Mandatory monitoring of medicines

Recent surveys by the clinical pharmacy and pharmacology departments of two universities in Dhaka on the use of medicines in Bangladesh seem to suggest that far too many antibiotics get prescribed here. Then again, these are not always used as required, with the result that the otherwise life-saving drugs end up losing their effectiveness as specific disease-causing microbes become resistant to the prescribed antibiotics. This kind of behaviour, in fact, has been noticed in other parts of the world as well, leading, over the years, to a veritable crisis in medical treatment worldwide. In Bangladesh some 40 per cent of the total amount spent on medicines is said to be on account of antibiotics, and that amounts to more than forty billion taka, according to one estimate. The preliminary findings are that 80 per cent of patients admitted to surgery, general medicine and pediatrics are given antibiotics because often the state of the patients is so acute as to lead even the best and well informed doctors to prescribe broad spectrum antibiotic cover rather than risk infection ---- regardless of the other risk of antibiotic resistance. One physician in Dhaka's Apollo Hospital admitted in the course of treating a patient with severe lung infection that he was giving multiple antibiotics because there was nothing else to do! It is no longer denied that antibiotic resistance is a global crisis today. It was, in fact, suspected decades ago as more and more pathogens proved smarter than the drugs when not used properly ---- at the right dose and duration. According to the World Health Organisation (WHO), in the US 25 to 30 per cent of hospital patients are given antibiotics although half of them don't need them at all! The Lancet last year claimed to have identified a new 'superbug' resistant to even the most powerful broad-spectrum antibiotics available, which could lead to unmanageable infections spreading rapidly across the world, such as bouts of the nastiest 'loose motion'. Such infections, though not uncommon here, have reportedly been seen in the US, Canada, Australia and the Netherlands as well, soon after The Lancet revelation. The subcontinent is obviously a hotspot given the general health and sanitation situation, compounded by indiscriminate use of antibiotics ---- self medication, taking small doses and discontinuing treatment when they feel better! Practicing physicians ought to go for compulsory drug-sensitivity tests, prior to prescribing any antibiotics. However, in Bangladesh facilities for such tests are available only in selected urban labs and hospitals, although the Alliance for Prudent Use of Antibiotics, established as part of the path-breaking New Drug Policy of the mid 1980s, has long been calling for action on this crucial front. 'Poly-pharmacy,' or prescribing too many medicines simultaneously regardless of the side effects and the potential for harm, is also a very big health hazard here. Given the fact that the population is largely unlettered and socially at the lower rungs compared to the status of the prescribing doctors, the latter most often can get away with insensitivity and abuse without risk to their practice ---- without so much as a 'why' or 'what' from the receiving end. Some doctors are not above prescribing anti-depressants and other related psychiatric drugs even for people who have had no such disorders. This kind of abuse might lead to an epidemic of doctor-induced mental disease, unless saner elements in the medical establishment and pro-people health activists take up the issue, to institute mandatory monitoring of prescribed medicines.