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People who routinely take painkillers or antibiotics without medical advice could be putting their kidneys at risk, the drug regulator has warned, urging doctors, pharmacists, and patients to curb the indiscriminate use of these medicines. The Central Drugs Standard Control Organisation (CDSCO) has issued an advisory cautioning against the indiscriminate use of painkillers and antibiotics, warning that their inappropriate or prolonged use can lead to avoidable kidney complications and contribute to antimicrobial resistance. The CDSCO's New Drugs Division said non-steroidal anti-inflammatory drugs (NSAIDs), commonly used as painkillers, and antibiotics are required to be sold and distributed on prescription under the Drugs and Cosmetics Act and Rules.
Public advised against self-medication
The drug regulator said NSAIDs and antibiotics should not be taken indiscriminately, repeatedly or for prolonged periods without medical advice. It specifically advised people not to use antibiotics for self-medication or for illnesses where antibiotic treatment is not clinically indicated, including most uncomplicated viral infections.
Patients prescribed antibiotics have been advised to take them strictly as directed and not share them with others or use leftover medicines.
The CDSCO also asked people with pre-existing kidney disease or other risk factors for renal impairment to inform their healthcare professional before taking NSAIDs.
It said people should seek medical advice if pain, fever or other symptoms persist or recur rather than repeatedly relying on painkillers or antibiotics on their own.
Doctors told to prescribe lowest effective dose
The circular calls on healthcare professionals to prescribe NSAIDs and antibiotics only when clinically indicated, taking into account a patient's clinical condition, age, co-morbidities, other medicines and relevant risk factors.
For NSAIDs, doctors have been advised to consider the lowest effective dose for the shortest appropriate duration, particularly for patients at increased risk of renal impairment.
The CDSCO has also asked doctors to exercise caution while prescribing NSAIDs to patients with renal impairment, dehydration, cardiovascular disease or other conditions that could increase the risks associated with their use.
For antibiotics, the regulator has called for judicious prescribing in line with antimicrobial stewardship principles. Doctors have been asked to consider the likely causative organism, site and severity of infection and, where appropriate, microbiological investigations and local susceptibility patterns.
Unnecessary combination therapy, inappropriate antibiotic selection, incorrect dosing and unnecessarily prolonged antibiotic treatment should be avoided, it said.
Chemists told to comply with prescription rules
The CDSCO has directed pharmacists, retailers and distributors to strictly comply with statutory requirements governing the sale and distribution of Schedule H, H1 and other prescription drugs. The circular states that Schedule H and H1 medicines should not be sold at retail except in accordance with the applicable provisions of the Drugs Rules, 1945.
Pharmacists and retailers have also been told not to encourage or facilitate self-medication with antibiotics or prescription-only NSAIDs and to follow the warnings and conditions of sale printed on the medicines.
Hospitals asked to strengthen monitoring
Hospitals and healthcare institutions have been advised to strengthen systems for rational prescribing and monitoring of NSAIDs and antibiotics. The CDSCO has also called for greater focus on antimicrobial stewardship, prescription review and appropriate patient counselling.
State and Union Territory drug control authorities have been asked to create awareness among healthcare professionals, pharmacists, retailers and the general public about the risks linked to indiscriminate use of NSAIDs and antibiotics and to ensure compliance with the relevant drug laws.
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