Mains Marathon

• Define Antimicrobial resistance.
• Discuss the causes and concerns related to antimicrobial resistance.
• Write about the measures taken to reduce AMR.
• Conclude by stating that this issue needs to be taken seriously.

Answer

The World Health Organization (WHO) has identified antimicrobial resistance as one of the top ten threats to global health. Antimicrobial resistance (AMR) is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics) that are used to treat infections. As a result, standard treatments become ineffective, infections persist and may spread to others. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”. According to the Global Research on Antimicrobial Resistance (GRAM) report, 1.27 million people died in 2019 as a direct result of AMR. The death due to AMR is now a leading cause of death worldwide, higher than HIV/AIDS or malaria. Most of the deaths from AMR were caused by lower respiratory infections, such as pneumonia, and bloodstream infections, which can lead to sepsis. MRSA (Methicillin-Resistant Staphylococcus Aureus) was particularly deadly, while E. coli, and several other bacteria, were also linked to high levels of drug resistance.

Reasons for the Spread of AMR

• The misuse of antimicrobials in medicine and inappropriate use in agriculture.
• Contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment.

AMR in India

• India, with its combination of large population, rising incomes that facilitate purchase of antibiotics, high burden of infectious diseases and easy over-the-counter access to antibiotics, is an important locus for the generation of resistance genes (such genes help bacteria in surviving on being exposed to antibiotics).
• The multi-drug resistance determinant, New Delhi Metallo-beta-lactamase-1 (NDM-1), emerged from this region to spread globally.
• Africa, Europe and other parts of Asia have also been affected by multi-drug resistant typhoid originating from South Asia.
• In India, over 56,000 newborn deaths each year due to sepsis are caused by organisms that are resistant to first line antibiotics.
• A study reported by ICMR (Indian Council of Medical Research) from 10 hospitals showed that when Covid patients acquire drug-resistant infections in hospitals, the mortality is almost 50-60%.

Concerns Related to Antimicrobial Resistance

• A threat to prevention and treatment of infections - medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very risky.
• Increases the cost of healthcare with lengthier stays in hospitals, additional tests and use of more expensive drugs.
• It is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals (SDGs).
• No new classes of antibiotics have made it to the market in the last three decades, largely on account of inadequate incentives for their development and production.
• Without urgent action, we are heading to antibiotic apocalypse – a future without antibiotics, with bacteria becoming completely resistant to treatment and when common infections and minor injuries could once again kill.

Steps to be taken

• We need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.
• Efforts to control prescription of antimicrobials should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines that would empower providers to stand up to such demands, as well as provide point-of-care diagnostics to aid clinical decision-making.
• To track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.
• Individuals should only use antibiotics when prescribed by a certified health professional.
• Policymakers can ensure a robust national action plan to tackle antibiotic resistance is in place. This plan should strive:
  • Improve surveillance of antibiotic-resistant infections
  • Strengthen policies, programmes, and implementation of infection prevention and control measures
  • Regulate and promote the appropriate use and disposal of quality medicines.
  • Make information available on the impact of antibiotic resistance.
  • Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.

The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer intercourse, and good food hygiene.