association (IDMA), Indian Pharmaceutical Association (IPA), Organisation of Pharmaceutical Producers (OPPI) along with non government organisations like All India Drugs Action Network (AIDAN) gave their presentations to the committee of experts consisting of public health experts at the meeting today.

While some pharma lobby groups are of the view that the third line antibiotics should not be included in the NLEM. AIDAN recommendation to adopt a “similar classification as WHO’s AWaRe, adapted to Indian context. “Importantly, we asked the committee to make negative recommendations too in light of the large number of antibiotic irrational combinations and provided guidance in this regard. Risks accompanying rampant use of irrational FDCs of antimicrobials include suboptimal therapy (e.g., administering smaller dose of a drug than is required because it is in a combination), expose of patients to adverse effects (from unnecessary components of fdcs), increased cost, and increased resistance at the individual and community level,”said Malini Aisola of AIDAN. 

Once the committee experts shortlist the list, it will then be sent to a second committee, comprising Rajiv Kumar, vice-chairman of NITI Aayog, Preeti Sudan, secretary of the health ministry, and P.D Vaghela, secretary of the department of pharmaceuticals, for deciding which ones are to be brought under price control

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