No prescription, no pills: Govt cracks whip on misuse of painkillers, antibiotics

The central government has asked pharmacies, doctors, and hospitals to crack down on the casual use of painkillers and antibiotics, citing kidney-related complications from indiscriminate use of non-steroidal anti-inflammatory drugs (NSAIDs) and the growing threat of antimicrobial resistance from inappropriate antibiotic use.

In a September 21 circular, the Central Drugs Standard Control Organisation (CDSCO) asked pharmacists, retailers and distributors to strictly follow prescription requirements for Schedule H and H1 medicines.

“Pharmacists and retailers should not encourage or facilitate self-medication with antibiotics or prescription-only NSAIDs,” the government said.

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Most NSAIDs fall under Schedule H, while most antibiotics are covered under Schedule H1. Their retail sale is subject to prescription requirements under the Drugs Rules, 1945, according to the circular. The directive does not impose a new ban or create a new prescription category; instead, it seeks stricter compliance with existing rules governing the sale and use of these medicines.

The CDSCO specifically flagged the renal risks linked to inappropriate NSAID use. It advised people with pre-existing kidney disease or other risk factors for renal impairment to consult healthcare professionals before taking NSAIDs. Consumers were also cautioned against using these medicines repeatedly or for prolonged periods without medical advice.

Doctors have been asked to consider a patient’s clinical condition, age, co-morbidities, concomitant medicines and other risk factors before prescribing NSAIDs and antibiotics. “The lowest effective dose for the shortest appropriate duration should be considered when prescribing NSAIDs, particularly for patients at increased risk of renal impairment,” the government said.

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The circular also called for caution while prescribing NSAIDs to patients with renal impairment, dehydration, cardiovascular disease and other conditions that could increase drug-related risks. The government advised people to seek medical attention if pain, fever or other symptoms persist or recur, instead of repeatedly taking painkillers or antibiotics on their own.

On antibiotics, the CDSCO warned against their use when treatment is not clinically indicated, including in most uncomplicated viral infections. Doctors have been asked to prescribe antibiotics judiciously, taking into account the likely causative organism, the 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 treatment should be avoided,” the government said.

Hospitals and healthcare institutions have been asked to strengthen systems for rational prescribing and monitoring of NSAIDs and antibiotics, including prescription reviews, antimicrobial stewardship and patient counselling.

The CDSCO has asked State and Union Territory drug control authorities to create awareness among healthcare professionals, pharmacists, retailers and the public about the risks of indiscriminate use of these medicines. It has also asked them to ensure compliance with the Drugs and Cosmetics Act, 1940, and the Drugs Rules, 1945.

The government said the measures are aimed at promoting the “rational, safe and responsible use” of NSAIDs and antibiotics and preventing avoidable adverse drug reactions, kidney complications and antimicrobial resistance.