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Dr. Rajeev Kaushik

MD - Internal Medicine

General Physician, Delhi

24 Years Experience
Dr. Rajeev Kaushik MD - Internal Medicine General Physician, Delhi
24 Years Experience
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Personal Statement

To provide my patients with the highest quality dental care, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies....more
To provide my patients with the highest quality dental care, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies.
More about Dr. Rajeev Kaushik
Dr. Rajeev Kaushik is an experienced General Physician in Rohini, Delhi. He has over 24 years of experience as a General Physician. He studied and completed MD - Internal Medicine . You can meet Dr. Rajeev Kaushik personally at Dr Rajeev Kaushik in Rohini, Delhi. Book an appointment online with Dr. Rajeev Kaushik and consult privately on Lybrate.com.

Lybrate.com has a nexus of the most experienced General Physicians in India. You will find General Physicians with more than 43 years of experience on Lybrate.com. You can find General Physicians online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Education
MD - Internal Medicine - Rohtak University - 1993
Languages spoken
English
Hindi

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I am 22 years old healthy boy. I am not satisfy with my penis size. I want make it little more long. I have a uncircumcised penis. Can I do any penis exercise (like jelqing) to make it little more long. My penis size is 4.7 inches when its erect. Suggest me any penis exercise for make it long and erect for a long time during sex.

