What’s in the news?

• Health experts at the All India Institute of Medical Science (AIIMS) warned that the increased use of antibiotics and the widespread use of hand sanitisers and antimicrobial soaps, can worsen the situation of antimicrobial resistance (AMR).

 What is AMR?

• Antimicrobial resistance (AMR) is the ability of a pathogenic microbe to develop a resistance to the effects of an antimicrobial medication.
• AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.
• The term antibiotic resistance is a subset of AMR, as it applies to bacteria that become resistant to antibiotics.
• Microorganisms that have antimicrobial resistance are sometimes called “superbugs”.

The issue of AMR

• Antibiotic resistance is one of the biggest challenges of modern medicine. This antimicrobial resistance mounts problems beyond the geographical as well as species barriers and can transmit from animals to humans. AMR needs to be addressed in totality by all sectors including healthcare, veterinary and agricultural domains.
• WHO has declared that AMR is one of the top 10 global public health threats facing humanity.
• Antibiotic resistant organisms have become rigidly established in our environment with many infections failing to respond to available antimicrobials.
• The emergence of antimicrobial resistance (AMR) is creating ‘superbugs’ that make treating basic infections difficult (and in some cases impossible) and surgery risky.

Causes of AMR

• Over-prescription and self-prescription of antibiotics.
• Patients not finishing the entire antibiotic course.
• Overuse of antibiotics in livestock and fish farming.
• Poor infection control in health care settings.
• Poor hygiene and sanitation.
• Current effluent standards do not include antibiotic residues, and hence they are not monitored in the pharmaceutical industry effluents, resulting in resistance.
• Bacteria can also acquire resistance naturally by:
  • Sharing and transferring resistance genes that is already present in the population
  • Genetic mutations that help the bacteria post it is exposed to antibiotics

Fight against AMR

• Based on the adoption of the Global Action Plan on AMR in 2015 in the World Health Assembly, member states were urged to develop National Action Plans based on the global framework within 2 years and share data with the WHO on implementation steps and AMR trends.
• In 2019, a new AMR indicator was included in the SDG monitoring framework.
• WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to continue filling knowledge gaps and to inform strategies at all levels.
• WHO estimates that, in 2018, there were about  half a million new cases of rifampicin-resistant TB (RR-TB) identified globally, of which the vast majority have multi-drug resistant TB (MDR-TB), a form of tuberculosis that is resistant to the two most powerful anti-TB drugs. In 2018, an estimated 3.4% of new TB cases and 18% of previously treated cases had MDR-TB/ RR-TB and the emergence of resistance to new ‘last resort’ TB drugs to treat drug resistant TB poses a major threat.
• National Action Plan on AMR (NAP-AMR) was released at the Delhi Declaration on Antimicrobial Resistance – an inter-ministerial consultation aimed at adopting a holistic and collaborative approach towards prevention and containment of AMR in India and increasing cooperation between various ministries.
• The Government of India adopted the National Action Plan on AMR (NAP-AMR) in 2017, with the Ministry of Health and Family Welfare (MoHFW) as the nodal ministry and the National Centre for Disease Control (NCDC) as the key surveillance body.
• India is amongst the nations with the highest burden of bacterial infections.
• In 2008, about 29% of isolates of Staphylococcus aureus were methicillin resistant, and by 2014, this had risen to 47%.
• The NCDC has prepared guidelines for the development of State Action Plans but till date, only three states—Kerala, Madhya Pradesh, and Delhi—have prepared and submitted them.
• In 2012, India’s medical societies adopted the Chennai Declaration, a set of national recommendations to promote antibiotic stewardship.
• Red Line campaign – demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics.
• The Food Safety and Standards Authority of India (FSSAI) banned the use of antibiotics and several pharmacologically active substances in fisheries.
• The Ministry of Health has capped the maximum levels of drugs that can be used for growth promotion in meat and meat products.

 Way Forward

• One Health Approach through coherent, integrated, multi sectoral cooperation and actions, since human, animal and environmental health are integrated for fighting against AMR.
• Lack of clean water and sanitation and inadequate infection prevention and control promotes the spread of microbes, some of which can be resistant to antimicrobial treatment. India in particular is known for lack of clean water. Hence, the Ministry of Jal Shakti scheme, “Swajal” (demand-driven programme involving the community to provide sustainable access to safe drinking water to people in rural areas) has to be given more seriousness.
• Strengthening resistance tracking– New infections should be collected and analysed, that can inform as to the degree of antibiotic resistance seen in different bacterial species or isolates from different types of infection
• Creating awareness, stopping self-medication, and investing in finding new antibiotics.
• New effluent standards that treat pharmaceutical industry effluents.

Additional Information

• Penicillin, world’s first antibiotic was discovered in 1928 by Scottish scientist Alexander Fleming.

Reference:

1. https://www.thehindu.com/news/national/widespread-use-of-sanitisers-soaps-can-worsen-antimicrobial-resistance-experts/article32827134.ece