International Journal of Current Research and Review
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IJCRR - 13(5), March, 2021

Pages: 168-178

Date of Publication: 03-Mar-2021

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Need for the Implementation of Antibiotic Policy in India: An Overview

Author: Rihana Begum Patnool, Ashish Wadhwani, Balasubramaniam V, Sivasankaran Ponnusankar

Category: Healthcare

Abstract:World health organization accepted that antimicrobial resistance is a natural phenomenon, there is an urgent need for comprehensive national plans, based on a multi-sectorial approach and with sustainable financing to fight antimicrobial resistance globally. AMR continues to pose a significant public health problem in terms of mortality and economic loss. Studies related to antimicrobial drugs usage, determining factors and development of antimicrobial drug resistance, provincial discrepancy and interventional strategies is a big challenge for any developing country. This review article aims to highlight the importance of Antibiotic policy and its implementation in every health care system to make physicians, general practitioners, and other stakeholders aware of the issue of AMR and its factors and what can be done. Scoping review was done using ScienceDirect, Web of Science, EconLit, and PubMed. To discuss some of the challenges in the implementation of policies in India such as varied discernments about antibiotic use and AMR among key stakeholders, inappropriate antibiotic use and to achieve the aim of this review was performed by collecting around 80 published articles from 1999 to 2020. Initial suitable antibiotic treatment has been shown to reduce mortality, the span of stay in ICU and hospital. Early correct antibiotic choosen have also served to the reduction in antimicrobial costs. The hospitals which are having antibiotic policy shown decreased morbidity and mortality due to antibioticresistant infections. In developing countries, antimicrobial stewardship programs are emerging up, which will help to develop antibiotic policies for management of infections in various settings. This article focuses on the current status and implementation of antibiotic policy in Indian healthcare settings like the primary, secondary and tertiary hospital to combat antimicrobial resistance.

Keywords: Antimicrobial resistance, Antibiotic policy, Antibiotics, Antimicrobial Stewardship Program, Developing Country, Indian Healthcare

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Antimicrobial resistance is a unique community health problem especially in developing countries where comparatively easy availability and higher consumption of medicines have led to the disproportionately higher prevalence of inappropriate use of antibiotics and greater levels of resistance compared to developed countries.1-3 Supervision of frequent and lethal bacterial infections has been significantly compromised by the appearance and quick increase of antibiotic-resistant bacteria. The Global Antibiotic Resistance Partnership (GARP) was started to begin the practice of developing actionable policy recommendations relevant to low- and middle-income countries.4,5 Auta et al.,6 recently demonstrated that obtaining antibiotics without restrictions is possible in many countries through prescriptions at community pharmacies. In their meta-analysis on the effects of the unregulated sale of antibiotics conducted during 2000-2017, the authors represented data suggesting that the largely pooled proportion of antibiotics sold with no a prescription had reached 72%. Proportions are high even in partially developed countries such as Mexico, where a ban on the sale of antibiotics without a prescription was instituted only nine years ago.7 Every time an antibiotic is used - whether appropriately or not, in human beings or animals- the probability of the development and spread of antibiotic-resistant bacteria is increased.8,9 In the evolution of drug resistance in bacteria ‘Drug selection pressure’ becomes the single most important factor. The reasons for selection of drug are multifactorial and involve both human and animal use. While antibiotic resistance is first and foremost a medical problem, the factors that control the spread of resistance are epidemiological, social, cultural, ecological and economic. Physicians, veterinarians, patients, retailers and healthcare facilities - from huge pharmacies to limited drug sellers - have little enthusiasm (economic or otherwise) to recognize the consequences of their use of antibiotics on others, especially on future generations.5 The microbial infection burden in India is among the highest in the world.10 Accordingly, antibiotics will perform a perilous role in limiting morbidity and mortality in the nation. As an indicator of disease burden, pneumonia causes an estimated 410,000 deaths in India each year.11 It is the number-one destroyer of children health.12Many of these leads to deaths which occur as patients do not have access to life-saving antibiotics when and where these are needed. At the other extreme, antimicrobial drugs are used in circumstances where these drugs cannot be expected to recover the patient's condition, mainly as a treatment for the frequent cold and unsophisticated cases of diarrhoea (which are appropriately treated with oral rehydration therapy).5 The crude infectious disease mortality rate in India today is 5169.5 per 100,000 persons (according to Global Burden of Disease (GBD) study, carried out by Institute for Health Metrics and Evaluation, the USA from 1990 to 2017) and is twice the rate prevailing in the United States when antibiotics were introduced (roughly 200 per 100,000 persons).13

