COVER STORY/ANTIBIOTIC
IN RURAL and urban markets of Nigeria, antibiotics are sold openly and without any prescription by hundreds of vendors such as Sadiq Abdullahi in Kpana Market in Utako district of Abuja. Abdullahi sells antibiotics like amoxicillin, ciprofloxacin, metronidazole, penicillin and clindamycin. It’s an open, hot and filthy outlet. People crowd his shop as he sells these antibiotics at prices much lower than those of the registered pharmacy.
Vendors like Sadiq Abdullahi do not ask customers for prescriptions and sell any amount of antibiotics, disregarding treatment guidelines. Abdullahi sources his drugs from sellers based on the outskirts of Abuja. But these medicines do not even have the mandatory codes for verification of the country’s National Agency for Food and Drug Administration. Despite his lack of medical qualification, Abdullahi is willing to sell antibiotics to Jumai Abdullahi, a young woman who believes—without medical diagnosis—that she is suffering from typhoid. She represents what is emerging as one of the major reasons for abuse of antibiotics—self-medication. But self-medication is only one of the many ways antibiotics are being misused and this is leading to resistance in microbes.
More than 70,000 people are dying across the world each year due to infectious diseases that have become resistant to antibiotics—the only line of treatment that could have saved their lives. By 2050, the death count will increase to 10 million each year, as much as those killed in the Rwandan genocide—one of the bloodiest in history. Since the development of antibiotics in the 1940s, these drugs have been used extensively. But over the years, the world is using them indiscriminately and inappropriately. Even low- and middleincome countries matched or surpassed consumption in high-income countries between 2000 and 2015. Attempts to combat this resistance only end up throwing new problems. It impacts our overall development agenda now, like the United Nations’ Sustainable Development Goals (SDGs)
Center for Disease Dynamics, Economics & Policy (CDDEP), Washington and Rollins School of Public Health, Emory University, Georgia was used to track global trends in effectiveness of antibiotic therapy in 41 countries in 2018. The result showed that high-income countries had the lowest DRIs and low-income and middle income countries had high DRIs. Among the 41 countries, India was the worst performer.
CONSUMPTION IS RISING. A paper published in in November 2017 says that between 2007 and 2012, total sales rose annually in India. What’s worrying is that this increase was driven by fixed-dose combinations (FDCs)
most of which are not approved for sale. Of the 118 different antibiotic FDC formulations available in the market, only 43 were approved by India’s drug regulator, the Central Drugs Standard Control Organization.
“Unapproved formulations figured prominently in sales figures—270 m units of the FDC antibiotics sold in 2011-12 contained unapproved formulations. The Indian government banned some unapproved FDCs,
including antibiotic formulations, most recently in 2016. But the bans have been challenged by the industry and it appears the FDCs remain on sale,” write Patricia McGettigan, a clinical pharmacologist at Queen Mary University of London and Allyson Pollock, a professor of public health, New Castle University, the UK, in
a news website.
There is also lack of awareness about antibiotics and their correct use, as researchers from Pune-based CSIR-National
Chemical Laboratory found when they assessed a cohort of 504 urban Indians for their knowledge, awareness and practice of antibiotic use and antimicrobial resistance.
According to their findings, published in May 2018 in 47 per cent were unaware of the differences between over-the-counter drugs and antibiotics. One in four were unaware that dose-skipping could lead to ABR. One in 10 bought medicines without a prescription.