ANTIBIOTIC ABUSES OF T.B.PATIENTS

ANTIBIOTIC ABUSES BY PHARMACIES

This article has been prepared on the basis of recent research which revealed that many pharmacies in cities like Delhi, Mumbai, and Patna, abuse their customers who come to their pharmacies with complaints of serious infections. The tragedy is these pharmacies are not giving them proper counsellings or advice to see the doctor.

Two model healthy customers were sent to the pharmacies in the disguise of patients. One such customer complained that he has a cough for the last ten to fifteen days. The other customer told them that he was having a cough for the last two months and was diagnosed with T.B.with positive results.

The first customer was dispensed with antibiotics (50% pharmacies out of which 13% pharmacies dispenced 4fluoroquinolones) and steroids(8% of the pharmacies).

The second customer with the complaint of cough for several months has got the advice to see the doctors.

The study shows that pharmacies as they could not dispense first line T.B.drugs without proper prescriptions(should be kept for at least 2 years in their records) they are not interested in dealing with them. Hence with a blindfold they randomly dispensing antibiotics freely to the customers without proper diagnoses they cause Antibiotic Resistance to the patient.

4-Fluoroquinolone causes Multi-Drug Resistant(MDR) Tuberculosis if dispensed to a T.B.patient without any proper diagnoses.

The MDR T.B. is more serious than ordinary T.B

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Pharmacies not likely cause of TB drug resistance

Most pharmacies in Delhi, Mumbai, and Patna found to be liberally dispensing antibiotics to TB patients even without a prescription. But none of them handed out first-line anti-TB drugs

For a while now, the medical community has been blaming pharmacies for indiscriminately giving antibiotics to patients with tuberculosis (TB), instead of referring them to a doctor. A Lancet paper has now corrected the popular misconception when a study found that none of the 622 pharmacies in Delhi, Mumbai, and Patna handed out first-line anti-TB drugs to these patients. So, pharmacies are the unlikely source of irrational drug use that contributes to multidrug-resistant tuberculosis.

Not playing a role

The study shows that pharmacies are not playing any role in increasing TB resistance in the country,” says Dr. Srinath Satyanarayana, from McGill University, Montreal, Canada, who is the lead author of the paper that was published on August 26, 2016. “TB drug resistance occurs primarily due to incorrect regimens, intake of drugs irregularly or intake of drugs for a very short duration of time. From our study, it appears that pharmacies are not playing a role in deciding the anti-TB regimens and are also not dispensing anti-TB drugs over-the-counter, at least in the three cities that we studied. So the drug resistance in India could be due to either patient related-factors or provider-related factors or health system-related factors (which has not created a system for all TB patients in [the] country to access quality-assured diagnosis and treatment free of cost and seamlessly),” he says in an e-mail to The Hindu.

One reason why pharmacies did not dispense first-line, anti-TB drugs could be because they belong to a more stringent Schedule H1 category of drugs where details of the prescription and name of the doctors and patients have to be documented and the registry retained for two years.

Quinolone abuse a concern

However, the good news ends here. The researchers found that that a vast majority of these pharmacies did dispense antibiotics to TB patients even when they did not have a prescription. This links to an earlier study that showed the tendency of private practitioners to liberally use antibiotics in treating TB, leading to a delay in diagnosis and treatment and an increase in the chances of TB spreading within a community.

In the Lancet study, healthy individuals were trained to pose as TB patients and interacted with pharmacists — to understand how the pharmacies in these cities treated patients presenting themselves with TB symptoms. The objective was to determine whether the pharmacies were contributing to the inappropriate use of antibiotics. One patient presented with 2-3 weeks of cough and fever, was directly seeking drugs from a pharmacy while a second patient was presented with one month of cough and microbiological confirmation of TB from a sputum test. In the case of the first patient, only 96 of 599 pharmacies (16 percent) referred the patient to health-care providers. But ideal case management was in only 13 percent of the cases, as a few pharmacies handed out antibiotics to the patients even while referring them to a physician. Antibiotics (37 percent), steroids (8 percent), and fluoroquinolones (10 percent) were given to patients with symptoms.

“That nearly 37 percent of the pharmacies are handing out antibiotics to persons presenting with TB symptoms is really worrisome,” says Dr. Satyanarayana. But more worrying is the dispensation of fluoroquinolones. “Fluoroquinolones are an essential part of the MDR-TB [multi-drug-resistant tuberculosis] treatment regimen and emerging regimens, so quinolone abuse is a concern.”

Impact

In stark contrast, in the case of the second patient, who had a microbiological confirmation, 67 percent (401 of 601) of pharmacies referred the patient to a health-care provider. Like in the earlier case, ideal case management was seen in only 62 percent as the standardized patient did receive antibiotics (16 percent) or steroids (3 percent) even while being referred to a health-care provider. “In the case of TB patients with microbiological confirmation of TB disease, antibiotics (without anti-TB properties) will be ineffective and unnecessary and can delay the initiation of proper therapy for patients. These patients will continue to spread the disease in the community and TB disease will continue to progress in the individual concerned. Steroids reduce body immunity, suppress symptoms temporarily, and can worsen the TB disease,” he says.