According to the centre for disease dynamics, economics & policy (CDDEP), one million Indian children die in the first 4 weeks of life each year, of these deaths 1,90,000 are caused by a bacterial infection, sepsis that surpass the bloodstream. Out of these deaths 58,319 (over 30%), deaths are due to antibiotic resistance. India already reported having resistance towards Colistin, an antimicrobial drug used when all other antibiotics fail.

Indian Council of Medical Research (ICMR) in recent times identified antimicrobial-resistant organisms in the digestive tracts of two out of every three healthy persons (67%) that it tested, pointing to a quick broaden of antimicrobial resistance in the Indian population. A mix of underprivileged community health systems and hospital infection, high rates of infectious disease, and irrational use of antibiotics is impending together to increase the prevalence of resistant pathogens and is increasing the burden of untreatable neonatal sepsis and health-care-associated infections.14 The answer to the current approach to antibiotic resistance is to protect the efficiency of the drugs currently available by antibiotic stewardship and to capitalize on hospital infection-control practices, to limit the spread of resistance. Hence there is an urgent need to implement the antibiotic policy at all levels of Indian health care system. The principal aim of the hospital antibiotic policy is to diminish the morbidity and mortality due to antimicrobial-resistant infection, and to preserve the effectiveness of antimicrobial agents in the treatment and prevention of communicable diseases. Such policies are supposed to assist in reducing the spread of antimicrobial resistance, get better public health directly, benefit the population and lessen stress on the healthcare system. Lastly, ever-increasing the types and reporting of childhood vaccines presented by the government would decrease the disease burden extremely and spare antibiotics.


The resistance to penicillin was noticed even earlier the widespread use of penicillin started. Abraham and Chain showed that E. coli cell extract could destroy the antimicrobial activity of penicillin by enzymatic action.15Sir Alexander Fleming, also, had cautioned about the development of antibiotic resistance due to the overuse of antibiotic, as early as 1945, stating:

“I would like to sound one note of warning. It is not difficult to make microbes resistant to penicillin in the laboratory, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

Sir Alexander Fleming: Nobel Lecture, December 11, 1945.

His cautioning has, unfortunately, turned out to be right. With the wide use of antibiotics, pathogens, which were previously sensitive to antibiotics, now started emerging resistance to many classes of antibiotics. The timeline for the development of antibiotics and antibiotic resistance is represented in Figure 2,16 it indicates the increase in the antimicrobial drug resistance as the development of antimicrobial drug progressed and which may result in "Post antibiotic era" in 7-10 years from now.


Pathogenic microorganisms are becoming resistant by the mutations of pre-existing Deoxyribonucleic acid (DNA) or by the procurement of DNA comprehending antibiotic resistance genes. These resistance genes converse ranges of different antibiotic resistance mechanisms to the pathogens. Table 1 represents the diverse classes of antimicrobial agents along with their mode of action and the mechanism of resistance by microorganisms clearly shows the resistance to antibiotics can be caused by four general mechanisms (inactivation, alteration of the target, circumvention of the target pathway or efflux of the antibiotic) and an organism can develop resistance by mutating existing genes, or by acquiring new genes from other strains or species.