PGD IN ULTRAASONOGRAPHY, Non invasive cardiology course, MD - Medicine, MBBS
General Physician, Narnaul
I am 22 years old healthy boy. I am not satisfy with my penis size. I want make it little more long. I have a uncircu...
#1 – “The Ultimate Stretcher” Grasp the head of your phallus (glans) firmly. Pay attention not to cut off too much blood circulation (you should not feel any discomfort). Pull and stretch it outwards in front of you with enough force to feel painless stretch inside the shaft and base of your willy. Hold it in that position for 10 to 30 seconds. Rest for a while and then repeat. Do this daily for 5 to 10 minutes. Extra tip: You should stretch it to all sides – up in the direction of your stomach, down between your thighs, to the left and the right as well. Do this for the same amount of time as instructed above. “The Thumb Stretcher” Grasp the tip of your “manhood” with one hand. Hold it firmly, but naturally! Again, do not cut off too much blood circulation or cause yourself any discomfort. Use your other hand to place thumb at the base of your penis. Then start to pull it away until you feel that stretch in it. Hold this position for around 10-15 seconds, then release. Have a short break and then repeat this whole process again. You can continue doing this for 2½ up to 5 minutes in one session. My advice: You can do one or two sessions during the day. I highly suggest using one of the most popular penis extenders for more efficient stretching! – “The Backwards Method” This technique is rather dangerous and potentially harmful so seek some advice from professional guides I mention after the 8th technique. All you need to do in the Backwards Method is to follow these steps: Pull the skin of your cock backward towards your body with your thumbs. Your other fingers will be providing support under your shaft. Hold this position in a firm manner for ten seconds. Have a short break and then repeat above steps. All you need should be 5 minutes a day. For 16 AWESOME and efficient ways to increase the size of your penis, check out my updated guide: 16+ Quick Ways to Make Your Penis Bigger Right Now! #4 – “The Opposite Pull” The Opposite pull is an exercise that might make you flinch a little just reading about it! However, make no mistake, as it’s very effective and will increase your size. All you need to do is just follow 6 simple steps: With your right hand, grasp the tip of your flaccid phallus. Put your left hand on the beginning of your base. Then, as horrifying as it may sound, pull with both hands in opposite directions for 10 seconds at a time. You should feel the stretching inside of your shaft. You can take a short break and then repeat. Do this for 5 minutes a day. Safety tip: Don’t continue if you feel any pain or discomfort. What is more, don’t do this without proper and detailed guidance by enhancement experts (see the end of 8th technique). #5 – “The Kegels” Click on the image to learn more. Click on the image to learn more. It’s common knowledge that Kegel exercises are beneficial to women´s health in a variety of ways. However, very few men know that you can make your dick look larger just by maintaining more control over the erection itself! All you need to do is the following: Identify and locate your Pubococcygeus (PC) muscle by trying a method of stopping your urine flow naturally. Once found, you will need to start contracting the PC muscle daily around 20-30 times. Once you master these, you should go for more contractions per day and session. Pay attention: Eventually, you’ll be able to not only feel, but to control the muscle itself! There are various regimes you could try out with the help of a mobile application that is available for free download at the end of this article. This workout will lead to a noticeable boost in length and girth of your erections as more blood will flow to your dick. Trust me that your girl will be aware of your gains and your rock-hard boners! You can read more about kegel exercises in my comprehensive guide here. You will discover 5 health benefits of kegels and 4 awesome ways to work out! #6 – “The Jelqing Method” (Milking) Before starting with the sixth workout on this list make sure that you’re already at least semi-erect (between ½ and ¾ of your maximum erection power). If you do this technique in a flaccid state, you will achieve no gains while doing this with complete boner will result in some tissue and nerve damage! post eating pussy 101 Click on the image to learn more. Now you have to follow these steps: Lubricate yourself a lot (use oil based lube). With your right hand make an OK sign and grasp the base of your little buddy. Then “massage” your phallus by pulling your right hand slowly outwards from your base up to its head (pay attention to not jelq your glans as you may lose sensation in it). Switch your hands and repeat the movement. The benefit of doing this is that you’re trapping and pushing blood from your base to the glans and in that way enlarging the whole size of your shaft. You can repeat it as much as you please, but I would not go into extreme and recommend to stop as soon as you start to feel any discomfort. My advice: As a beginner, consider a lower number of repetitions and then increase this amount gradually in one session. By the way, I have published an excellent and easy-to-follow guide on Jelqing. #7 – “The Circular Rotation” Click on the image to learn more. Click on the image to learn more. This technique is very similar to the first exercise on this list. However, there are some differences you need to pay attention to. You will need to follow these steps: Use your right hand to bring your dick outwards. Grasp your glans firmly but gently. Then you need to start stretching and rotate your little buddy at the same time. You should do this for 30 seconds for clockwise direction. Then you can switch your hands (if you want to) and repeat that movement for another 30 seconds in the counter-clockwise direction. All this makes for one session, and you can do five a day. You might want to check out my list of best selling pills that will help you make your penis grow: Top 5 Male Enhancement Pills on the Market. #8 – “The Weight-Lifter” Click on the image to learn more. Click on the image to learn more. Some experts recommend that you should avoid this method for safety reasons, but if done properly, and in moderation, this exercise can have REALLY positive effects on your penile size. It has been popularized over the years by Japanese, and it has indeed been proven to work on several occasions. However, it is advisable to try all of the other workouts listed above as first. Here are 4 tips worth taking into consideration: Always try this method on your flaccid “manhood”. Attach a particular weight to it that has been created solely for this purpose (the best are “Bib Hanger” and “LG Hanger“). This will force it to stretch downwards like in other techniques mentioned here already. Doing this should make your dick size larger gradually – in a permanent way. Pay attention: You should consider doing a little more research before attempting this as it’s potentially very harmful!
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I am 67 years male. Suffering from diabetes for last four years and joints knee pain For last six months. diabetes under control with allopathy Metformin 500 plus sitagliptin 50 plus reglide 50 all bd. Request suggest ayurvedic med to replace allopathic med. Plus med for knee pain.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
I am 67 years male. Suffering from diabetes for last four years and joints knee pain For last six months. diabetes un...
Avoid sitting Cross legged. Avoid Squatting- Quadriceps Exercises- Lie straight, make a towel role and put it under the knee, press the keen against the role, hold it for 20 secs. Repeat 20 times twice a day. This will help relieve some pain. Core Strengthening Exercise- Straight Leg Raised With Toes Turned Outward, repeat 10 times, twice a day.
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Sexual Communication - Why is it Important for Couples?

MD - Obstetrics & Gynaecology, DGO, MBBS, MCPS
Gynaecologist, Mumbai
Sexual Communication - Why is it Important for Couples?

Communication in any relationship is indispensable for creating a strong bond between a couple and a part of that communication is communicating about your desires and fantasies.

