The Kumbh Mela festival in India, which is the largest religious gathering in the world, has been found to have excessive antibiotic prescription rates. Researchers from US-based institutes, supported by Harvard University and UNICEF, discovered that clinics at the festival were prescribing high amounts of antibiotics to pilgrims primarily suffering from respiratory tract infections. The overuse of antibiotics contributes to antimicrobial resistance, where bacteria become resistant to drugs used to treat infections, leading to a rise in antibiotic-resistant “superbug infections”. The World Health Organization warns that this poses a significant global threat to public health and resulted in 1.27 million deaths worldwide in 2019. India has the highest rate of human antibiotic use globally and experiences nearly 60,000 neonatal deaths each year due to antibiotic-resistant infections.
The Kumbh Mela festival, which takes place in four Indian cities and attracts millions of pilgrims, involves participants taking a holy dip in the river waters. Researchers analyzed data from 70,000 patients who visited clinics at two editions of the festival in 2013 and 2015. They found that over a third of patients were prescribed antibiotics, including nearly 69% of patients with upper respiratory tract infections. This high prescribing rate is concerning since the majority of these infections are viral. Antibiotics were often prescribed without a thorough patient examination and with little consideration for the specific infection. Protocols allowed for a three-day supply of antibiotics and a follow-up visit, though many pilgrims only attended the festival for a day.
To address this issue, researchers recommend implementing measures to reduce antibiotic prescriptions at future festivals. They suggest that mid-level health providers, medical students, and community health workers should identify patients and implement triage to reduce the number of patients requiring physician attention. The clinics should also be equipped with diagnostic services to avoid over-prescription of antibiotics. Additionally, doctors should receive more education on appropriate antibiotic use, and the policy of providing a three-day antibiotic dose should be re-evaluated. Strengthening regulations around antibiotic prescribing in India is crucial, and the Kumbh Mela festival could serve as a starting point for implementing these changes.
India’s Massive Gathering, Kumbh Mela, and its Encounter with Antibiotics