  1. Modification of the antibiotic: The resistance can be achieved by shifting the drug molecule so that it is no more effective. This kind of resistance is observed in the case of β-lactams, macrolides and chloramphenicol. The β-lactam antibiotics are antibiotics that contain a beta-lactam ring in their molecular structure. This includes penicillin derivatives, carbapenems, cephalosporins, carbacephems, and monobactams are one of the most commonly prescribed drug classes with numerous clinical indications. The intact β-lactam ring is necessary for the action of penicillins. Bacteria produce a heterogeneous group of enzymes called β-lactamases, which cleave the β-lactam ring and inactivate the drug, thus, conferring resistance.15 Chloramphenicol resistance is usually due to inactivation of the antibiotic by chloramphenicol acetyl-transferase,18 while resistance to aminoglycosides is widespread, with more than 50 aminoglycoside-modifying enzymes being discovered.19

  2. Resistance by influx–efflux systems: Microorganisms have dissimilar arrangements for transport of small molecules crosswise the cell membrane. If the antibiotic does not stay in the cell, then it would not have any adverse effect. The antibiotics are flushed out of the cells by efflux pumps thus, conferring resistance. Resistance to fluoroquinolones and tetracyclines is commonly observed by efflux mechanism.17, 20

  3. Modification of the target site: If the target site is altered, it means that antibiotic cannot affect. The alterations in the antibiotic target sites can be carried out by mutation e.g., the mutation in DNA gyrase for resistance against quinolones, or enzyme modification of the target site e.g., methylation of an adenine residue in 23S rRNA making it insensitive to macrolides or by replacing targets e.g., ribosomal protection proteins conferring resistance to tetracyclines.17,20,21

There are other mechanisms of resistance such as overproduction of the target gene (dihydrofolate reductase overproduction for sulfonamide resistance), target protection (qnr genes for quinolone resistance), or production of other proteins which bind to the drug and prevents the original target (penicillin-binding proteins), but the above-discussed mechanisms are the major basic mechanisms of resistance widely encountered in pathogens.17, 20, 21


Development of penicillin-resistant Streptococcus pneumoniae (PRSP), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Pseudomonas aeruginosa, vancomycin-resistant Enterococcus (VRE) and multidrug-resistant Mycobacterium tuberculosis has led to difficulties in the treatment of infections caused by this pathogens.22 According to 'scoping report on antimicrobial resistance in India (2017),23 under the tutelage of Government of India, among the Gram-negative bacteria, above 70% isolates of Escherichia coli, Acinetobacter baumanniiand Klebsiella pneumoniae and approximately 50% of Pseudomonas aeruginosa were resistant to fluoroquinolones and 3rdgeneration cephalosporins. While the resistance to the drug combination of piperacillin-tazobactam was still below 35% for E. coli and P. aeruginosa, the existence of multiple resistance genes including carbapenemases leads to 65%K. pneumoniae resistant.23,24 Increasing rates of carbapenem resistance, 71% for A. baumannii led to the frequent use of colistin as the last resort antimicrobial.23 The percentage of resistance among Salmonella Typhi was 28% and Shigella specieswas 82%, respectively, for ciprofloxacin, 0.6% and 12% for ceftriaxone and 2.3% and 80% for co-trimoxazole. For Vibrio cholerae, resistance rates to tetracycline varied from 17 to 75% in different parts of the country.23,24 Recently, high mortality rates are detected due to multidrug-resistant bacterial infections. Each year, around 410,000 people die in India from infection with multidrug-resistant. 11

The drug susceptibility study results of various laboratories in India disclose an increasing trend of development of resistance to commonly used antibiotics in pathogens like Salmonella, Shigella, Vibrio cholerae, Staphylococcus aureus, Neisseria gonorrhoeae, N. meningitidis, Klebsiella, Mycobacterium tuberculosis, HIV(human immunodeficiency virus), plasmodium and others.25 New resistance mechanisms, such as the Metallo beta-lactamase NDM-1 (New Delhi Metallo beta-lactamase 1), have developed among several gram-negative bacilli. This can render powerful antibiotics ineffective, which are often used as the last line of defence against multi-resistant strains of bacteria.3 Table 2 shows the various studies on antimicrobial resistance in India. Due to the Extended-spectrum beta-lactamases (ESBL), multidrug-resistant entero bacteriaceae, have become very frequent in India. Besides, different studies in South India highlighted the resistance pattern like Ciprofloxacin resistant Salmonella enteric serovar Typhi, multidrug-resistant Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae, fluoroquinolone resistance among Salmonella enteric serovar Paratyphi A, the emergence of vancomycin-intermediate staphylococci, Pseudomonas aeruginosa and Acinetobacter baumannii resistant to ceftazidime, cefepime and ciprofloxacin. The resistance to colistin has also developed in India. Although the percentage of colistin resistance was below one, high mortality of 70% was associated with colistin-resistant K. pneumoniae. Amongst the Gram-positive organisms, 42.6% of Staphylococcus aureus were methicillin-resistant and 10.5% of Enterococcus faecium were vancomycin-resistant.26,27


