Too much of a good thing is generally bad for you. And in the case of antibiotics, could even kill you. The world over, decades of overuse and misuse of antibiotics has governments, doctors and drug researchers worried because our allies have turned traitors.
The situation is quite alarming. In 2010, India bagged the dubious distinction of being the world’s largest consumer of antibiotics for human health. Thus in addition to being diabetes capital of the world, we will most probably top the charts in antimicrobial resistance (AMR) as well. In fact, we could soon be confronted with the situation where hospital acquired infections, which generally involved super bugs resistant to most antibiotics, could result in more deaths than disease itself, predicts Dr Ramakant Panda, Vice Chairman and Managing Director, Asian Heart Institute.
(Read our cover story in the July issue: Antibiotic Apocalypse, Page no 22-31)
Getting AMR under control requires multi-pronged action. While the clinical and medical community has to resolve to prescribe less antibiotics, pharmacists/ chemist shops have to stop selling them over the counter. Patients have to be counselled on the importance of finishing their dosage regimes and not resorting to self medication. Pharmaceutical companies have to stop the practice of incentivising the clinical fraternity to prescribe more antibiotics as well as zerodischarge facility across their supply chain. Beyond the medical and pharma sectors, governments are calling for the food and livestock industry to reduce the use of antibiotics in feedstock.
Besides, awareness drives in public and private hospitals, medical education needs to reflect the challenge of AMR. Including a section on AMR and antibiotic use, guidelines will automatically take care of the overuse/ misuse of antimicrobials in the future. Old habits die hard and unless we act fast to sensitise the current generation of medical students to the need for rational antibiotic prescribing habits, patients too will keep dying.
Partnerships will have to be forged to tackle the AMR challenge. For instance, in a paper published on the Center for Disease Dynamics, Economics & Policy (CDDEP) website, titled, A role for private sector laboratories in public health surveillance of antimicrobial resistance, the authors point out how unlike developed countries, low- and middle-income countries (LMICs) lack the public health resources to track AMR. This is where the expanding private healthcare sector, both hospitals and testing laboratories, can be leveraged to collect data. For instance, the CDDEP’s ResistanceMap for India shows antibiotic resistance rates based on data from a large private laboratory network with, approximately 5700 collection points including private hospitals and community diagnostic labs in 26 states, aggregating more than 18,000 blood isolates between 2008 and 2014. This data can throw up country-wide AMR trends, which can be used to formulate policy guidelines as well as decide fund allocation.
Many medical device companies are experimenting with diagnostic tests to detect AMR and help clinicians detect as early as possible if the infection is viral or bacterial, and if the latter, whether there is drug resistance and if so, the level.
India has taken quite a few steps in its battle against AMR. The Jaipur Declaration, signed in September 2011 by health ministers of member states of WHO South-East Asian Region, recognised the seriousness of the problem, while the Chennai Declaration two years later, coinciding with the global initiatives to combat AMR, resolved that the country did not need a ‘perfect antibiotic policy’ but rather ‘an implementable antibiotic policy’. In line with the Chennai Declaration, the ICMR initiated a programme on antibiotic stewardship, prevention of infection and control (ASPIC) to raise awareness and to train participants on antibiotic stewardship and infection control. Under this programme, 15 microbiologists, four pharmacologists and one physician were trained in 2012. ICMR then followed up with the launch of the Anti Microbial Resistance Surveillance and Research Network (AMRSN) across the country in 2013 with a mission to rationalise Antimicrobial Stewardship Programmes (AMSP) in India.
In February this year, the Ministry of Health & Family Welfare released the 64-page National Treatment Guidelines for Antimicrobial Use in Infectious Diseases. This is part of the Ministry’s national programme for containment of AMR under the 12th Five year plan (2012-17). Appreciating the efforts of the National Centre for Disease Control to put together these guidelines, Dr Jagdish Prasad, Director General of Health Services, quoted estimates that 50 per cent or more of hospital antimicrobial use was inappropriate. Many hospitals have antibiotic use policies but are they implemented properly? Only time will tell.
Viveka Roychowdhury
Editor
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