CDSCO's September 2026 Circular on Painkillers and Antibiotics: An OPD Prescribing Checklist

On 21 September 2026 the Central Drugs Standard Control Organization (CDSCO) issued a three-page circular titled "Indiscriminate use of painkillers (NSAIDs), antibiotics and associated risk of Chronic Kidney Disease". It is listed on the CDSCO Circulars page as the latest circular, with a release date of 22 September 2026. It is addressed to the public, healthcare professionals, pharmacists and retailers, hospitals, and state drug controllers. It does not name any medicine to stop. It restates what the Drugs Rules already say about prescription-only medicines and sets out what each group should do.

For a doctor in a one-room OPD, the part of this CDSCO circular on NSAIDs and antibiotics that matters is Section B, five short points for healthcare professionals. This guide quotes them, explains the legal background the circular cites, and turns Section B into a checklist you can use between patients.

Information as of 16 October 2026. This is general information, not medical or legal advice. The checklist below is our reading of the circular. It is not a clinical protocol, and it has not been signed off by a named doctor.

What Section B of the circular says to prescribers#

Section B, "Healthcare Professionals", reads in full:

"I. NSAIDs and antibiotics should be prescribed only when clinically indicated, after considering the patient's clinical condition, age, co-morbidities, concomitant medicines and relevant risk factors.

II. The lowest effective dose for the shortest appropriate duration should be considered when prescribing NSAIDs, particularly in patients at increased risk of renal impairment.

III. Appropriate precautions should be taken in patients with renal impairment, dehydration, cardiovascular disease or other conditions that may increase the risk associated with NSAID use.

IV. Antibiotics should be prescribed judiciously and in accordance with applicable antimicrobial stewardship principles, taking into consideration the likely causative organism, site and severity of infection and, wherever appropriate, relevant microbiological investigations and local susceptibility patterns.

V. Unnecessary combination therapy, inappropriate antibiotic selection, incorrect dosing and unnecessarily prolonged duration of antibiotic treatment should be avoided."

The circular's opening adds one sentence that frames all of this: "it is mandatory to ensure that, these drug shall only be used when clinically indicated, in the appropriate dose and for the appropriate duration, and under the supervision of a Registered Medical Practitioner."

The legal background the circular cites#

The circular does not create a new schedule. It points to the Drugs and Cosmetics Act, 1940 and the Drugs Rules, 1945. The Drugs Rules are on the CDSCO site.

• "As per the said rules, all drugs including non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics are required to be sold and distributed in the country on prescription of RMP/ specialist only."
• "Most of NSAIDs are included in the Schedule H of Drugs Rules, 1945." They are "not to be sold by retail without the prescription of a Registered Medical Practitioner" under Rule 97.
• "Most of the antibiotic drugs are included in the Schedule H1 of Drugs Rules", and are labelled "It is dangerous to take this preparation except in accordance with the medical advice" and "Not to be sold by retail without the prescription of a Registered Medical Practitioner."

Section C tells pharmacists and retailers that "Schedule H/H1 drugs shall not be sold at retail except in accordance with the applicable provisions of the Drugs Rules, 1945" and that they "shall not encourage or facilitate self-medication with antibiotics or prescription-only NSAIDs." In practice that puts more weight on the prescription you write. Our digital prescription guide and the free prescription template cover what a readable prescription contains. Schedule H, H1 and X medicines carry extra rules beyond a clear layout.

What the circular asks of patients#

Section A, "General Public", has five points. Three are things a doctor can say in one line at the end of a consult:

• A.III: "Antibiotics prescribed by a healthcare professional should be taken strictly as advised and should not be shared with other persons or used from leftover medicines."
• A.IV: "Individuals, particularly those with pre-existing kidney disease or other risk factors for renal impairment, should inform their healthcare professional before using NSAIDs."
• A.V: "The public is advised to seek medical advice where pain, fever or other symptoms persist or recur rather than repeatedly using painkillers or antibiotics on their own."