India has been raised as ‘the AMR capital of the world’.54 Whereas, development of newer multi-drug resistant (MDR) organisms posture newer diagnostic and therapeutic challenges, while India is still striving to combat old enemies such as tuberculosis, malaria and cholera pathogens, which became more and more drug-resistant. Factors such as poverty, illiteracy, overcrowding and malnutrition additional compound the situation.55 Lack of awareness about infectious diseases in the common people and inaccessibility to healthcare frequently prevent them from seeking medical guidance. This, often, leads to self-prescription of antibiotics without any expert knowledge about the dose and duration of treatment.56 Patients who seek medical guidance, many end up consuming broad-spectrum high-end antibiotics due to lack of appropriate diagnostic modalities for identifying the pathogen and its drug susceptibility. Low doctor to patient and nurse to patient ratios along with lack of infection prevention and control (IPC) guidelines favour the spread of MDR organisms in the hospital settings.13,55 Easy accessibility of over the counter (OTC) drugs.57 additional contributes to antimicrobial resistance. Also, the increase in the pharmaceutical segment has triggered a corresponding increase in the amount of waste generated by these firms. With the absence of firm controlling and legal actions, this waste reaches the water bodies and serves as a continuous source of AMR in the environment.13,58 Another important challenge is the use of antimicrobial agents as pesticides and insecticides in the agriculture industry, while the evidence for the same is inadequate currently.59


Antibiotic resistance had a great impact on health and wealth consequences. Increase in the resistance results in a decrease in the patient outcome and increase in the cost of pharmacy. According to most recent study resistance developed patients had an increase in intensive care admission and long duration of stay in hospitals. There is also an increase in the mortality rate of the patients admitted with antibiotic resistance. Bacterial resistance makes the therapeutic dilemma to clinicians.15 However, the rules for controlling the sale of antibiotics worldwide, but particularly in developing countries, are weak, thus making it necessary to establish more rigorous preventive actions to control the side effects of infections that are resistant to antibiotics (usually unnecessarily prescribed) or even multi-drug-resistance (MDR).60 MDR, defined as antimicrobial resistance to at least one agent across three or more antimicrobial categories, results from one of two mechanisms.61 multiple genes accumulated by bacteria, each coding for resistance to a single drug within a single cell,62and increased expression of genes that code for multidrug efflux points.63,64 The prevalence of MDR has been reported as ranging from 4% to 20%, with higher prevalence in nosocomial infections. MDR affects both Gram-positive and Gram-negative bacteria, but therapeutic options are more limited for the latter. MDR is a major global public health concern, magnified by antibiotic overuse and unwarranted prescribing antibiotics. The use of inappropriate empiric antimicrobials increases the risk of MDR and mortality.7

Antibacterial drugs have been misused in humans for several decades, thereby creating ways for selection and spread of drug-resistant bacteria. Consequently, antibacterial drugs have become less effective or even ineffective, resulting in an accelerating global health security emergency that is rapidly outpacing the availability treatment options. WHO reports identify Staphylococcus aureus resistance to beta-lactam antibacterial drug methicillin as an international concern.65 Excess usage of antibiotics has expedited the development of methicillin resistance in S. aureus (MRSA). Risk of death in patients infected with MRSA is as high as 26.3%. Antibacterial resistance by MRSA also causes additional medical costs for antibacterial therapy, medical care and additional cost variable.66 MRSA strains identified four decades ago have become more problematic due to the evolutionary mechanisms adapted by the bacteria to evade antibiotics which are supported by environmental changes which aid the bacterial spread beyond the restrictions of health care facilities. Virulence conferred by these factors rendered the bacterium dominant resulting in making significant changes in the choice of antibiotics for the management of community-acquired infections.67

