Antibiotic use for typhoid in India: Estimation from private sector prescription data during 2013-15

Background India’s typhoid burden estimates are based on a limited number of population-based studies and data from a grossly incomplete disease surveillance system. In this study, we estimated the total and sex- and age-specific antibiotic prescription rates for typhoid. Methods We used systematic antibiotic prescription by private sector primary care physicians in India. We categorized antibiotics using the WHO classification system and calculated the prescription for various classes of antibiotics. Results We analyzed 671 million prescriptions for the three-year period (2013-2015), of which an average of 8.98 million antibiotic prescriptions per year was for typhoid, accounting for 714 prescriptions per 100,000 population. Combination antibiotics are the preferred choice of prescribers in the adult age group, while cephalosporins are the preferred choice in children and young age. The prescription rate decreased from 792/100,000 in 2013 to 635 in 2015. Conclusion We report a higher rate of antibiotic prescription for typhoid using prescription data, indicating a higher disease burden than previously estimated. Quinolones are still widely used in monotherapy, and children less than 10 years account for more than a million cases annually, which calls for a routine vaccination program. What we already know Typhoid is a major cause of morbidity in India especially among young adults and children. The reported incidences are based on data from limited number of population-based studies and the disease surveillance program which is largely limited to public healthcare system in India. The emergence of antibiotic resistance among typhoid is a growing concern. What this article adds Age-specific typhoid antibiotic prescription estimate for India, using a large volume of geographically representative medical audit data. We report a high rate of antibiotic prescription (714/100,000 population) for typhoid indicating a higher disease burden than previously estimated. Fluroquinolones are still widely used as monotherapy for the treatment of typhoid in India.