ANTIMICROBIAL RESISTANCE- A SLOW TSUNAMI

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Source: The Hindu dated 29/4/2021 https://www.thehindu.com/opinion/op-ed/antimicrobial-resistance-the-silent-threat/article34434231.ece

Context: Covid-19 pandemic has underscored the need for cross-national collaboration in tackling antimicrobial resistance (AMR), which is regarded as one of the greatest challenges of the 21st century.

What is AMR?

  • Antimicrobial resistance is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials , and antihelmintics) that are used to treat infections.
  • As a result, standard treatments become ineffective, infections persist and may spread to others.
  • Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

 How does AMR develop?

  • Some bacteria due to the presence of resistance genes are intrinsically resistant and therefore survive on being exposed to antibiotics.
  • Bacteria can also acquire resistance. This can happen in two ways:
    • by sharing and transferring resistance genes present in the rest of the population or
    • by genetic mutations that help the bacteria survive antibiotic exposure.

Reasons for developing AMR

Antibiotic consumption in humans

Unnecessary and injudicious use of antibiotic fixed dose combinations could lead to emergence of bacterial strains resistant to multiple antibiotics

Access to antibiotics without prescription.

  • Cultural Activities : Mass bathing in rivers as part of religious mass gathering occasions.
  • Antibiotic Consumption in Food Animals : Antibiotics which are critical to human health are commonly used for growth promotion in poultry.
  • Pharmaceutical Industry Pollution: The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.
  • Environmental Sanitation : Untreated disposal of sewage water bodies – leading to contamination of rivers with antibiotic residues and antibiotic-resistant organisms.
  • Infection Control Practices in Healthcare Settings : A report on hand-washing practices of nurses and doctors found that only 31.8% of them washed hands after contact with patients.

Impacts of AMR

  • Antimicrobial resistance increases the cost of health care.It is estimated 
    • to cause 10 million deaths annually by 2050
    • To result in 7.5% reduction in livestock production
    • To negatively impact the global GDP by 3.5%

What should be done?

There are two major solutions to combat this menace

  1. Discovery of new drugs, before the emergence of resistance in germs – expensive, unpredictable process. Since 1984,no new class of antibiotics has been developed. The estimated cost for developing a new antiobiotic is 1 billion USD.
    Major pharmaceutical companies have largely abandoned innovation in this space. A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies,75% of which have no products currently in the market.
  2. Prudent use of available antibiotics – a realistic and inexpensive solution.

Steps taken so far

GLOBAL

  • WHO Global Action Plan on AMR(2015)- provides a roadmap for tackling this challenge.Almost 80 countries have developed their respective national action plans in alignment with this plan.
  • A multi sectoral 1 billion USD AMR Action Fund was launched in 2020 to support the development oif new antiobiotics
  • UK – is trialling a subscription based model for paying for new antimicrobials
  • Peru – patient education to reduce unnecessary antibiotic prescriptions
  • Australia – regulatory reforms to influence prescriber behaviour 
  • EU – VALUE-Dx programme 

INDIA

  • The National Health Policy 2017 highlights the problem of antimicrobial resistance and calls for effective action to address it.
  • The Ministry of Health & Family Welfare (MoHFW) identified AMR as one of the top 10 priorities for the ministry’s collaborative work with WHO.
  • In 2012, India’s medical societies adopted the Chennai Declaration, a set of national recommendations to promote antibiotic stewardship.
  • India’s Red Line campaign demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics.
  • National Policy for Containment of Antimicrobial Resistance 2011.
  • National Action Plan on AMR resistance 2017-2021.
  • India has instituted surveillance of the emergence of drug resistance in disease causing microbes in programmes on Tuberculosis, Vector Borne diseases, AIDS, etc.
  • Since March 2014 a separate Schedule H-1 has been incorporated in Drug and Cosmetic rules to regulate the sale of antimicrobials in the country.
  • The Food Safety and Standards Authority of India (FSSAI) banned the use of antibiotics and several pharmacologically active substances in fisheries.
  • The government has also capped the maximum levels of drugs that can be used for growth promotion in meat and meat products.

KERALA – A Case Study

  • Became the first state to have an action plan to tackle AMR -Kerala Antimicrobial Resistance Strategic Action Plan(KARSAP)

Way Forward

AMR has the potential to return the world to a pre-antibiotic era when medicines could not treat even simple infections. Therefore, to contain AMR, there is need for a One Health Approach through coherent, integrated, multi sectoral cooperation and actions, as human, animal and environmental health are integrated.

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