Antibiotics handed out at first consultation under scrutiny:Powerful drugs routinely given for cold, cough and fever despite repeated health warnings

India’s battle against Antimicrobial Resistance (AMR) is becoming increasingly difficult. While medical associations often blame over-the-counter sale of antibiotics for the crisis, a Bhaskar investigation into patient prescriptions suggests the problem runs much deeper. An examination of prescriptions issued to children and adults for common ailments such as fever, cold, cough and dental problems found that antibiotics were frequently prescribed during the first visit itself, often without any diagnostic tests to confirm a bacterial infection. Experts warn that such irrational use of antibiotics accelerates antimicrobial resistance, a phenomenon in which bacteria evolve and become immune to medicines that once killed them. According to health experts, if this trend continues unchecked, the world could enter a “post-antibiotic era” where even routine surgeries and childbirth may become life-threatening. Case 1: Azithromycin prescribed on the second day of fever One prescription reviewed by Bhaskar involved a six-year-old child suffering from fever and upper respiratory infection (URI). Although symptoms had begun only a day earlier, the child was immediately prescribed Azithromycin syrup, a powerful macrolide antibiotic generally used for bacterial infections. Case 2: Broad-spectrum antibiotic for common cold and cough A female patient complaining of a routine cold and cough was prescribed Amoxicillin-Clavulanate, a broad-spectrum antibiotic. The prescription was issued despite no indication in the record that the infection had been confirmed to be bacterial. Case 3: Two antibiotics for fever of unknown origin In another case, a 34-year-old patient diagnosed with Pyrexia of Unknown Origin (PUO), dry cough and chills was prescribed two antibiotics simultaneously-Cefpodoxime and Azithromycin-during the first consultation itself. Rule: Test first, then prescribe antibiotics Key recommendations include: Antibiotic introduction up 50% in five years Dr Darshan Kataria, President of the Madhya Pradesh Small Drugs Manufacturers’ Association, said production of third-line antibiotics such as Meropenem and Ceftriaxone has increased by nearly 50% over the past five years. “The demand for these drugs has increased both in government procurement and the private sector. It reflects growing antimicrobial resistance and declining effectiveness of conventional antibiotics,” he said. Medical stores alone cannot be blamed Rajiv Singhal, National Secretary of the All India Organisation of Chemists and Druggists, said pharmacists are frequently blamed for AMR because of over-the-counter antibiotic sales. “We have repeatedly instructed our members not to dispense antibiotics without prescriptions. But if prescriptions themselves are increasingly carrying such drugs, then that aspect also needs serious scrutiny,” he said. Bhaskar expert “Treatment Must Be Evidence-Based, Not Based on Assumptions” Senior physician Dr V.P. Pandey said antibiotics should not be prescribed merely on the basis of symptoms. “ICMR guidelines clearly recommend culture and sensitivity-based treatment whenever required. If protocols are ignored, we may enter a post-antibiotic era where routine surgeries and deliveries become high-risk procedures,” he said. “No antibiotics for routine fever, cold and cough” Infectious disease expert Dr Salil Bhargava said every hospital should formulate its own antimicrobial plan based on infection-control committee data. “Each hospital has a different infection pattern. Antibiotics should be used rationally and rotated periodically to maintain their effectiveness. No doctor should prescribe antibiotics for routine fever, cough and cold,” he said.