India’s typhoid burden decreasing, study of antibiotic prescription trends shows

PTI

New Delhi, October 20

Typhoid burden is decreasing in India, although overall cases are higher than previously estimated, shows a multi-year study of nationally representative antibiotic prescription data.

The researchers found that young adult patients account for close to one-third of the typhoid cases and children less than 10 years old account for more than a million cases annually.

The study, published in the BMJ Open journal, calls for including Indian’s own typhoid vaccine in its national immunisation programme.

“The key findings of the study include decline in cases from 9.9 million in 2013 to 7.9 in 2015 — largely in the north and west regions, but children less than 10 years account for more than a million cases annually, males and boys have the highest burden,” Dr. Shaffi Koya, Research Fellow at Boston University School of Public Health, US, told PTI.

“10 different antibiotics accounted for 73 per cent of all prescriptions. Combinations and cephalosporins were the most prescribed antibiotics. Cefixime–ofloxacin combination is the preferred choice except in south India,” Koya said.

The data came from prescriptions of a panel of 4,600 private sector primary care clinicians selected through a multistage stratified random sampling.

The data had 671 million prescriptions for antibiotics extracted from the IQVIA database for the years 2013, 2014 and 2015.

The study provides the first age-specific typhoid antibiotic prescription estimates for India, using a large volume of geographically representative medical prescription audit data.

It shows a high rate of antibiotic prescription (714/100,000 population) for typhoid indicating a higher disease burden than previously estimated, especially among young adults and children, the authors said.

The team, including researchers from Public Health Foundation of India, New Delhi and Qatar University, noted that the lack of laboratory confirmation of typhoid may lead to some degree of misclassification.

However, this is reflective of the real-world setting, where laboratory confirmation is not the norm in India, they said.

There were 8.98 million antibiotic prescriptions per year for typhoid, accounting for 714 prescriptions per 100,000 population, according to the study.

Children 10–19 years of age represented 18.6 per cent of the total burden in the country in absolute numbers, 20–29 year age group had the highest age-specific rate, and males had a higher average rate (844/100, 000) compared with females (627/100,000), the researchers found.

Ten different antibiotics accounted for 72.4 per cent of all prescriptions. Cefixime–ofloxacin combination was the preferred drug of choice for typhoid across all regions except the south, they said.

Combination antibiotics are the preferred choice of prescribers for adult patients, while cephalosporins are the preferred choice for children and young age, according to the researchers.

Quinolones were prescribed as monotherapy in 23 per cent of cases, they said.

“Introduction of conjugate typhoid vaccine in routine immunisation programme can further reduce the typhoid burden and antibiotic demand in India,” Koya added.