Sexual Communication is when you and your partner are able to express your needs and wants without the conversation being awkward, taking in account what the other feels. It is a fulfilling, satisfying, and a fun part of life. The physical aspect of love is an important part of a relationship and communicating with your partner about it only helps to make it better. Sexual communication will make it easier for you to take pleasure in sex with safety and have a satisfying sex life.

  1. Physical Communication: Communication is not linked with words only. Sometimes, a gentle hand placed on your shoulder or back, a simple glance at you or even a wink are enough to lure someone towards you. Healthy and amazing sexual activity is procured mainly through physical intimacy. Almost all the time, couples find out what the other is thinking even without asking them. ‘Actions speak louder than words’ is proven to be very true in this case. So, ensure that you understand physical cues of each other.

  2. Sexual Directions: Giving your partner verbal or physical direction is an integral part of achieving a satisfied sexual life. He or she needs to be informed of where to touch you and where not to in order to turn you on. If your spouse is clueless of what you might want or expect in bed, sexual gratification will not only become impossible but may turn disastrous. If there is verbal communication between you two such as, ‘kiss me’ or ‘touch me there’, the sexual experience will become ten times better. This happens only when there is love and proper sexual communication.

  3. Conversational Communication: Sexual urge is aroused only when there is vocal communication. All relationships require good oral communication. Communication related to sex must be done tactfully without making it awkward or uncomfortable. It will help solve many issues in your sexual and love life. You must focus on what your partner might prefer doing more or may work around issues which cause strife and eventually resolve them.

  4. Intimacy: Emotional as well as sexual intimacy requires honest communication. Some display their inner inhibitions while others are reserved in matters of expression on sexual life. Each couple is accustomed to different and unique styles of communication with their partners. It is important to be able to comfortably and smoothly express yourself and get instant feedback from your spouse in order to be most compatible with each other. If you wish to discuss about any specific sexual problem, you can consult a sexologist and ask a free question.

2298 people found this helpful

Hi. Whenever I has gas issues, burping, I also get neck pain, crackling sound when moving neck and headache can all of it be related. What can be done to avoid as it happens on weekly basis even though I do not take fried or heavy food.

MCh HPB Surgery, Fellow, European Board of Surgery, MS - General Surgery, MBBS
Gastroenterologist, Guwahati
Hi. Whenever I has gas issues, burping, I also get neck pain, crackling sound when moving neck and headache can all o...
Please get lft, lipid profile and usg whole abdomen done. Avoid chillies in any form. Drink plenty of water.
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I am 19 years old. The problem which I am having is for past few years, when I started masturbating; I last very less; like 1 minute or so. What should I do to improve my stamina at this. Any particular type of exercise, medication?

MBBS
General Physician, Chennai
I am 19 years old. The problem which I am having is for past few years, when I started masturbating; I last very less...
Stop masturbating frequently exercise and eat well include almonds dates in your diet for now when you grow up if you continue to have the problem consult again.
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I am 35 years of old & having premature ejaculation problem for which my wife is not satisfied with my sex performance.

MD - General Medicine
Sexologist, Nashik
I am 35 years of old & having premature ejaculation problem for which my wife is not satisfied with my sex performance.
Hi, I had gone through your question and understand your concerns, Premature ejaculation is one of the most common sexual dysfunction in men, However very few ever Talk about it due to embarrassments. The ability to finish early and quickly can be advantageous in many areas in life, but not when it comes to sex. Premature ejaculation is a common and often distressing problem for couples who simply want to find ways to make sex last longer. No one is born with the ability to control ejaculation. Men can learn to control ejaculation similar to the way bladder control (toilet training) is learned at young age.. The commonest cause for premature ejaculation is stress or anxiety but other causes like neurological disorders, infection and inflammation of prostate gland or thyroid hyper function may lead to premature ejaculation. There are several very successful ways of treating premature ejaculation with proper approach and treatments. CONSULT PRIVATELY
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I have two major issues. Both of them are related with sex issue. First one is that front skin of my penis is very tight and when I do sex I feel very painful. Second one is that my sexual time is very less. Dear sir/mam please do help me out.

