India: Over-counter drugs fuel TB threat
CHENNAI: Doctors are waging a losing battle against tuberculosis with chemists indiscriminately selling drugs over the counter. Four months after the Union health ministry's ban on the sale of 46 drugs without prescription, the contribution of pharmacists in the city to the growing pool of drug-resistant bacteria remains unabated.
Doctors say repeated and wrong use of antibiotics is the main cause of increase in drug-resistant bacteria. Although the state Directorate of Drug Control promised strict action against medical stores selling these 46 drugs, mostly for TB and respiratory ailments, without prescription, most drugs are available over the counter in many pharmacies in the city.
In 2013, the Union health ministry introduced a new schedule in the Drugs and Cosmetics Act, which came into force on March 1, 2014. The schedule has made it almost impossible to buy antibiotics, anti-TB and habit-forming drugs without prescription from a registered medical practitioner. The move was made to check the indiscriminate use of antibiotics, anti-TB and other drugs in the country.
Director of Drugs Control Abdul Khader said, "We have been checking if the 536 drugs under the previous H schedule are being sold without prescription. We have also sent a directive to all pharmacies to add the new list to their sale records," he said. Since last June, 217 stores were booked for selling antibiotics without prescription, he added.
But many pharmacies TOI visited in T Nagar, Anna Nagar, Nungambakkam and Vadapalani didn't have a prescription registry as mandated in the new schedule. According to the new rules, the prescription register, either manual or computerized, should comprise the name and addresses of the prescriber and the patient, name of the drug and the quantity sold. This record has to be maintained for three years. But only a handful of shops maintain this register.
Some claimed they were unaware of the new schedule, some brought out dusty registers with the last entry made months ago, while many refused to show the registry.
The new schedule includes 24 antibiotics, 11 anti-TB drugs and 11 psychotropic drugs. The packaging of these drugs will have mandatory warning printed on them in a box with a red border on the label and will be sold by chemists on production of a prescription.
Doctors have welcomed the introduction of the new schedule, but feel more needs to be done for enforcement. "People don't realize the danger of relying on pharmacists to buy medicines. For example, if a person has hypertension and asthma and asks for a drug like Cardace, he is inviting trouble. The medicine is good for hypertension, but causes bronchial constriction which will aggravate asthma," said asthma and allergy specialist Dr R Sridharan. He said he had seen several patients who had taken sub-optimal doses, overdoses or discontinued antibiotic courses. "All these lead to bacterial resistance."
The fight against TB has taken the biggest hit because of the sale of drugs without prescriptions. "Drugs like Moxifloxacin, used to treat multi-drug resistant tuberculosis, have been included in the schedule. If these are sold over the counter like generic drugs, it would increase the resistance of the bacteria. This, in turn would lead to spiralling cases of extreme-drug resistant tuberculosis," said Dr Ramya Ananthakrishnan of REACH, which has been striving to bring doctors and pharmacists on a common platform. To add to the woes many a times pharmacists leave the shops in the care of a subordinate, she added.
Source: The Times of India
