Ramanan Laxminarayan and Ranjit Roy Chaudhury examine the factors encouraging the emergence of antibiotic resistance in India, the implications nationally and internationally, and what might be done to help.

Prior to 1994, most Delhi hospitals and dispensaries experienced constant shortages of essential medicines. There was erratic prescribing of expensive branded products, frequent complaints about poor drug quality and low patient satisfaction. Delhi took the lead in developing a comprehensive Drug Policy in 1994 and was the only Indian state to have such a comprehensive policy. The policy's main objective is to improve the availability and accessibility of quality essential drugs for all those in need. The Delhi Society for the Promotion of Rational Use of Drugs (DSPRUD), a non-governmental organization, worked in close collaboration with the Delhi Government and with universities to implement various components of the policy. The first Essential Drugs List (EDL) was developed, a centralized pooled procurement system was set up and activities promoting rational use of drugs were initiated. In 1997, the Delhi Programme was designated the INDIA-WHO Essential Drugs Programme by the World Health Organization. The EDL was developed by a committee consisting of a multidisciplinary group of experts using balanced criteria of efficacy, safety, suitability and cost. The first list contained 250 drugs for hospitals and 100 drugs for dispensaries; the list is revised every 2 years. The pooled procurement system, including the rigorous selection of suppliers with a minimum annual threshold turnover and the introduction of Good Manufacturing Practice inspections, resulted in the supply of good quality drugs and in holding down the procurement costs of many drugs. Bulk purchasing of carefully selected essential drugs was estimated to save nearly 30% of the annual drugs bill for the Government of Delhi, savings which were mobilized for procuring more drugs, which in turn improved availability of drugs (more than 80%) at health facilities. Further, training programmes for prescribers led to a positive change in prescribing behaviour, with more than 80% of prescriptions being from the EDL and patients receiving 70-95% of the drugs prescribed. These changes were achieved by changing managerial systems with minimal additional expenditure. The 'Delhi Model' has clearly demonstrated that such a programme can be introduced and implemented and can lead to a better use and availability of medicines.

This study clearly showed the irrational use of antibiotics for the treatment of acute diarrhea in children and adults that warrants interventional strategies.

Objective:The Delhi State Drug Policy was adopted in 1994 following which the first Essential Medicines List (EML) was developed in 1996. The Delhi State Essential Medicines Formulary was brought out in 1997. A need was felt to revise the formulary to match with the EML as the EML is renewed every 2 years.Materials and Methods:A survey was undertaken to elicit the opinions of the doctors practicing in the state on the usefulness of the formulary before revising and printing the updated version. The survey covered dispensaries, 10–20 bedded hospitals, 100-bedded hospitals and two tertiary care hospitals. Discussions were focused on questionnaires on attitudes toward adopting Essential Medicines Formulary using a 10-point scale.Results:Of the 200 doctors approached, only 90 doctors completed the questionnaire. Sixty-nine respondents (76.6%) had received the copy of the formulary. Most practitioners welcomed the formulary and were satisfied with the coverage and selection of the medicines. Most respondents (76.9%) agreed that a well-developed formulary would improve the quality of the public health care system, although they had reservations about the authority, relevance and effect on professional autonomy.Conclusion:About 74% of the respondents used the formulary in clinical practice as a source of medicine information, which makes its regular revision necessary.

January 1965Imferon-Clay et al. BRIT]SH 31 ConclusionsWe have noted no other similarities in our cases, but the manufacturers have been searching for some cause. The possibility of some reagent used in the sterilization of the syringes causing instability of the iron dextran complex has been suggested, but seems unlikely. However, until the problem can be solved, this method of iron therapy has been suspended. It certainly has many advantages, but we have noted that oral iron, with sufficient coercion of the patient, will give satisfactory haemoglobin levels in the great majority ; the remainder appear to be those who have a folic-acid deficiency in addition to their iron deficiency. SummaryOne hundred and fifty maternity patients were treated with intravenous Imferon by the total-dose-infusion technique. Thirteen reactions occurred, of which seven were severe and demanded emergency treatment. All those who suffered reactions were later safely delivered of healthy infants. All the babies were girls. No reactions occurred in any of 22 postnatal patients treated. In view of the reactions, treatment by this method was suspended. We were unable to discover the cause for the reactions.This account is published in order to point out that, despite the reported safety of this method, such was not our experience. A plastic intrauterine loop is being investigated as an antifertility agent, and studies are being carried out in humans. This method of fertility control, which appears to be cheap and efficient, can finally be accepted only after its mechanism of action and possible toxic effects have been thoroughly investigated in experimental animals. The presence of a loop in the uterine horn of the female rat also interferes with pregnancy, and this is a situation similar to that observed in humans (Doyle and Margolis, 1963). We have investigated the effect of an intrauterine silk thread suture in the lumen of one and both horns of the uterus on (a) pregnancy, (b) the gonadotrophin content of the pituitary, (c) the oestrous cycle, (d) lactation, (e) teratogenicity of the litter born when there is a suture in one horn, and (f) sperm migration in the uterine horn with the suture. The effect of removal of the suture on later pregnancy has also been studied. EXPERIMENTALSixty female rats were operated upon under ether anaesthesia, and a silk thread was inserted in 30 rats in one horn of the uterus. The suture was introduced through the muscular layers into the lumen of the horn, down which it ran for about 4 mm. The thread was then brought to the surface of the horn again and anchored by knots at each end. Twenty of these rats were sacrificed on the 14th day and 10 were allowed to go to term. In 30 rats the silk thread suture was placed bilaterally into the lunen of both horns of the uterus. Twenty of these rats were also sacrificed on the 14th day and 10 were allowed to go to term. In 20 animals a sham operation was performed in that the rats were operated on under ether anaesthesia and the silk thread suture was inserted b...