MBBS
General Physician, Jalgaon
I have two major issues. Both of them are related with sex issue. First one is that front skin of my penis is very ti...
Please you may have phimosis, please put some coconut oil drops below penile skin and do forward and backward movements of penile skin slowly avoiding masturbation do it for 1 month, if skin becomes loose enough, it's ok, otherwise consult nearby surgeon in person to increase your stamina wake up early go for morning walk daily do kegel and perineal exercises daily take musali pak by patanjali 2tsf 2 times with milk cap ashwagandha 1 1 cap shilajeet 1 1 all for 3 months minimum.
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What are the symptoms of malaria and how can we over come to it. Please reply fast and what are the symptoms of flu. And how can we over come to it.

MBBS
General Physician, Cuttack
What are the symptoms of malaria and how can we over come to it. Please reply fast and what are the symptoms of flu. ...
) symptoms of malaria 1. Intermittent high fever with chills 2. Profuse sweating 3. Headache, fatigue 4. Nausea, vomiting 5. Diarrhea 6. Anemia7. Enlarged spleen prevention 1. Take anti mosquito measures like use of mosquito net, mosquito repellent, 2. Spraying of insecticides in surrounding and keep it free from vegetation, 3. Wearing full sleeve shirts in the evening, 4. Discarding empty containers for collection of water and promoting mosquito breeding swine flu symptoms 1. Fever, cough 2. Nasal congestion, sore throat 3. Headache, myalgia, fatigue, dyspnoea (shortness of breath) 4. Vomiting, diarrhea 5. Pneumonia and respiratory failure (in severe cases). Prevention 1. Avoid over crowding places and avoid contact with infected patients 2. Avoid sharing food, linen, utensii with infected patient 3. Frequently wash your hands with soap and water 4. Use face mask while going to crowed places 5. When coughing orsneezing, cover your mouth/nose with tissue pape and dispose of used tissue paper promptly and carefully. Put them in a bag and throw in dust bin. 6. Clean hard surfaces like door handle, electrical switches/taps/toilet flush/telephone receivers/computer key board etc frequently. 7. Frequently touched items like mobile/telephones etc should be cleaned with disinfectant.
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H I want to sex with my gf But she didn't want to pregnant and I didn't want to use condom can you tell me what to do please. Give me some suggestions please . I have listen that during period a girl can't be pregnant if is true than please tel me. In which day of period I most too sex please thank you.

Diploma in Diabetology, Pregnancy & Diabetes, Hypertension, Cardiovascular Prevention in Diabetes ,Thyroid
General Physician, Sri Ganganagar
H
I want to sex with my gf
But she didn't want to pregnant and I didn't want to use condom can you tell me what to do...
During period girl can not become pregnant. It is 100 % true. Safe period is 1 st day to 7th day and 20 th to start of mc. So you do safely sex during these days.
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I have herpes zoster on my abdomen region .what may the reason doctor? How it occurs .thank you so much.

MBBS, MD - Obstetrtics & Gynaecology, FMAS, DMAS
Gynaecologist, Noida
I have herpes zoster on my abdomen region .what may the reason doctor? How it occurs .thank you so much.
Hello, herpes zoster usually occurs during low immunity states and due to hsv 2 virus or if you have come in contact with someone who has been infected with the same and in scab shedding stage.
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Hi am 23 Years old. Having pcod problem taking krimson 35. Now I completed 21 days of tablets. When can I expect my periods? But I have spotting and light red discharge for past 7 days is this normal? please help me out.

MBBS, DNB (Obstetrics and Gynecology), MD - Obstetrtics & Gynaecology
Gynaecologist, Delhi
Hi am 23 Years old. Having pcod problem taking krimson 35. Now I completed 21 days of tablets. When can I expect my p...
No this is not normal, a flow shd start 3-6 days after the last pill. Is your thyroid status normal?
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But mangoes are king of fruits. Summer is the only season to consume them as they are available. It's stupid to not consume them because of heat. Don't eat in large quantities but mangoes are good for health too.

