What was an assumption until now has received statistical support: the private healthcare industry is now a significant driver of antimicrobial resistance.

According to a paper published by the British Medical Journal (BMJ), private health clinics and private pharmacies may be the leading cause of excessive antibiotic use.

WHO study

“A WHO pilot study in New Delhi found high antibiotic consumption: 43,390 defined daily doses (DDD) per 1,000 patients in the public sector, 125 544 DDD per 1,000 patients in private pharmacies, and 81 467 DDD per 1000 patients in private clinics,” said the paper, titled “Antibiotic resistance and its containment in India”.

India has a dangerous cocktail of extremely high burden of infectious diseases, relatively low oversight and increasing income, which are together increasing the widespread use of antibiotics, it said.

Infections such as pneumonia, diarrhoea and tuberculosis claim hundreds of thousands of lives each year. According to statistics, nearly 3.6 million cases of severe pneumonia were diagnosed in India in 2010, and nearly 300,000 children died of diarrhoea.

“Incomes have risen in India, and antibiotics are cheap, so the threat of infections may lead to their inappropriate use, and precipitate resistance,” the BMJ paper said.

At about 10.7 units per person, the per capita use of antibiotics, however, is still relatively lower in India as compared to countries such as the US. However, India still had the highest total consumption of antibiotics among humans in 2010, further influenced by low level of awareness.

“Without a national surveillance programme for antibiotic resistance, we had to rely on smaller studies that examined resistance patterns and antibiotic consumption in local or institutional settings. These do not provide a full understanding of the scale of the problem, what drives resistance, and effective interventions,” the paper said.

“Systematic surveillance needs to be combined with efforts to increase awareness among professionals in healthcare facilities, and livestock and aquaculture sectors, and the general public to reduce the misuse of antibiotics,” it added.

Animal trade

Blooming animal trade is also increasing the misuse of antibiotics among livestock, the paper said, resulting in resistance developing among animals which are often consumed by people, besides exposing more people who are in contact with these farm animals. The paper estimated that the trade in poultry has increased 40 fold between 1990 and 2014.