Compared with the abrupt contests of HIV/AIDS, tuberculosis, malaria, pneumonia, and many other communicable diseases, the loss of antibiotics at some future time does not capture the same consideration. Resistance in contradiction of certain antibiotics is already at high levels in certain places in India (and around the world), but the problem has persisted largely unidentified because comparatively few studies were available and countrywide observation was not being carried out. But the issue came to the fore in India when New Delhi Metallo-?-lactamase-1 (NDM-1), first reported in 2009, made front-page news in 20105. Briefly, NDM-1 is an enzyme produced by the gene blaNDM-1; it is named for New Delhi because the Swedish patient in whom it was first identified had undergone surgery in a New Delhi hospital.68 NDM-1 may be the most widely known form of antibiotic resistance in India, but several studies in recent years have documented significant rates of resistance to a wide range of antibiotics. Many are of hospital-acquired Gram-negative infections with Acinetobacter, Pseudomonas, Klebsiella, E. coli and gonorrhoeae.69,70

Comparable studies on the rise of antimicrobial resistance in gram-positive and gram-negative bacteria are reported also from India. The resistance array varies widely reliant on the type of the geographical location and health care setting, availability of antibiotics in hospitals and over the counter, prescribing habits of treating clinicians coming from different streams of medicine like allopathy, ayurvedic, homoeopathy or quacks. The drug resistance has been reported to develop in a population to an antibiotic molecule following its improper and irrational use. Irrespective of whether NDM-1 turns out to impend patients' health in India, the attention focused on this pathogen has encouraged the Government to act on antibiotic resistance. As an outcome, a Ministry of Health and Family Welfare task force declared a new national anti-microbial policy.71


The terms antibiotic guidelines and policy are frequently used interchangeably and may be unclear to many healthcare professionals. An antibiotic policy is a set of ideologies to guide the execution of prudent and rational antimicrobial prescribing in the healthcare system. Antibiotic guidelines are detailed endorsements for antibiotic treatment or prophylaxis for particular infections, diseases or syndromes.72The antibiotic policy is the set of approaches and events commenced to establish the antimicrobial treatment in the hospital and reach health outcomes for patients. The straightforward ideologies are to be direct evidence-based medicine, local epidemiology and liberty for prescribing physicians. An antibiotic policy is now more mandatory than ever for clinical, epidemiological and economic reasons. The Infection Committee is responsible for the antibiotics policy in hospitals.73 The primary aim of the hospital antimicrobial policy is to diminish the morbidity and mortality due to antimicrobial-resistant infection, and to preserve the efficiency of antimicrobial agents in the treatment and deterrence of communicable diseases. The antibiotic policy is fundamentally for prophylaxis, definitive and empirical therapy. The policy shall include detailed endorsements for the treatment of diverse high-risk/special groups such as immunocompromised hosts; community-associated infections and hospital-associated infections. It ought to similarly set the stages for recommending antibiotics; for instance, first-choice antibiotics can be prescribed by all doctors while restricted choice antibiotics can only be prescribed after consulting the antimicrobial team (AMT) representative or the head of the department. Reserve antibiotics, conversely, are prescribed only by designated experts.74


The policy should be simple, clear, clinically appropriate, flexible and pertinent to day-to-day practice and accessible in user-friendly presentation such as a pocket guide, web-based form, etc. The recommended antibiotic should be effective against pathogens often seen in that locality.72 Guidelines should be provided for optimal selection, dosage, route of administration, duration, and alternatives for allergy to first-line agents; and for adjusted dosage for patients with impaired liver or renal function. Recommendation for prophylactic use should specify procedures for which antibiotic are needed, optimal agents, dosage, timing, route and duration of administration so that adequate antibiotic concentrations are available at the time of bacterial contamination. Prophylaxis recommendation should mainly focus on clean as well as contaminated procedures. The prophylactic dose is recommended for a short duration, free of side-effects, and should be relatively cheap. Also, the antibiotics selected for prophylaxis should not be used therapeutically; as this may lead to the emergence of antimicrobial resistance.74

