In 2011, the Indian government introduced the H1 rule to prohibit the over-the-counter (OTC) sales of antibiotics without a prescription, responding to the growing concern over antimicrobial resistance (AMR). However, due to the healthcare system’s heterogeneity across the country, the implementation of this rule faced significant challenges. In 2013, following the Chennai Declaration document and initiative by medical societies in India, the Indian government modified the rule to limit the OTC restriction to second- and third-line antibiotics, allowing the sale of first-line antibiotics without a prescription. This modification was aimed to ensure that life-saving antibiotics remained accessible to the public, especially in remote areas of the country where doctors might not be readily available. Despite a decade passing since the rule’s announcement, no State government had adopted it until Kerala recently initiated Operation AMRITH (Antimicrobial Resistance Intervention for Total Health). This programme enforces the original H1 rule, mandating a doctor’s prescription for acquiring any class of antibiotics.
Kerala’s high doctor-patient ratio, even in villages, facilitates the enforcement of this rule. Also, the high literacy rate in the State is poised to contribute significantly to the efficient implementation of the rule. An informed populace is more likely to understand the importance of regulations like these and adhere to them, facilitating smoother execution and compliance. While it is highly commendable that Kerala is implementing the H1 rule to rein in AMR, it is unlikely to have a significant impact on drug-resistant infections in the immediate future. The effects of this initiative may take several years, if not a decade, to manifest. However, it will foster a culture of respecting antibiotics and encourage further actions to combat AMR.