PGDD, RD, Bachelor of Home Science
Dietitian/Nutritionist, Mumbai
But mangoes are king of fruits. Summer is the only season to consume them as they are available. It's stupid to not c...
Hye. Mangoes can be soaked in water for about half an hour before consumption in case you feel they cause indigestion.
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Sirs, My mother aged 58, get sleep once in 4 nights. Because of this her nerves systems have gone bad. Not able to walk and talk properly. She is tried with English medicine, Siddha and Flower medicines. No use. Please guide. Thanks.

MBBS
General Physician, Hyderabad
Homeo medicines: coffea 30. four pills at 8pm opium 30 four pills at 9pm or if u are from hyderabad walk-in Kamadhenu.13-1-67/2A. Motinagar Extension. Erragadda.Hyderabad18. 9441178096 45 minutes dryoga training will solve any problem pernanently.
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I am jogging 45 minutes without any break and after that I am doing 18 minutes abdominal workout. I am taking break weekly Sunday and Monday. Now one week over. Is it possible to get six pack abs in four months?

MBBS
General Physician, Cuttack
I am jogging 45 minutes without any break and after that I am doing 18 minutes abdominal workout. I am taking break w...
It depends on the type of abdominal exercise to strengthen your abdominal muscle.Follow the advice of Gym Instructor and undertake exercise accordingly
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My stomach always tight and slowly pain when I stand up or walk and running Please provide me normal treat which followed by me?

BAMS
Ayurveda, Ambala
My stomach always tight and slowly pain when I stand up or walk and running
Please provide me normal treat which foll...
Follow these best tips to get relief from stomach pain - *take 10 gms powder of carom seeds (ajwain, 10 gm powder of cumin (jeera), 10 gm of rock salt. Mix them well and take 1/2 teaspoon (3-5 gm) of mixture daily after meal. *take 1/2 teaspoon of black pepper (kali mirch), 1/ 2 tea spoon of jeera (cumin), 2-3 slice of ginger. Boil it in one glass of water for 2-3 minutes. Drink 5-10 teaspoons (15-20 ml) in morning and evening. * take 1 tea spoon of liv-52 syrup daily one time. * walk for atleast 15-20 minutes daily and avoid long duration continuos sitting. * avoid taking nonveg at night & in day time after taking food, do not sleep in day. You can consult me privately for medicine treatment & details.
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Ayurveda and Kidney Problems

Bachelor of Ayurveda, Medicine and Surgery (BAMS), PGCRCDM, PDCR, MBA
Ayurveda, Ghaziabad
Ayurveda and Kidney Problems

Kidney failure and other kidney problems are the leading causes of death nowadays. Common problems that lead to kidney failure include chronic blood pressure and chronic uncontrolled diabetes. However, there are a number of ayurvedic medications which help solve kidney failure and other kidney problems including;

  1. Punarnava: Punarnava is commonly called hogweed as well but the medical name for it is boerhavia diffusa. It is extremely helpful in preventing micturition, a disorder which is characterized by unexplained fainting after urinating. However, that is not the only symptoms hogweed helps with as it also removes excess water from the body due to kidney failure.
  2. Varun: Varun is commonly known as caper and is medically known as crataeva nurvala. The diseases which varun is best at dealing with are urinary tract infections and renal stones. Varun also helps in stopping the swelling and extra fluid accumulation after kidney failure.
  3. Gokshura: Gokshura is known as tribulus terrestris and is an herbal tonic for the genito-urinary system. Gokshura is one of the best ways to avoid dialysis. This is because it stops infections from occurring and also clears obstructions in the urinary tract. It is also very good at regenerating the kidney cells.
  4. Raktachandan: Rakt chandan is known as p. Santalinus or red sandalwood and is another excellent remedy for kidney problems. It acts as both a diuretic and an anti-infectant.
  5. Palaash: Palaash, medically, is known as butea monosperma. It is a type of urinary alkalizer and it also stops micturition. A urinary alkalizer is a medication which allows the urine to pass more easily. This is yet another great remedy for kidney failure.
  6. Kaasni: Kaasni is commonly known as chicory but its medical name is cichorium intybus. Kaasni gives strength to the kidneys and is also a very good alkalizer. However, its most valuable property is the fact that it helps in nephritis and nephrotic syndrome (disorder of the kidneys characterized by protein loss).
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Hi doctor, inside foreskin of my penis I can see some white sand like substances I have a habit of washing my penis daily without fail but still I have this and when I rub it also it's not going so please tell me why I got this and any problem will come because of this.

