Antibiotics have saved millions of lives till date. Unfortunately, they are now becoming ineffective as many infectious diseases have ceased to respond to antibiotics.There is a growing health threat from antimicrobial resistance in the country .
The slow progress in healing this critical component of healthcare highlights the fact that the authorities’ attempts to find a way out of the complex web of causative factors have been ineffective. Poverty is at the root of this rampant illegality, for a majority of the patients can’t afford proper treatment and the near-absence of medical insurance drives them to quacks or pharmacies that blatantly sell drugs without prescriptions. Such patients, thus, fall into a vicious trap as over-the-counter antibiotics and their ill-matched combinations often lead to resistance to drugs.
According to the recent study published in the Lancet journal, an alarming 47 per cent of the antibiotics consumed by patients undergoing treatment in the private sector of the country in 2019 were formulations that did not have the nod of the drug regulator. And, given that the private sector contributes to over 85 per cent of the total consumption of antibiotics, this practice assumes alarming proportions and raises safety and efficacy concerns.
The World Health Organisation (WHO) defines antimicrobial resistance as “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.” WHO has declared antimicrobial resistance to be one among the top 10 global public health threats facing humanity.
Apart from indiscriminate prescription by doctors, there are other causes for AMR. These include patients not completing the full course of medicines prescribed to them, excessive use of antibiotics in animal husbandry, and indiscriminate prescriptions from quacks.
Poor infection control and lack of rational use of antibiotics may soon make ICUs a hot bed for infections. Complex surgeries such as organ transplantation and cardiac bypass might become difficult to undertake because of untreatable infectious complications that may result post-surgery.
Everything from how we take antibiotics to environmental pollution with antimicrobial chemicals, use of antibiotics in agriculture and even preservatives in our shampoo and toothpaste are all contributing to resistance.
India has one of the highest drug-resistant pathogens globally, including the highest numbers of multidrug- resistant tuberculosis and an alarmingly high resistance among Gram-negative and Gram-positive bacteria. More than 50,000 newborns die from sepsis annually due to pathogens resistant to first-line antibiotics. While exact estimates of the effect of AMR in India are not available, neonates and the elderly are the worst affected.
In India, over two million deaths are projected to occur due to AMR by 2050.Antimicrobial resistance, if not prevented and managed effectively, can wipe out decades of medical advances threatening the very existence of life.
In the past couple of decades, antimicrobial resistance (AMR) has grown in the shadows and has now come out as a public health emergency.
Three strategies for reducing AMR: First, create awareness at a population level and education at a professional level, including vets, conservationists, and people from the pharma industry.
“Second, find alternative diagnostics which will give real-time information about the target organism and perceptibility of antibiotics, so that medics don’t need to go empirical about the treatment.
The third measure is popularisation of alternative therapies. “Currently, it’s either antibiotics or nothing. There are other therapies too, like phage therapy – which uses viruses to kill bacterial infections.
The drug regulators need to devise a stricter system of controls and checks as the spurious production and sale of unapproved pills and potions undermine India’s reputation as the leading producer of generic drugs. On one hand, its multi-billion dollar pharmaceutical industry aims to scale global heights in the production of vaccines, medicines and medical devices, but on the other hand, it is tainted with scams. Several instances of pharma units failing quality tests of drugs in the country have been reported in the past .
(Dr Naresh Purohit is Executive Member, Federation of Hospital Administrator. He is also advisor to the National Communicable Disease Control Programme. Dr. Purohit is also Advisor to six other National Health Programmes. He is visiting Professor in five Medical Universities of Southern India including Thrissur based Kerala University of Health Sciences ) (The views and opinion expressed in this article are those of the author)