An OPD checklist built from Section B (our reading)#

This checklist is our reading of Section B, written for a busy single-doctor OPD. It adds no dosing advice beyond the circular.

Before an NSAID (B.I to B.III)

• Is there a clinical indication for an NSAID at this visit?
• Have you looked at age, co-morbidities and the patient's other medicines (B.I)?
• Is kidney disease, dehydration or cardiovascular disease on the chart or in the history (B.III)?
• Is another NSAID already on this prescription, or one the patient is taking?

Writing the NSAID line (B.II)

• Write a dose, a frequency and a fixed duration, so the patient and the pharmacist know when to stop.

Before an antibiotic (B.I, B.IV)

• Is there a clinical indication for an antibiotic at this visit?
• Have you considered the likely organism, the site and the severity (B.IV)?
• Would an investigation help, where appropriate (B.IV)?

Writing the antibiotic line (B.V)

• One antibiotic unless a combination is truly needed.
• A dose and a fixed number of days, not an open-ended "till review".

Advice line (A.III to A.V)

• Take antibiotics exactly as written. Do not share them or use leftovers.
• Tell a doctor about kidney problems before taking painkillers.
• Come back if pain or fever persists instead of repeating painkillers or antibiotics on your own.

What Medabha checks, and what it does not#

If you prescribe in Medabha, some of this checklist is backed by checks in the consult room. Here is exactly what they cover.

What it flags. Medabha recognises these NSAIDs by generic name on a medicine line: ibuprofen, diclofenac, aceclofenac, naproxen, nimesulide, piroxicam, ketorolac, mefenamic acid, indomethacin and aspirin. It warns when:

• two of them are on the same prescription (the warning includes "One is usually enough.")
• an NSAID is prescribed and kidney disease is in the patient's Chronic conditions ("NSAIDs can worsen kidney function.")
• an NSAID is prescribed and hypertension is in the patient's Chronic conditions
• an NSAID is prescribed with an ACE inhibitor or ARB, or with warfarin, acenocoumarol, rivaroxaban, apixaban or dabigatran
• an NSAID is prescribed for a patient recorded as pregnant, from about 28 weeks, and only when those weeks are on the chart

The check runs while you write the prescription and again when you sign. If a warning is showing, signing stops until you tick "I have reviewed the interaction warning." You can still sign. The decision stays with you.

Durations. Every prescription line has a separate Duration field, printed in its own column. Clinics can save their own suggestions under Settings, then Duration presets. Until you save your own list, the starter suggestions are "3 days", "5 days", "7 days", "10 days", "14 days", "1 month", "Till review" and "Continue till next visit". They appear as autocomplete on every prescription line. You can still type your own duration. The prescription abbreviations page is a separate reference for shorthand such as 1-0-1.

What it does not do.

• It is not a complete interaction database. The code says so: "This is not a complete interaction database. It warns; the prescriber decides."
• It looks for the generic names listed above. A line that shows only a brand name may not trigger the warning.
• It has no antibiotic stewardship check. It does not judge whether an antibiotic is indicated, whether two antibiotics overlap, or how long a course is. It does flag a few specific antibiotic interactions, such as clarithromycin or erythromycin with atorvastatin or simvastatin.
• It does not stop you signing a line with no duration.
• It only knows about kidney disease or hypertension if they are written in the patient's Chronic conditions.
• The pregnancy warning for an NSAID does not appear if the patient is marked pregnant but the weeks are blank.

What is still unclear#

How state drug controllers will act on Section E, which asks them "to create awareness among healthcare professionals, pharmacists, retailers and the general public". Watch your state drug control department and your council. We have not found a state follow-up notice, and we are not claiming there is none.

Related reading: how to create a digital prescription, the prescription template, prescription abbreviations, and prescription software.

This is general information, not medical or legal advice. Information as of 16 October 2026.