Drug war: On use of antibiotics and antimicrobial resistance

Context: Antimicrobial resistance is a health issue that will negate advances in medicine

News:

The 'First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22,' conducted by the National Centre for Disease Control under the Health Ministry, has revealed alarming statistics.

• More than 70% of patients in tertiary-care hospitals across 15 States and two Union Territories were prescribed antibiotics, with over 50% having the potential to cause AMR.
•  Notably, 55% of patients received antibiotics as a preventive measure, while only 45% were prescribed antibiotics for actual infections, and of this, merely 6% were based on the identification of specific bacteria.

Antimicrobial Resistance

• Antimicrobial Resistance (AMR) refers to the ability of microorganisms, such as bacteria, viruses, fungi, and parasites, to resist the effects of drugs designed to combat infections. This crisis is exacerbated by inappropriate medical and animal husbandry practices, as highlighted in the survey.
• Over time, these microorganisms undergo changes that make them unresponsive to the medications, rendering infections more challenging to treat and escalating the risks of disease transmission, severe illness, and death.
• The World Health Organisation (WHO) recognizes AMR as a significant global health threat, listing it among the top ten. Microorganisms that develop resistance to antimicrobials are commonly referred to as "superbugs."
• The World Health Organization (WHO) estimates that bacterial AMR directly caused 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.
• In India, more than 56,000 newborn deaths occur annually due to sepsis caused by organisms resistant to initial antibiotics. A study by the Indian Council of Medical Research (ICMR) revealed that Covid patients acquiring drug-resistant infections in hospitals face a mortality rate of approximately 50-60%.
• A notable example of AMR is the emergence of the multi-drug resistance determinant known as New Delhi Metallo-beta-lactamase-1 (NDM-1), which originated from this region.
• Furthermore, multi-drug resistant typhoid originating from South Asia has affected regions like Africa, Europe, and other parts of Asia. This underscores the global implications and challenges posed by the spread of antimicrobial resistance.

Concerns Regarding AMR:

1. Life-threatening Condition:

•   The rise of Antimicrobial Resistance (AMR) poses a significant challenge in treating life-threatening conditions like sepsis.
•    Antibiotic failure is contributing to preventable deaths, especially in cases where antibiotics are unable to combat infections effectively.

2. Reduction in Medical Advances:

•    AMR is eroding and reversing decades of medical progress, particularly in the treatment of prevalent diseases such as tuberculosis and various forms of cancer.
•    The efficacy of antibiotics, a cornerstone in medical advancements, is being compromised by the growing threat of resistance.

3. Achievements of Goals:

•    The emergence of AMR jeopardizes the achievements of Millennium Development Goals and poses a threat to the attainment of Sustainable Development Goals.
•    Progress made in improving global health and well-being is at risk due to the challenges posed by antimicrobial resistance.

4. Increase in Superbugs:

•    Untreated wastewater from medical facilities contains chemical compounds that contribute to the proliferation of superbugs.
•    The unregulated discharge of chemical compounds fosters the development and spread of drug-resistant microorganisms.

5. Expanding with Time:

•    The combination of self-medication practices and over-the-counter (OTC) antibiotic availability has led to some of the highest rates of antibiotic resistance globally.
•    The widespread misuse and availability of antibiotics without proper medical oversight contribute to the growing challenge of antimicrobial resistance over time.

Way Forward to Address AMR:

1. Multipronged Strategy:

•    Addressing Antimicrobial Resistance (AMR) necessitates a comprehensive strategy involving multiple sectors. Developing new drugs should not overshadow measures to judiciously use existing antimicrobials.
•    Implementing improved infection control practices, ensuring quality diagnostics, and educating the public about antimicrobials have proven effective in reducing antimicrobial pressure, a key factor in resistance.
•    A coordinated plan, supported by appropriate funding and led by a designated coordinating agency, is essential for success.

2. One Health Approach:

•    Recognizing the potential regression to a pre-antibiotic era, a One Health Approach is crucial for addressing AMR. This approach involves integrated cooperation across human, animal, and environmental health sectors.
•    The development of antibiotic resistance breakers (ARBs) to restore the effectiveness of older antibiotic classes is vital for combating AMR.

3. Effective Surveillance and Data Management:

• Strategies must be adopted to optimize antibiotic use across various disciplines, exercising prudence, including in the discharge of pharmaceutical effluents.
•    Robust microbiological surveillance in agriculture, livestock, and pharmaceutical manufacturing can inform policy actions to mitigate AMR.
•    Promoting research to address data deficiencies related to AMR is essential for evidence-based assessment and intervention, contributing to the overall fight against antimicrobial resistance.

Both doctors and the government play crucial roles in regulating drug use, with a particular emphasis on the latter. Patients' expectations for immediate relief need to align with the realities of medical science, which lacks magical remedies. Ultimately, the agency with the authority to establish strict regulations on antimicrobial use and promote and fund research on new antibiotics will determine the line between life and death.