NEW DELHI: The Central Drugs Standard Control Organisation (CDSCO) has issued a strong advisory against the indiscriminate use of painkillers and antibiotics, warning that their unregulated consumption can contribute to serious health complications, including the development and progression of Chronic Kidney Disease (CKD).
The advisory, dated September 21, has been issued to healthcare professionals, pharmacists, retailers, distributors, hospitals and the general public. The Directorate General of Health Services (DGHS) has stressed that Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics should be used only when clinically indicated, at the appropriate dose and for the appropriate duration, and under the supervision of a Registered Medical Practitioner.
Most NSAIDs require a prescription
The DGHS pointed out that the import, manufacture, sale and distribution of medicines in India are regulated under the Drugs and Cosmetics Act, 1940, and the rules framed under it.
Several medicines, including NSAIDs and antibiotics, fall under Schedules G, H, H1 and X of the Drugs Rules, 1945, depending on their risks and applicability. These medicines are subject to prescribed warnings, cautions and conditions governing their sale.
According to the advisory, most NSAIDs are classified under Schedule H and therefore cannot be sold at retail without a prescription from a Registered Medical Practitioner, as required under the Drugs Rules.
The government has also highlighted that most antibiotics are listed under Schedule H1 and carry specific warnings against use without medical advice.
Warning against self-medication
The advisory specifically cautions against taking NSAIDs and antibiotics repeatedly or for prolonged periods without medical supervision.
The public has been urged not to self-medicate with antibiotics, particularly for conditions where antibiotics are not clinically indicated, such as most uncomplicated viral infections. Patients prescribed antibiotics have been advised to follow the prescribed course strictly and not share medicines with others or use leftover antibiotics.
The DGHS has also advised people with pre-existing kidney disease or other risk factors for renal impairment to inform their healthcare providers before taking NSAIDs. If pain, fever or other symptoms persist or return, people have been advised to seek medical attention rather than repeatedly taking painkillers or antibiotics on their own.
Doctors urged to prescribe with caution
For healthcare professionals, the advisory calls for NSAIDs and antibiotics to be prescribed only when medically necessary, after considering factors including the patient’s age, clinical condition, co-morbidities, other medicines being taken and potential risk factors.
Doctors have been advised to use the lowest effective NSAID dose for the shortest appropriate duration, particularly in patients who may be vulnerable to kidney problems.
Additional precautions have been recommended for patients with renal impairment, dehydration, cardiovascular disease and other conditions that can increase the risks associated with NSAID use.
Antibiotic misuse also flagged
The DGHS has called for more judicious antibiotic prescribing in line with antimicrobial stewardship principles. Doctors have been advised to consider the likely causative organism, location and severity of the infection, relevant microbiological investigations where appropriate and local antibiotic susceptibility patterns.
The advisory warns against unnecessary combination therapies, inappropriate antibiotic selection, incorrect dosing and unnecessarily prolonged antibiotic treatment.
Pharmacies and hospitals told to tighten controls
The CDSCO has directed pharmacists, retailers and distributors to strictly follow statutory requirements governing the sale and distribution of prescription medicines.
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 advised against encouraging or facilitating self-medication with antibiotics or prescription-only NSAIDs.
Hospitals and healthcare institutions have been asked to strengthen systems for rational prescribing and monitoring of these medicines. The advisory also calls for stronger antimicrobial stewardship, prescription reviews and patient counselling.
State and Union Territory Drugs Control Authorities have been requested to create wider public awareness about the advisory.
The government’s warning puts renewed focus on the risks of treating everyday pain, fever and infections through unsupervised medication, particularly when repeated or prolonged use can expose vulnerable patients to serious complications.
