Antimicrobial Resistance (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 of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

Effect of AMR

• Antimicrobial resistance (AMR) is a global health and development threat. It requires urgent multisectoral action in order to achieve the Sustainable Development Goals (SDGs).
• WHO has declared that AMR is one of the top 10 global public health threats facing humanity.
• Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.
• 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.
• The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted.
• Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk.
• AMR could kill up to 10 million people per year by 2050, according to the report. The economic impact is also expected to be substantial: By 2030, the shortfall in gross domestic product caused by AMR could be $3.4 trillion per year, with an additional 24 million people pushed into extreme poverty, the report estimated.

Major contributors

• The major sources of AMR mentioned in the UNEP report released on the sidelines of the fifth session of the UN Environment Assembly include: Poor sanitation, sewage and waste effluent; Effluent and waste from pharmaceuticals manufacturing; Effluent and waste from healthcare facilities; Use of antimicrobial and manure in crop production; Releases, effluent and waste in animal production.
• Poor sanitation, sewage and waste effluent: Over 56 per cent of domestic and industrial wastewater globally is released into the environment with little or no treatment. The lack of sanitation, poorly functioning sanitation or fragmented systems (open defecation, poorly contained pit latrines, septic tanks and sewers) that contaminate water sources spread AMR. This also includes releases from unused drugs disposed of in toilets, bins or waste dumps and leaching from open waste dumps.
• Pharmaceuticals manufacturing: Release of active pharmaceutical ingredients and high concentrations of antimicrobials in the environment without its proper treatment is one of the critical drivers of AMR. This also includes the solid waste and effluents from these institutions because of the presence of residual antimicrobials.
• Healthcare facilities: As antimicrobials are frequently used in healthcare, effluent and hospital solid waste from healthcare facilities is an important source of discharges of resistant microbes, antimicrobial pollution and antibiotic resistance genes (ARG) into the environment.
• Antimicrobials and manure in crop production: Pesticides with antimicrobial properties such as antibiotics and fungicides are widely used in industrial crop production and could impact AMR in the environment. This includes untreated manure and wastewater that may contain pharmaceuticals residues, ARGs and resistant microbes intentionally applied to soil and crops.
• Releases, effluent, waste in animal production: The report emphasises the environmental contamination caused by pharmaceuticals residues, ARGs and resistant microbes derived from aquatic as well as terrestrial animal production manure and effluent.
• Another source of concern in aquaculture is the use of antibiotics and parasiticides, which are then released into the environment. The improper disposal of unused drugs, which results in these drugs entering the environment, is a source of concern for the entire animal production industry.
• Pollution from antimicrobial agents disrupts the microbial composition of environmental media and affects biodiversity and ecosystem services. Water, soil and air then serve as vehicles for spreading antimicrobial resistant microbes and affects human, animal and other environmental reservoirs.

Initiatives

• National Action Plan on AMR: It was launched in April 2017 with the goal of integrating multiple stakeholder ministries/departments and focuses on the One Health concept.
• National Programme on AMR containment: Established in 2012. The AMR Surveillance Network has been strengthened as a result of this initiative by the establishment of labs at State Medical College.
• AMR Research and International Collaboration: To strengthen medical research in AMR, the Indian Council of Medical Research (ICMR) has made measures to produce novel drugs/medicines through international cooperation.
• AMR Surveillance and Research Network (AMRSN): The AMR Surveillance and Research Network (AMRSN) is a network that monitors It was established in 2013 with the goal of gathering information and capturing trends and patterns of drug-resistant diseases in the country.

Way forward

• Enhancing environmental governance, planning and regulatory frameworks
• Identifying and targeting priority AMR-relevant pollutants
• Improving reporting, surveillance and monitoring
• Prioritising financing, innovation and capacity development
• Infection-control methods, in addition to creating novel antimicrobials, can minimise antibiotic use. It is vital to guarantee that all people who require antimicrobials get access to them.
• To track the development of microbe resistance, surveillance procedures to identify these organisms must be expanded beyond hospitals to include livestock, wastewater, and agriculture run-offs.
• Efforts to control antimicrobial prescription should be accompanied by efforts to educate consumers in order to reduce inappropriate demand, to issue standard treatment guidelines that would enable providers to stand up to such demands, and to provide point-of-care diagnostics to aid clinical decision-making.
• Because microorganisms will certainly continue to develop and grow resistant to new antimicrobials, we will require continual investments and worldwide cooperation to discover and battle emerging resistant strains.

https://www.downtoearth.org.in/news/food/unea-5-2-pharma-health-sectors-among-5-major-sources-of-amr-says-unep-report-81780

How to structure

1. Give an intro about antimicrobial resistance(AMR)
2. Explain in detail about it
3. Mention the major contributors to AMR is getting formed, transmitted and spread
4. Suggest measures to contain it
5. Conclude