Kerala’s antibiotic misuse policy: AMR reduction?

• Kerala, the first state in India to ban the over-the-counter sale of antibiotics without a prescription, has seen a significant decrease in the irrational use of antibiotics.
• The state has seen a fall of Rs.1,000 crore in the sale of antibiotics through hospitals and medical stores across Kerala in the last year.
• Kerala enforced the Indian government’s 2011H1 rule to prohibit the sale of all antibiotics without a prescription.
• The 2011 H1 rule, which prohibits the sale of all classes of antibiotics without a prescription, was modified in 2013 to allow first-line antibiotics to be sold over-the-counter without a prescription.
• Kerala’s success in enforcing the 2011 H1 rule is attributed to its high doctor-patient ratio and varied healthcare-seeking behavior.
• Dr. Abdul Ghafur suggests Kerala should consider adopting the modified 2013 H1 rule, which monitors only second and third-line antibiotics while allowing the sale of first-line antibiotics without a prescription to continue without strict monitoring.
• Kerala’s reliance on other States for vegetables, eggs, and broiler chicken makes it vulnerable to the continuous import of antibiotic-laden products.
• Kerala’s AMR efforts can only have a lasting impact if it becomes self-sufficient and stops importing poultry, eggs, and vegetables from other States.
• The 2011 H1 rule, which prohibits the OTC sale of all classes of antibiotics, will not be implemented by other States.