It will take substantial effort, time and resources to formulate antibiotic policies and guidelines from the scratch in this situation. It is worthwhile to go through the other guidelines that are pertinent to the local condition in the hospital setting or country and adapt accordingly. A multidisciplinary antibiotic administration team can be set up to engrave the antibiotic policy and guideline in hospital and the team includes surgeons, physicians, paediatricians, clinical microbiologists and pharmacists.43 And the policy should recommend the principles of antimicrobial stewardship, antibiotics for general use, reserved and restricted antibiotics; replacements for antibiotic use in case of allergy, guidance for the route of administration like intravenous to oral switch etc. Further, the guideline should also provide information on the diseased/syndrome e.g. pneumonia; type of clinical setting – inpatient units, outpatient clinics, ICU setting; when to switch from IV to oral and measures for the finding of infection/syndrome. The policy and guideline should be clear, simple, appropriate to day to day practice, relevant to local clinical conditions and available in suitable formats. The antibiotic guidelines and policy are alive documents and consequently should be revised at regular intervals. They should be modernized conferring to current medical information, medical practice and local circumstances.75


Generally, the hospital antibiotic policy should concur or align with the national antibiotic policy except for a few changes as warranted by the local antimicrobial resistance profiles. If there is a wide variation from national to hospital, and hospital to hospital then the desired purpose is defeated i.e., to minimize the morbidity and mortality due to antimicrobial-resistant infections; to preserve the effectiveness of antimicrobial agents in the treatment and to prevent microbial infections.74 A national antibiotic policy should address all relevant issues for antibiotic use, both in the community and the hospital, including veterinary and agricultural use.

The National Policy for Containment of Antimicrobial Resistance - India covers a range of topics, including curbing antibiotic use in animals, particularly those raised for human consumption; conducting infection surveillance in hospitals; improving hospital surveillance for monitoring antibiotic resistance; promoting rational drug use through education, monitoring, and supervision; researching new drugs; and developing and implementing a standard and more restrictive antibiotic policy. Under the new Schedule H1 (now called HX), which will regulate antibiotic use, selling antibiotics over the counter will be banned. Certain antibiotics, including carbapenems, will be available at only tertiary hospitals.71


Antibiotic policy contributes to the optimization of antimicrobial therapy, ensuring the proper use (indication, dose and duration) and minimizing side effects.76 An adoption of these kinds of policies leads to a reduction in the prevalence of antimicrobial resistance, costs and save lives.77 In 2015 Canter for Disease Control and Prevention (CDC) published a report about core elements of hospital antibiotic stewardship programs.78 According to CDC “there is no single template to optimize antibiotic usage”. The medical decision is complex and the antibiotic implementation policies should be flexible. Therefore, there is a need for defined leadership and coordinated multidisciplinary approach.78 For ideal decision making in prescribing antibiotics, doctors essentially have adequate information about infectious diseases, infecting microbes, and antimicrobials. So, the leader of the program should be infectious disease expert or infectious disease professional should co-direct the program with a clinical pharmacist. Thus, the key members of an antimicrobial stewardship team are constituted.79 For antimicrobial resistance investigation a clinical microbiologist, and the computer support an information system specialist is also needed.80 The infectious diseases physician or a clinical pharmacist with infectious diseases training has to have interactions with the prescriber physicians. They should perform a prospective audit and a feedback system, serving to reduce the inappropriate use of antimicrobials.79,80

