Dr Sanjay Pandey, Head- Andrology & Reconstructive Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute emphasises that while India is focusing on strengthening the primary healthcare infrastructure through its allocation in union budget, ignoring AMR can shake the laid foundation and pose a major threat in the coming years
One of the serious threats faced by healthcare systems globally is of Anti-Microbial Resistance (AMR), which is a complex problem that needs to be addressed by multiple stakeholders. Indian scenario is no different as there have been multiple cases wherein hospitals from many states of India have reported high resistance rates of pathogens. Many urologists have also observed that diseases and infections pertaining to urinary tract have become extremely difficult to treat due to high levels of drug resistance. In certain critical surgeries, AMR may also lead to increase in mortality rate as certain antibiotics may not respond in the treatment of a medical infection.
A recent Study by ICMR, has found that a major portion of Indian patients in India may no longer benefit from carbapenem, a commonly used antibiotic in most of the ICU settings. Many individuals have already developed antimicrobial resistance, thus leading to drug resistant pathogens, found the study, which was conducted between January 1 to December 31, 2021. The Study also found that resistance to Imipenem (to treat bacteria E coli) has increased from 14 per cent to 36 per cent from 2016 to 2021.[i]
Now, one may question why India needs to consider AMR issue on priority, if the issue is global? To begin with, India has one of the highest drug-resistance in the world. Also, India tops the list of countries for antibiotic consumption per person. A recent study by John Hopkins School of Medicine highlighted that the situation is quite alarming in India. These, in turn, will lead to longer duration of hospitalisation and increasing out-of-pocket expenses for the patients and caregivers. [ii]
While the scientists and researchers are evaluating the exact factors that is leading to AMR in India, there are certain highlights and factors to consider for healthcare community while dealing with AMR. Some of the factors like overuse of antibiotics in viral infections, availability of antibiotics as over-the-counter medicine etc are rampant in the healthcare systems. These two factors overlap and are deeply connected with diagnostics. Due to lack of diagnostics to determine to type of infection, medical professionals prescribe antibiotics which may or may not work in certain infections. Apart from this, urologists have seen increasing incidents of discontinuation of medicines by patients, once the patient is recovering. This means that the patients have stopped the medicines midway even when the infection in the body has not been completely been killed.
While India is focusing on strengthening the primary healthcare infrastructure through its allocation in union budget, ignoring AMR can shake the laid foundation and pose a major threat in the coming years.
Role of science in dealing with AMR
To tackle this global potential crisis, Antibiotic Resistance Breakers (ARBs) can play a major role and the results can be very promising. ARBs are novel new-age drugs when combined with current antibiotic can tackle antimicrobial resistance and the results are quite promising for the patients and their overall health. ARBs have a great potential, in the current scenario, as they are effective against resistant pathogens.
Secondly, Point-of-Care diagnostics with shorter Turn-Around Time (TAT) for early diagnosis of infections should be prioritised. Highly advanced diagnostics like immunoassays (simplest, oldest and no cold storage required), metagenomics and genomics (highly sensitive) etc can be widely used to determine to type of pathogen and resistance mechanism. A quick 15-minute test can detect Ebola from saliva sample, Rabies from tissue samples and Paratuberculosis from fecal samples. This enables clinicians to determine the timely course of treatment and identify the right kind of antibiotics for treatment.[iii]
Thirdly, a strong nation-wide awareness program to sensitise people on use of antibiotics should be initiated with public and private partnership. Unlike Western countries, antibiotics are available in India without prescription and this aggravates the situation of AMR. Patients need to be sensitised and trained so that they stop popping antibiotics every time for their common cold, flu and other viral infections.
In conclusion, efforts are being made in tackle AMR. The Indian government has recently announced strengthening its antimicrobial resistance surveillance to monitor AMR situation in the country. However, it is imperative to understand that drug resistance can affect economic growth, per capita expenditure and can negatively impact health of the society. Hence, curbing the silent killer needs a stronger holistic framework and requires policy level intervention addressing action points for multiple stakeholders. There is a strong need to create a holistic framework at tertiary as well as primary healthcare levels.
References:
[i] https://main.icmr.nic.in/sites/default/files/upload_documents/AMR_Annual_Report_2021.pdf
[ii] https://researchmatters.in/news/india-tops-list-countries-highest-antibiotic-resistance-finds-study
[iii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709694/
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