Colistin use against resistant infections up

Critical care drug colistin’s market size doubles in four years.

Five years after an antibiotic-resistant superbug was traced to India, the market size of colistin — the last antibiotic that can work on resistant infections — has more than doubled in the country. Usage of the last-resort drug has shot up in hospitals — 91 lakh units (one unit is one injection vial), estimated at Rs. 80 crore, was sold in 2015, up from units valued at Rs. 30 crore three years ago.

Vying for a share are over a dozen firms — three manufacturers and the rest marketers. In the critical-care segment, colistin, in the past five years, has emerged as the fastest-growing drug. With doctors prescribing higher dosages to contain resistant infections, companies are now launching the drug in higher strengths. Doctors said the highest strength formulation was the most consumed, accounting for 50 per cent of the total usage.

The drug was pulled out from a five-decade hibernation about six years ago to treat resistant infections. “Earlier, we used to give three doses of the mildest strength. Now we give as many of the highest strength,” said Abdul Ghafur, consultant, infectious diseases and clinical microbiology, Apollo Hospitals, Chennai.

Doctors working in the intensive care units have inadvertently mapped the rise of a drug that pharmaceutical companies were once not too keen to launch. “About six years ago, we had to convince a pharma major to introduce colistin. And then the market just shot up,” said J.V. Divatia, head of the department of anaesthesia, critical care and pain, Tata Memorial Hospital, Mumbai.

A senior official with a pharma major tracking colistin consumption globally said consumption in India had been building up in the past three years. “And this consumption is limited to tertiary-care hospitals in metros,” he said.

Both pharma companies and doctors are now looking at how to effectively administer this drug, and not compromise its efficacy on resistant infections, a step coming in a tad late, say observers.

“If we had taken care in 2010, we wouldn’t have reached this stage now,” a senior microbiologist said. Experts note that the rise in colistin usage is almost identical to the sharp increase in the use of the third-generation antibiotic carbapenem between 2005 and 2010. Now, resistance to carbapenem is pegged at 50- 60 per cent, leading to the rise in colistin use.