In a move to curb the indiscriminate use of painkillers and antibiotics, the country’s apex drug regulator has issued an advisory asking the public, healthcare professionals, pharmacists, retailers and hospitals to ensure their rational and supervised use lest overuse results in a higher risk of kidney disease.The advisory comes amid concerns over the health risks associated with inappropriate and prolonged use of these medicines, including the risk of chronic kidney disease. Most non-steroidal anti-inflammatory drugs (NSAIDs), commonly used as painkillers, are covered under Schedule H of the Drugs Rules and cannot be sold without a prescription from a registered medical practitioner. Most antibiotics are listed under Schedule H1 and must carry a warning stating: “It is dangerous to take this preparation except in accordance with the medical advice. Not to be sold by retail without the prescription of a Registered Medical Practitioner.”Also Read | India using too many powerful antibiotics meant for specific infections, says global Lancet studyThe regulator said these medicines should be used “only when clinically indicated, in the appropriate dose and for the appropriate duration, and under the supervision of a Registered Medical Practitioner.”No self-medicationThe advisory asks people not to use painkillers or antibiotics indiscriminately, repeatedly or for prolonged periods. Antibiotics should not be self-medicated or used for conditions where they are not clinically required, such as viral infections. Patients have also been advised not to share prescribed or leftover antibiotics with others. People with existing kidney problems, or those at risk of kidney disease, should inform their healthcare professionals before taking NSAIDs.The regulator has advised people to seek medical attention if pain, fever or other symptoms persist or recur rather than repeatedly taking painkillers or antibiotics on their own.Doctors asked to prescribe judiciouslyHealthcare professionals have been advised to prescribe NSAIDs and antibiotics only when clinically indicated, taking into account the patient’s age, medical condition, co-morbidities, risk factors and other medicines.For NSAIDs, doctors have been asked to use the lowest effective dose for the shortest appropriate duration, particularly in patients at increased risk of kidney impairment.Also Read | Expert Explains | Why India’s drug-resistance problem is bigger than antibiotic overuseThe advisory also calls for caution while prescribing NSAIDs to patients with kidney impairment, dehydration or heart disease. For antibiotics, doctors should consider the likely causative organism, site and severity of infection and, where appropriate, microbiological investigations and local antimicrobial susceptibility patterns.“Unnecessary combination therapy, inappropriate antibiotic selection, incorrect dosing and unnecessarily prolonged duration of antibiotic treatment should be avoided,” it states.Pharmacies told not to facilitate self-medicationPharmacists, retailers and distributors have been directed to comply with the rules governing the sale of Schedule H and H1 medicines. Such medicines should not be sold without a prescription except where specifically permitted under the rules.Story continues below this ad“Pharmacists and retailers shall not encourage or facilitate self-medication with antibiotics or prescription-only NSAIDS,” the advisory states.Also Read | Antibiotic-resistant infections kill more patients and cost more, finds major India studyHospitals asked to monitor useHospitals and other healthcare institutions have been asked to strengthen systems for rational prescribing and monitoring of NSAID and antibiotic use.The advisory also recommends prescription reviews and patient counselling wherever appropriate. State drug regulatory authorities have been asked to create awareness among doctors, pharmacists, retailers and the public about the risks associated with indiscriminate use of NSAIDs and antibiotics.