In India, National Centre For Disease Control, under Directorate General of Health Services, Ministry of Health & Family Welfare, has formulated National Treatment Guidelines for Antimicrobial Use in Infectious Diseases in the year 2016 to combat emerging Antimicrobial resistance in India71, and the implementation in the hospital level is lagging. As per data available from NABH assessor’s conclave most accredited hospitals, though having a well written antibiotic policy on paper, are not compliant in practice. And so far, no hospital is maintaining a separate register for the use of antibiotics up to the mark. In a recent study antibiotics usage in an intensive care ICU are more expensive that has to be concerned and there is a need to follow the guidelines to be followed in using them which clearly states that the policies and guidelines for antibiotics used in the country are not efficient practice. India, with more than20,000 hospitals, more than a billion population, wide cultural diversity, socio-economic disparity, and a large medical community of more than three-fourths of a million doctors, will find the resistance problem an issue very difficult to tackle. Hence the government, policymakers and stakeholders should initiate the strategies to reduce the economic burden on the patient by developing and implementing the antibiotic policies in Indian healthcare settings like the primary, secondary and tertiary hospital to combat Antimicrobial resistance. To implement antibiotic usage as per the developed policies in India the national Action plan of the government should develop information, educate the physicians and the patients and training should be given on the usage of policies.


In summary, the choice of suitable antimicrobial depends on an understanding of the prospective pathogens and local vulnerability patterns. In selecting the right antibiotics, the properties of the antimicrobials; such as Pharmacokinetics and Pharmacodynamic (PK and PD) profiles, mechanism of action and strength, permissibility and safety, are all important factors.81 Initial suitable antibiotic treatment has been shown to reduce mortality, the span of stay in ICU and hospital. Early correct antibiotic chooses have also served to the reduction in antimicrobial costs.82In this reverence, it is emphasized that infectious disease specialist service being a professional in the arena, plays a significant part in improving antimicrobial usage, by advising on the judicious use of antimicrobial agents and by developing evidence-based guidelines under the light of antibiotic implementation policies.83,84 Therefore it is essential to develop Antibiotic policy in every Indian health care system and implement it properly by educating and training the infectious disease specialist. All hospitals must have an infection control committee (ICC) and an antibiotic policy and should initiate or augment efforts towards implementation. Those hospitals with an existing ICC and an antibiotic policy should augment efforts to increase compliance with the policy. Hospitals without a policy must initiate efforts to formulate an ICC and an antibiotic policy. The Government of India and respective state governments should take initiative to develop the antibiotic policy at every public care hospital to decrease the morbidity and mortality due to antimicrobial-resistant infection, and to preserve the efficiency of antimicrobial agents in the treatment and prevention of communicable diseases.


Authors wish to thank JSS College of Pharmacy, Ooty and JSS Academy of Higher Education & Research, Mysuru for providing all the necessary facilities and support to write this article. We also thank physicians/consultants of Govt. Medical College Hospital, Ooty for providing the necessary inputs and corrections of this manuscript.

Conflict of Interest


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  37. Sharma NC, Mandal PK, Dhillon R, Jain M. Changing profile of Vibrio cholerae 01, 0139 in Delhi & its periphery (2003-2005). Indian J Med Res 2007 May 1;125(5):633.

  38. Arora S, Saha S, Bal M. Imipenem-resistance among multi-drug resistant clinical strains in urinary infections from Kolkata. Indian J Med Res 2007 May;125(5):689-692.

  39. Jain A, Mondal R; Prevalence & antimicrobial resistance pattern of extended-spectrum beta-lactamase-producing Klebsiella spp isolated from cases of neonatal septicaemia, Indian J Med Res 2007;125(1):89-94.

  40. Menezes GA, Harish BN, Sujatha S, Vinothini K, Parija SC; Emergence of vancomycin-intermediate Staphylococcus species in southern India, J Med Microbiol 2008 Jul; 57(Pt 7):911-912.

  41. Chande CA, Shrikhande SN, Jain DL, Kapale S, Chaudhary H, Powar RM; Prevalence of methicillin-resistant Staphylococcus aureus nasopharyngeal carriage in children from the urban community at Nagpur. Indian J Public Health 2009; 53(3):196-198.

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  44. Adhikari L. High-level aminoglycoside resistance and reduced susceptibility to vancomycin in nosocomial enterococci. J Global Infect Dis 2010 Sep;2(3):231.

  45. Behera B, Mathur P. High levels of antimicrobial resistance at a tertiary trauma care centre of India. Indian J Med Res 2011 Mar;133(3):343.

