Anti-microbial resistance on the rise

Overconsumption of antibiotics is making bacteria smarter than doctors, capable of outfoxing their presc-ription patterns. Unless urgent measures are taken, conducting surgery may become pointless within a decade because of infections that cannot be defeated.

Antimicrobial resistance has emerged as a significant challenge to our creaking public health system. If not tackled on a war footing, India may soon come to be known as the anti-microbial resistance capital of the world. This has the potential to render all advances in medical and surgical fields irrelevant. Antibiotic treatment failures may soon become the norm rather than the exception.

Several factors are contributing to the rising threat of anti-microbial resistance. The prim-ary cause is that the use of antibiotics is not regulated in India. Anyone can buy these from the neighbourhood pharmacy without a doctor’s prescription, even the ones on the restricted list. Antibiotics are also being used indiscriminately in animal husb-andry to keep animals free from disease. In addition, doctors of alternative systems of medicine commonly prescribe them desp-ite their lack of formal training.

There are more than one lakh laboratories in India but not many are accredited. Most of them do not adhere to quality-assurance measures. They produce reports about antibiotic cultures and sensitivity patterns, which are used by doctors to prescribe antibiotics. To add to the state, medical reports are often prepared by technicians due to severe shortage of medical microbiologists who apparently lack knowledge.

A recent study in Kerala has found that 89% of all doctors prescribe antibiotics on a daily basis. According to a 2014 report published in the journal ‘The Lancet Infectious Diseases’, India consumes the highest volume of antibiotics in the world.

Further, business dynamics are outweighing the pharma industry’s resolve to fight antimicrobial resistance. Investing in new antibiotics has become a losing proposition. The result is that no new family of antibiotics has been discovered in the world since 2000.

There is also poor awareness about antimicrobial resistance among people and policy makers. India has neither a national antibiotic policy nor an infection-prevention policy. A gazette notification by the Central Government in August 2013 stated that 14 antibiotics and an equal number of anti-tubercular drugs would soon be restricted but on the bleak side of it, nothing has been done in this respect so far.

Some progress has, however, been made recently. In February this year, the Government of India and WHO called for a national meeting on antimicrobial resistance and voiced a strong commitment to overcome the challenge. The government’s mandate that packaging of all antibiotic drugs carry a red line to alert the users is encouraging.

What India needs is a national antibiotic and infection-control policy, with states to follow. This can be achieved through collaborative work between private and public health sectors. An example is shown by Kerala, the only state to have adopted an antibiotic policy.

The Amrita Institute of Medical Sciences (AIMS) coordinated the drafting of the document and has now partnered with the government to implement AIMS’ Antibiotic Policy and Infection Prevention Protocol and Practices in all hospitals and healthcare facilities in the state.

Training on antibiotics

On the education front, training on antibiotics must be made ma-ndatory at the undergraduate and postgraduate levels in medical colleges to change the beha-viour pattern of prescriptions, with involvement of nursing personnel and clinical pharmacists. The Medical Council of India  should introduce a refresher course for doctors on “Rational Prescription Practice.”

Over the long-term, the government needs to institute a system of quality checks to remove drugs of substandard quality from the market. Use of antibiotics on animals should be curtailed and more collaboration and research need to be initiated to probe antimicrobial-resistance patterns unique to India.

The government should imp-ose restrictions on use of high-end antibiotics and limit their prescriptions to referral and tertiary-care centres. Proper sanitation and infection-prevention practices at hospitals have to be encouraged. There is also a need to increase the number of infectious-disease specialists in India.

Antimicrobial resistance directly impacts morbidity, mortality and cost of care. If India doesn’t act now, the capacity of its health system of fight diseases may be in grave trouble soon. Worse yet, within the next decade, surgery itself may become useless because antibiotics will not be able to cure post-operative infections. Can India afford such a scenario?

(The writer is Head, Infection Control, Amrita Institute of Medical Sciences, Kochi)