BHMS, PGDM (Emergency Medical services)
Homeopath, Pune
Hi doctor, inside foreskin of my penis I can see some white sand like substances I have a habit of washing my penis d...
hello bibin...it can be lubricating subject over that parts...But if u are still suffering again and again...U can take some good homeopathic remedies to stay clean n healthy...Good luck
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I have developed allergy from egg for last 2 years. Earlier I dont have any problem by eggs. It causes pain in my stomach.

MBBS, MD - Internal Medicine
Internal Medicine Specialist, Faridabad
I have developed allergy from egg for last 2 years. Earlier I dont have any problem by eggs.
It causes pain in my sto...
stop eating eegs. take tab. meftal spas sos for abdomen pain. tab. pan -40 mg before meal for 5 days. take fiber meal, green veg., plenty of water, if not ok checkup usg whole abdomen, urine r/m, lft,kft, cbc, blood sugar,urine r/m. after test consult again.
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My husband is 33 years old, whenever he eats non veg items he get loose stools and to stop this he drinks lemon tea, he can't stop eating these items, when he saw doctor he said to avoid hotel food. Is he sensitive over oily foods? How can I help him to recover from this?

C.S.C, D.C.H, M.B.B.S
General Physician,
If he takes outside food it need to be stopped and only homemade food need to be taken and it is best to avoid too much oily and non veg foods
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AntiBiotic Resistance on the rise very fast

Post Graduate Diploma in Hospital and Healthcare Management, MD - Consultant Physician, Fellowship Critical Care Management
Internal Medicine Specialist, Faridabad
AntiBiotic Resistance on the rise very fast

In 5 Years, Threat Of Drug-Resistant Superbugs Doubles


A 72-year-old woman in Bengaluru consulted a hospital physician about a severe skin infection and fever. She had previously consulted a couple of general practitioners, who prescribed a course of penicillin for three days and fluoroquinolones—both antibiotics—for two days.

There was no relief.

So, the consultant ordered a culture sensitivity test of pus from the skin lesions to identify what was causing her ailment and figure out what antibiotics it would respond to.

Here’s what the report said:
Pathogen: Klebsiella pneumoniae
Susceptible to: No antibiotic
Resistant to: All antibiotics, including advanced drugs like fluoroquinolones, carbapenems and even the last resort combination usually reserved for severe cases of ICU infection, colistin-tigecycline.

With nothing to offer the patient, save a prescription for paracetamol to keep her fever in check, the doctor sent the patient home, and asked her to return after a week.

In such cases, sometimes, the body’s immunity kicks in and throws off the infection, the physician, Sheela Chakravarthy, consultant (internal medicine) at Fortis Hospital, Bengaluru, told IndiaSpend.

Sometimes, resistance to one or more drugs abates, allowing treatment to be resumed. Chances of that happening are greater at home, not in the hospital, which is a more infectious space where sepsis—a disproportionate and potentially life-threatening immune response by your body to an infection—could set in, she explained.

Most patients, however, succumb to the infection.

Chakravarthy faces situations where she has nothing to offer patients, not because they are suffering from terminal illnesses, such as some forms of cancer, but even when they present with what should be curable infections, “almost every day”, she said.

What Chakravarthy described is the consequence of rampant, inappropriate consumption of antibiotics, spurring the development of superbugs, as the recently released State of the World’s Antibiotics Report 2015 affirms.


India is fast becoming home to superbugs

Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus are three of the deadliest pathogens facing humanity, according to the World Health Organisation (WHO). And India is gradually but increasingly becoming home to multi-drug resistant strains of these pathogens, according to the State of the World’s Antibiotics Report 2015.

Escherichia coli is notorious for causing food poisoning and urinary tract infections.

In 2010, 5% of Escherichia coli samples in India were resistant to carbapenems, last-resort antibiotics for bacteria that are resistant to first-, second- and third-line drugs. By 2014, 12% of E. coli samples were similarly resistant.


