Anti Microbial Resistance
Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria become “resistant” and continue to multiply in the presence of therapeutic levels of antibiotic.
Why Anti-biotic resistance is more prevalent in India: Key Factors
- India is the largest consumer of anti-microbials globally and the use of last resort anti-microbials like cephalosporins is soaring.
- Easy availability and overuse of anti-biotics is the most important factor: Over the Counter Availability; Irrational Use; over-prescription by doctors
- For e.g. Children often receive multiple courses of antibiotic every year since the viral infections are recurrent. This makes them more vulnerable to anti-microbial resistance.
- Poor Health Sector -> improper treatment -> Development of anti-biotic resistance
- Further, exposure to subtherapeutic levels of anti-microbials or non-adherence to prescribed medications has also been cited as a driver of AMR
- eg.: in case of TB
- Increasing and completely unregulated use of antibiotic in Agriculture, live stocks and Poultry
- Amount of antibiotics used in the farm animal and food industry is three to four times more than those used by humans.
- For instance, Colistin is extensively used in veterinary practices as a growth promoter. This leads to generation of colistin-resistant bacteria in poultry and fresh water fish.
- Poor Sanitation conditions -> More diseases -> More use of medicines -> More AMR development
- Unchecked discharge of effluents by the pharmaceutical industries -> high concentration of pharmaceutical substances are found in surface and ground water systems near production facilities -> anti-biotics cause development of anti-microbial resistance in environment.
- Cultural factors such as bathing in Ganga.
- A study published in Nov, 2017 shows that mass bathing is one important source for the transfer of AMR.
Impact of increasing anti-microbial resistance
- Damage to Public Health:
- In 2019, drug-resistant superbugs killed about 27 million people globally – a toll more than HIV/AIDs or malaria – and according to the UN estimates, the number could reach 10 million by 2050.
- Demands complicated treatment pattern, with longer stay in hospitals -> increase in cost of treatment.
- Stronger antibiotics which are used after the first line of drugs fail generally have toxic side effects
- Resistance also emerging for second line of drugs (e.g. XDR-TB emerging)
- Without functional anti-microbials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with the risk of untreatable infections.
- All this is compounded by the fact that no new class of anti-biotics have made it to the market in the last three decades, largely on account of inadequate incentives for their development and production.
- Economic damages due to AMR can be equivalent to what 2008-09 economic shocks resulted into: UN Report
- Environmental Damages
- Extensive amount of anti-biotics lead to development of AMR in some micro-organisms. It impacts the microbial biodiversity and thus the environmental balance needed.
Steps that government has taken and Steps that we further need to take
- National Policy for Containment of Antimicrobial Resistance, 2011
- Guidelines for appropriate antibiotic usage which have revised Schedule H drugs to make over-the-counter availability of certain antibiotics nearly impossible
- Programs such as Red Line Campaign
- Sanitation campaigns such as Swatch Bharat Mission etc.
- National Surveillance system for AMR (April 2017)
- National Action Plan on Antimicrobial Resistance (April 2017): Focused on enhancing awareness, strengthening surveillance, improving rational use, promoting research and supporting neighboring countries
What more could be done
- Strengthen healthcare services -> early detection; high quality medicines, complete treatment.
- Strengthening infection prevention and control in health care facilities and farm
- Proper Implementation of National AMR resistance action plan should get high priority, towards tackling drug resistance.
- Efficient utilization -> Following WHO’s ‘Access, Watch and Reserve‘ strateg
- Strict implementation of various drugs control regulation and increasing the fine for over the counter sale of drugs.
- Import and Export policies of food and feed should strictly regulate the anti-biotic use.
- Proper regulation of livestock sector to reduce the use of anti-biotics there.
- Improve biosecurity and ensure that harmful pathogenic organisms are not present at the farm.
- Promote vaccination over drugs
- Developing and Using Alternatives
- Botanical products with anti-microbial properties: Extracts from turmeric, ginger, pepper and garlic are effective anti-microbial and can be added to the feed to control bacteria.
- Use of Probiotics and Prebiotics
- Using Seaweed extracts for improvement of immunity and additional physiological performance among aquaculture animals.
- Using enzymes instead of antibiotics as growth enhancers. For e.g. enzymes like proteases, amylases, cellulase, esterase, lipase etc. are intended to enhance the availability of nutrients and help nutrient absorption in the digestive system.
- Phage therapy (i.e. using Bacteriophages in aquaculture)
- Irradiation of food crops
- DAHD should develop standard treatment guidelines to reduce misuse of anti-biotics.
- Bring a law to regulate manufacturing and sale of poultry feed laced with anti-biotics.
- Regulating pharmaceutical industry effluents -> strengthening BWM rules and improving its strict implementation.
- Tackling AMR in Environment
- Come up with a technical guidance to contain AMR from waste and environment.
- Shift to safer manufacturing practices for pharma to ensure reduced wastage and discharge in environment.
- More Research in the field of Anti-biotic resistance and coming up with safe mechanism to treat these AMR diseases
- A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new anti-biotics. Similar steps to allocate more resources for AMR research would be required.
- International Collaboration should increase.
- All UN member states should phase out the use of anti-microbial on the WHO’s highest priority list as growth promotion agents.
- Trade of anti-biotics must be regularized for therapeutic purpose only with strict legalized medical prescription and supervision.
- Increased focus on awareness generation among common people against the need of excessive use of anti-biotics.
- Develop new varieties of anti-biotics:
- Since developing new anti-biotics is expensive and requires a few years at least, a developing country like India needs to jump tart in-house development of new anti-biotics through PPP. Government agencies like ICMR and CSIR, long with DBT, DST can also work with global partners like Global Antibiotic Research Development Partnership (GARDP) etc.
The world can’t contain anti-microbial resistance unless stakeholders from all sectors such as human and animal health, environment, crops, food and drug come forward to act. One-Health action is must to slow down AMR.
Antimicrobial resistance is a multi-driven problem and only a multi-pronged approach can be helpful in tackling the scourge. Elaborate [10 marks, 150 words]