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            09 / 01 / 17

            Disregard for dosages makes India the epicentre of antibiotic resistance

            • Indian culture isn’t strictly prescriptive. Being exact isn’t a virtue in India. Every assertion is taken with a pinch of salt. We are a culture that is fuelled by approximations. This affects our understanding of time, space and quantity. An appointment at 5pm could have a starting point anywhere from 15 minutes to an hour after the scheduled time. The idea of space and quantity has varying definitions that depend on the person and their experience set. This trait impacts the way Indians interact with the world around them, including in the sphere of health and wellness.

              Erratic attitudes towards dosing

              Patients who are prescribed medication will leave the doctor’s clinic with a clear set of instructions that are easy to follow. However, there is a huge variance in terms of how people follow these instructions, frequently exceeding or falling short of the recommended dosage.

              This is becoming such a huge health concern that recently, Prime Minister Narendra Modi appealed to the Indian populace through the 22nd edition of his monthly programme 'Mann ki Baat’ to follow doctors’ prescriptions precisely. He also cautioned against the overuse or underuse of antibiotics.

              Modi especially stressed the need to follow the entire course of medicines prescribed by doctors and spoke of the consequences of not doing so.

              “I request you to complete the course,” he said. “Because if you take more than prescribed antibiotics, or even less, it is in the benefit of the disease-causing microbes. It is important to complete the course.”

              The beliefs behind the behaviour

              The belief that antibiotics will provide for fast relief often leads Indians to over dose if they don’t feel better soon after the treatment begins. In other cases, there is the tendency to abandon the prescribed course of medication once the patient starts feeling better. They do not follow through on the complete treatment, and often neglect to return to the doctor for a check up.

              The reason for this is that our notion of health centres on its physical manifestation. As long as the symptoms of illness are visible or felt, Indians consider themselves to be sick. Once these symptoms disappear or diminish, they think that their bodies have healed and continue with their daily lives, abandoning the treatment all together. Taking medication even after the symptoms have disappeared is thought to do unnecessary harm to the body.

              Self-medication is commonplace

              For Indians, self-medication is usually the first form of treatment. One of the main reasons for this is that lower-income people wish to avoid doctors’ high consultancy fees. In these scenarios, they self medicate based on the recommendation of the chemist or a friend. But even among the educated upper classes in India who can afford consulting a doctor, self-medication is very common.

              This is a source of major concern, since a lack of precision in dosing is causing more harm than good. The World Health Organisation (WHO) has underscored the control of self-medication as it results in wastage of resources and increased resistance to pathogens, besides creating serious health hazards and prolonged illness. Often, self-medicating patients either don’t recover fully, relapse soon after, or fall prey to side effects.

              The challenge for pharmaceuticals companies

              The tendency to self-medicate common ailments with antibiotics is so high that India is considered the epicentre of antibiotic resistance. Microbes are achieving super resistance and increasingly common curable ailments are becoming life threatening.

              When Princeton University analysed antibiotic consumption between 2000 and 2010, they found that antibiotic usage globally rose by 36 per cent while in India it went up by 62 per cent. This variance can only be explained by the ease of availability of medicines over the counter and the lax attitude that Indians have towards dosage.

              Dosing is a major challenge that the pharmaceutical industry faces as it navigates a complex market like India. Often medicines are blamed when treatment fails, irrespective of the irregularities in dosage.

              Education and a strong policy for selling medication only with prescriptions are required in order to change this dangerous behaviour. The challenge of enacting a major cultural change now lies in the hands of the pharmaceutical industry and the Indian government.

              Health through the Culture Lens is a weekly series exploring important cultural currents in health and pharma

              • Article by Sriharsh Mallela