Klebsiella pneumoniae causes pneumonia, septicaemia and infections in the urinary tract, lower biliary tract and at surgical wound sites, to name a few.

While 29% of Klebsiella pneumonia isolates were resistant to carbapenems in 2008, this increased to 57% in 2014.

For comparison, fewer than 10% of Klebsiella pneumoniae infections in Europe are carbapenem-resistant.

Staphylococcus aureus can cause skin and soft tissue infections, bloodstream infections, pneumonia and surgical site infections. A particularly nasty strain of, methicillin-resistant Staphylococcus aureus (MRSA), is common in India and increasingly hard to treat.

MRSA was responsible for 40% of post-surgical site infections, according to a 2013 study by the Jawaharlal Nehru Medical College and Hospital, Aligarh.

Between 2009 and 2014, the incidence of MRSA in India has risen from 29% to 47%.

People with MRSA are 64% more likely to die than people with a non-resistant form of the infection, according to the WHO.

How ignorance is spurring the development of superbugs

“My understanding of antibiotic is that it stops bacteria growing in body…I think amoxicillin is for throat infection.”

–An urban participant of a study of perceptions about antibiotic use and resistance among urban and rural doctors, pharmacists and public in Vellore.

Mox, short for amoxicillin, has become a household word across India.

A little knowledge, however, is a dangerous thing. It encourages self-medication, even when medicine is unnecessary, such as when people suffer viral infections—against which drugs are ineffective. Most viral fevers dissipate on their own after a few days with rest, hot fluids and a check on the fever.

Consuming too many antibiotics contributes to pathogen drug resistance.

“Resistance is an outcome of accumulated use,” said Ramanan Laxminarayan, vice president, Research and Policy, Public Health Foundation of India, and director and senior fellow, Centre for Disease Dynamics, Economics & Policy, US, and co-author of the State of the World’s Antibiotic Report 2015.

Indians often rely on corner pharmacists, whose knowledge of dosages may be limited.

Here’s what a rural pharmacist participant of the aforementioned Vellore study said: “Amoxicillin, 6 tablets is to be taken [for full course].”

Amoxicillin’s full course depends on the kind and severity of bacterial infection.

When an antibiotic of lower strength or fewer pills than needed is prescribed, the body cannot fully eradicate the pathogen. Sensing it has come under attack, the bacterium responds by evolving into more resilient, antibiotic-resistant strains.

But with a course of antibiotics, say generic Amoxicillin, costing about Rs 160, close to a day’s wage in many states, and a doctor’s consultation costing anywhere between Rs 100 and Rs 1,000, more than a day’s wage in most places, patients are bound to cut corners.

Another Vellore study participant summed up the situation thus: “If I have money I go to hospital. If not, I get medicine from pharmacy shop. If I get better, I stop and keep for future use.”

Stopping a course of drugs mid-way also contributes to antibiotic microbial resistance.

In a 2015 study in Chennai, 70% respondents confessed to stopping the medication when they felt better. Only 57% completed the antibiotic course.

“Less is more”: the key to preserving antibiotic efficiency

Educate health professionals, policy makers and the public on sustainable antibiotic use, says the State of the World’s Antibiotics Report 2015.

That is sensible advice.

Denmark and Sweden boast of low rates of antibiotic use and near-zero rates of antibiotic resistance because the risks of antibiotic overuse are widely known.

Instituting regulations on antibiotic use has reduced the proportion of MRSA in Europe and the US by about a fifth over the last eight years.

India requires more stringent regulations for antibiotic use.

It isn’t enough to tell physicians that they should prescribe antibiotics only when essential to cure bacterial infections. The right way is to order a culture sensitivity test, which costs money, and the patience to wait for the result.

“Patients want instant and cheap relief, and are willing to shop around for a doctor who obliges,” said Dr Himanshu Shekhar, medical director, SCI International Hospital, New Delhi.

“Some judge doctors on how fast the prescribed medicine cures. Practice pressures lead many doctors to prescribe advanced drugs, without getting a culture-sensitivity test done.”

So, it’s also not enough to have 24 advanced antibiotics, including third- and fourth-generation cephalosporins, carbapenems, and newer fluoroquinolones, under the ambit of Schedule H1 of the Drugs & Cosmetic Rules, 1945, with effect from March 1, 2014.

