ANTIMICROBIAL RESISTANCE (AMR)
CONTEXT:
- Recently, a recent report by government throws light on the importance of prevention of AMR.
WHAT IS AMR ?
- It is defined as resistance of pathogens to an antimicrobial agent to which they were sensitive earlier.
- Many fungi, bacteria, viruses and parasites have evolved to become resistant to the drugs that are earlier used to treat them.
- According to the World Health Organization (WHO), the growth of dangerous new AMR superbugs is a global crisis that shouldn’t be ignored.
- AMR lead to longer duration of illnesses, higher healthcare costs and even deaths.
- Number of deaths due to AMR have been rising, reaching upto 4.95 million in 2019.
STATUS OF AMR IN INDIA:
- In 2019, India had an estimated 297,000 deaths from AMR.
- As per the government study, published earlier this month was conducted across 20 government medical colleges and hospitals,”Indiscriminate use of antibiotics is the main reason for spread of AMR”.
- Use of antibiotics was “remarkably high”, around 72% of patients were given such drugs.
- 55% of total patients got them for mere prevention and only about 6% were given antibiotics after proper diagnosis.
CAUSES OF AMR:
- Overuse, incorrect diagnosis and dosage, and not completing the prescribed course can lead to development of AMR.
- High use of antibiotics and hormones in food- producing animals to bump up production such as colistin is also responsible for the rise of AMR.
- The inappropriate use of antibiotics in non-bacterial infections, both because of prescribing practices and the use of over-the-counter antibiotics.
- Inadequate labs facilities to inform clinicians rapidly about an appropriate antibiotic even in bacterial infections, based on cultures.
- The lack of adequate training in antibiotic selection, escalation, and de-escalation.
- The inadequate monitoring of AMR and control of antibiotic prescription and dispensing practices by health systems inspite of repeated warnings.
- The incentivisation of prescribing practices by the pharmaceutical industry.
POSSIBLE TREATMENTS FOR AMR:
- The search for new antibiotics against the rising challenge of antimicrobial resistance (AMR) is critical.
- Zosurabalpin stands out as a promising new candidate, offering a potential new way to tackle drug resistant Acinetobacter infections.
- The Indian pharmaceutical landscape is witnessing a leap forward with Wockhardt’s cefepime-zidebactam, showing the capacity to neutralise most resistance mechanisms exhibited by Gram negative bacteria.
- Developed by the Japanese firm Shionogi and now distributed by GARDP, Cefiderocol, already approved for use in various countries, stands out as another beacon of hope.
- Bacteriophages, also known as phages, are viruses that specifically target and eliminate bacteria.
- They are emerging as a potent weapon against bacterial infections in humans, thanks to their ability to selectively hit harmful bacteria.
- Bacteriophages benefits stretch across human health to agriculture, food processing and animals.
STEPS TAKEN TO COUNTER AMR:
- In a move towards rationalize prescription of antibiotics, the Indian Council of Medical Research (ICMR) published guidelines on prescription of antimicrobials for 12 syndromes such as sepsis, acute fever and urinary tract infection.
- India brought the first National Policy for Containment of Antimicrobial Resistance in 2011.
- The government also launched a National Action Plan on AMR in 2017 which calls for improved surveillance on antibiotic use and higher investment in R&D.
- India is a member of the Global AMR R&D Hub, which consists of 17 countries and the EU.
- The banning on use of colistin by the Indian government in 2019, as a growth promotional agent in poultry farming is a significant step in regulating antibiotic use.
WHAT MORE NEEDS TO BE DONE ?
- As currently many of our antibiotics in use date back to the 1950s and 60s. Thus, there is an urgent need to develop newer antibiotics and ensure access to everyone.
- Doctors also need to rationally prescribe antibiotics, antivirals, or antifungals after proper diagnostics.
- A behavioural change is also needed from the common public. Avoiding self- medicating, sticking to the dosage prescribed by clinician and avoiding sharing medicines prescribed for someone else are some of the changes required in common public.
WAY FORWARD:
- AMR is not just a scientific issue but a complex socio-economic and political challenge to be solved.
- It cannot be tackled in isolation as the pandemic has taught us that everything is interconnected. Thus,we must work with all the stakeholders.
