Antimicrobial Resistance: A Man-Made Pandemic India Needs To Be Aware Of

The overuse of antibiotics contributes to the acceleration of antimicrobial resistance. With the ever increasing antimicrobial resistance, we are left with few options to treat such patients.

AMR alone is killing more people than cancer and road traffic accidents combined together

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In the pre-antibiotic era, organisms with the potential to spread infection caused widespread outbreak, epidemics, or pandemics killing millions of people globally, more so in developing countries. The introduction of antibiotics into clinical use was undoubtedly the greatest medical breakthrough of the 20th century. These miraculous drugs, often called 'life-savers' were capable of eliminating the biological organisms in our body without harming us. 

The next three decades noticed development and discovery of a wide variety of antimicrobial agents, after which there was a steep down fall and finally a discovery void. 

But these antibiotics are being used on an exponentially increasing scale ever since their discovery. The overuse and misuse of antibiotics especially contributes to the acceleration of antimicrobial resistance(AMR).

Mutations are inevitable as these organisms spread and multiply. Most of these mutations may not greatly modify the characteristics of the organisms. But in the background of rampant antibiotic usage, there are mutations that enable them to thrive even in presence of the drug thus rendering the drug useless and the patient at a risk of non-improvement from the respective infection. This not only increases the mortality, but also increases hospital stay and cost of treatment with higher antibiotics. More so, these organisms spread to other individuals in the hospital or community slowly but effectively causing an increase in drug-resistant infections. The infections caused due to these resistant organisms are the sole reason for primary drug resistance to some antibiotics. 

Globally, about 700,000 people lose the battle to AMR per year and it is estimated that annually more than 10 million will die from it by 2050. AMR alone is killing more people than cancer and road traffic accidents combined together.

The scenario is no different for India. According to some reports, more than 70 per cent isolates of  some common bacteria were resistant to commonly used antibiotics. That means if a person gets a common urinary tract infection, several of the otherwise routinely prescribed, oral drugs will be rendered ineffective. 

Sadly, each one of us has been guilty of contributing to this predicament in some way or the other. Almost all of us have taken antibiotics for viral infections without realizing that antibiotics work on bacteria, not on viruses. Covid-19 pandemic is the best example for abuse of antibiotics. In India, buying pills over the counter on the ‘expert’ advice of the shopkeeper or on basis of an old prescription which provided clinical relief is a common practice. Wrong antibiotic choices, insufficient doses and interrupting treatment once the patient is feeling better have all been responsible for the rise of superbugs.

It is unfortunate that even doctors have been major contributors to this - using inappropriate antibiotics without the culture and drug sensitivity reports, giving broad-spectrum antibiotics that cover multiple organisms, moving to higher antibiotics without sufficient evidence to do so and prescribing antibiotics for the most mildest of viral infections.

Antibiotics are now used in livestock and poultry to prevent and control common diseases, in sub-therapeutic doses to promote growth and therapeutically to treat infections. Use of these antibiotics commonly used in both animals and humans is also a contributory factor towards primary resistance. 

With the ever increasing antimicrobial resistance, we are left with few options to treat such patients. The new antibiotic pipeline is almost dry as research and manufacturing of antibiotics is not profitable to pharmaceutical companies in comparison to production of drugs for chronic diseases. And therefore, in many senses we find ourselves in the pre-antibiotic era where people died of untreatable bacterial infections and the realization that even you, me and our loved ones could be facing this eventuality, should be an eye-opener for all of us. 

Each of us has a role to play in the fight against antimicrobial resistance.

Common Man:

• Protect yourself from infections.
• Follow hand hygiene, this has a proven efficacy towards prevention of infection and hence AMR.
• Get vaccinated to prevent common vaccine preventable diseases    like typhoid and influenza
• Practice safe sex
•  Ask if antibiotic is really needed and never insist on antibiotics. Over 90% of fever and regular cough cold are viral and will resolve on their own.
• Ensure the dose is appropriate and you complete the entire prescribed course. Never share or use leftover antibiotics.
• Avoid self-medication
• When possible, insist on culture and drug sensitivity testing.

Healthcare Professionals

• Use antibiotics judiciously
• Practice infection control and prevention measures
• Establish and follow a good antimicrobial stewardship program 

Policy Makers

• Establish a robust national action plan to tackle AMR.
• Establish SOPs to collect appropriate data on antibiotic-resistant infections and use of antibiotics.
• Strengthen policies, programmes, and implementation of infection prevention and control measures in government as well as private establishments.
• Regulate over the counter dispensation of antibiotics with penal provisions for violations.
• Promote the appropriate use and disposal of quality medicines.
• Make scientific information available in simple to understand and in multilingual formats.

The author is a clinical microbiologist at the UniLabs Diagnostics, Mumbai.

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