That means these drugs cannot be sold over-the-counter, but they are still freely prescribed.

Chakravarthy’s suggestion: “Make Schedule H antibiotics available only through hospitals and health centres.”

“Changing antibiotic usage behaviours is critical to preserve the efficacy of existing and new drugs,” proposed Laxminarayan.

India also sorely needs regulations to check antibiotic use in animals raised for human consumption, to meet the State of the World’s Antibiotic Report 2015 recommendation to reduce and eventually phase out sub-therapeutic antibiotic use in agriculture.

Sub-therapeutic use implies mixing antibiotics in animal feed to make them grow faster and to prevent infections from devastating the herd or flock.

India is among the world’s five biggest consumers of antibiotics for livestock. IndiaSpend has earlier reported increasing evidence of antibiotic-resistant bacteria in animals in India, and how this impacts humans.

“Using antibiotics to make animals fatter faster is a waste of a precious resource,” said Laxminarayan.

How surgeons contribute to antibiotic resistance

Surgical antibiotic prophylaxis refers to the prescribing of antibiotics before, during and after operations to prevent infection.

Between 19% and 86% of patients in hospitals in India receive “inappropriate antibiotic prophylaxis”, according to the State of the World’s Antibiotics Report 2015. A prophylactic is preventive treatment for a disease.

Ideally, antibiotic prophylaxis should be administered as a single dose within 60 minutes of the skin incision. However, a 2013 Mangalore-based study found timing adhered to in 22% of cases in a government hospital, 64.9% cases in a medical-college teaching hospital and 80.7% of patients in a tertiary care corporate hospital.

“Smart antibiotic prophylaxis also includes choosing narrow-spectrum antibiotics to target the organism most likely to present concerns based on the kind of surgery being performed, this avoids needless exposure to antibiotics for the other microbes and helps prevent resistance,” said Vimesh Mistry, assistant professor, Pharmacology, Baroda Medical College.

Staphylococcus aureus, which lives on the skin, is most likely to cause infection during surgery. But surgeons frequently make poor antibiotic choices.

“We found appropriateness of choice of antibiotic in 68% cases and 52% compliance with the in-house prophylaxis guidelines,” said Tanu Singhal, infectious diseases specialist, Mumbai, and co-author of another study on antibiotic prophylaxis conducted in PD Hinduja Hospital, Mumbai.

Other prophylaxis inaccuracies include the unnecessary prescribing of antibiotics, inaccurate dose and inaccurate duration of prescription.

“We logged 63% accuracy in prescription duration. Surgeons tend to prescribe antibiotics for too long fearing post-surgery infection,” said Singhal.

In the trade off between protecting the patient better and increasing the risk to society of a pathogen developing resistance, surgeons are choosing the former.

Needed: A back-to-the-basics approach to health

Reducing the need for antibiotics through improved water, sanitation and immunisation is another strategy recommended in the State of the World’s Antibiotics Report 2015.

“Vaccination against pathogens such as the diarrhoea-causing rotavirus and pneumonia-causing Klebsiella pneumoniae helps curtail antibiotic demand, thereby reducing the chances of resistant strains developing,” said Laxminarayan.

In Canada, the widespread use of pneumococcal conjugate vaccines for pneumonia in children has reduced the incidence of pneumonia caused by strains the vaccine covers.

However, just as antibiotic usage spurs the development of superbugs, vaccination is a double-edged sword.

Canada is seeing a rapid increase in the incidence of other strains of pneumonia not protected against by the vaccine.

So, it is better to focus on the basic constituents of health.

Making available clean drinking water and improving sanitation would prevent people from getting sick in the first place. India still has a lot to do on both these fronts.

Improving individual immunity is the best bet to ward off infections, and that is also achievable by healthier eating, exercising, healthier living and the better management of chronic conditions like diabetes and asthma that increase vulnerability to infections when they are not kept in check.


Dr Himanshu Shekhar
MD,Medicine
New Delhi
+919818433208
( Above Article , with My Inputs was published in a leading Health Magazine)
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