  46. Menezes GA, Harish BN, Khan MA, Goessens WH, Hays JP. Antimicrobial resistance trends in blood culture positive Salmonella Typhi isolates from Pondicherry, India, 2005–2009. Clin Microbiol Infect 2012;18(3):239-245.

  47. Bagla J, Ghosh V, Ramji S, Gothi D. Antimicrobial susceptibility patterns following the change in antibiotic policy in NICU. Pediatr Infect Dis 2013;5(2):59-63.

  48. Wattal C, Raveendran R, Goel N, Oberoi JK, Rao BK. Ecology of bloodstream infection and antibiotic resistance in the intensive care unit at a tertiary care hospital in North India. Braz J Infect Dis 2014;18(3):245-251.

  49. Bouchiat C, El-Zeenni N, Chakrakodi B, Nagaraj S, Arakere G, Etienne J. Epidemiology of Staphylococcus aureus in Bangalore, India: the emergence of the ST217 clone and high rate of resistance to erythromycin and ciprofloxacin in the community. Microbes new infecti 2015;7:15-20.

  50. Agarwal R, Sankar J. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Global Health 2016;4(10):e752-760.

  51. Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, et al. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008–2014. Int J Infect Dis 2016;50:75-82.

  52. Gupta R, Malik A, Rizvi M, Ahmed M, Singh A. Epidemiology of multidrug-resistant Gram-negative pathogens isolated from ventilator-associated pneumonia in ICU patients. J Global Antimicrob Resis 2017;9:47-50.

  53. Mohapatra DP, Debata NK, Singh SK. Extensively drug-resistant and pan drug-resistant Gram-negative bacteria in a tertiary-care hospital in Eastern India: A 4-year retrospective study. J Global Antimicrob Resis 2018 Dec;15:246-249.

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  69. Sinha M, Srinivasa H, Macaden R. Antibiotic resistance profile & extended-spectrum beta-lactamase (ESBL) production in Acinetobacter species. Indian J Med Res 2007; 126: 63-67. 

  70. Gaur A, Garg A, Prakash P, Anupurba S, Mohapatra TM. Observations on carbapenem resistance by minimum inhibitory concentration in nosocomial isolates of Acinetobacter species: an experience at a tertiary care hospital in North India. J Health Popul Nutr 2008; 26:183-188. 

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  72. Özgenç O. Methodology in improving antibiotic implementation policies. J Hepatol 2016 Jun;6(2):143.

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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021

Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

A study by Dorothy Ebere Adimora et al. entitled \"Remediation for Effects of Domestic Violence on Psychological well-being, Depression and Suicide among Women During COVID-19 Pandemic: A Cross-cultural Study of Nigeria and Spain\" is awarded Best Article of Vol 14 issue 23
A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
A study by Saurabh Suvidha entitled \"A Case of Mucoid Degeneration of Uterine Fibroid with Hydrosalphinx and Ovarian Cyst\" is awarded Best article of Vol 14 issue 21
A study by Alice Alice entitled \"Strengthening of Human Milk Banking across South Asian Countries: A Next Step Forward\" is awarded Best article of Vol 14 issue 20
A study by Sathyanarayanan AR et al. entitled \"The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare\" is awarded Best article of Vol 14 issue 19
A study by Gupta P. et al. entitled \"A Short Review on \"A Novel Approach in Fast Dissolving Film & their Evaluation Studies\" is awarded Best Article of Vol 14 issue 18.
A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
A study by Ali Nawaz et al. entitled \"A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) \? A Randomized Controlled Study\" is awarded Best Article for Vol 14 issue 16.
A study by Singh R. et al. entitled \"A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)\" is awarded Best Article for Vol 14 issue 15
A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
A Study by Amol Sanap et al. entitled "The Outcome of Coxofemoral Bypass Using Cemented Bipolar Hemiarthroplasty in the Treatment of Unstable Intertrochanteric Fracture of Femur in a Rural Setup" is awarded Best Article Award of Vol 13 issue 24
A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.


International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal


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