Disclosing these findings of a survey conducted jointly by the Delhi Government and the European Union, Professor J.S. Bapna, Director, Institute of Human Behaviour and Allied Sciences, today made a strong case for the rational use of antibiotics to prevent them from becoming redundant.

``Clinical decisions are not based on scientific evidence,'' Bapna said, pointing to the tendency of doctors, especially those in private practice, to prescribe antibiotics without waiting for the results of a bacterial culture.

``The foremost principle for the use of antibiotics is that these should target a narrow spectrum of bacteria, but the use of broad-spectrum drugs like amoxicillin and ciprofloxacin is widespread. These only expose patients to the risk of resistance.''

The survey, based on a scrutiny of 5,000 prescriptions at 80 of the city's 800-odd pharmacies, also revealed that 89 per cent of the city's doctors prescribe antibiotics for ailments like an itchy throat or a common cold, and that this practice is widespread in private clinics.

``Sometimes doctors prescribe two or three antibiotics for one ailment,'' emphasised Bapna, who also chairs the Delhi Government's committee for the selection of essential drugs and quality assurance. ``But what's distressing is that doctors are favouring newer and more expensive antibiotics because they don't want to take chances against drug resistance. So, they would rather prescribe the Rs 100 per day third-generation cephalosporin injection, when the Re 1 per day septran is as effective''.

Such widespread and irrational use of antibiotics has made drug resistance an established fact at Delhi's hospitals. Last year, a hospital-based study at the Maulana Azad Medical College revealed that certain bacteria were 100 per cent resistant to penicillin, amoxicillin and cloxacillin (that is, one of Delhi's major hospitals will only be wasting money and exposing patients to adverse reactions if it prescribes these drugs, otherwise known to be effective yet inexpensive). Significantly, ciprofloxacin and erythromycin, too, were effective in just 30-32 per cent of the patients studied.

Vancomycin was the only antibiotic that proved to be 100 per cent effective, but it comes for Rs 300 a capsule! Bapna, though, cautioned against doctors and patients rushing for such expensive therapy to circumvent the problem of resistance. ``A more expensive treatment does not mean a better treatment,'' he insisted. ``And the problem with new-generation antibiotics is that we know very little about their side-effects''.