Antimicrobial Resistance (AMR)
Context:
Ahead of the United Nations General Assembly High-Level Meeting on antimicrobial resistance (AMR), the World Health Organization (WHO) released its first-ever guidelines addressing antibiotic pollution from manufacturing.
More on news
- The rise and spread of AMR driven by antibiotic pollution could jeopardise the global effectiveness of antibiotics, including those produced at manufacturing facilities.
- AMR, which leads to the development of “superbugs,” poses a significant threat to healthcare systems worldwide, with especially severe outcomes for patients with multiple health conditions.
What is Antimicrobial resistance (AMR)?
- Antimicrobial resistance (AMR) occurs when a pathogen evolves to withstand the effects of an antimicrobial drug, allowing it to survive and continue causing infection despite treatment.
- This resistance develops primarily due to the misuse or overuse of antibiotics.
- The overuse of antimicrobial drugs can lead to the emergence of resistant or highly resistant superbugs, which can spread in hospitals, through drinking water, or via sewage systems.
- Infections caused by these resistant pathogens no longer respond to commonly prescribed antibiotics.
- As antibiotic resistance increases, even simple infections may become difficult to treat.
Reasons for increasing AMR
- INDIVIDUALS: Many in India take antibiotics for fevers without confirming if they’re bacterial, even though antibiotics don’t work on viral infections like the flu.
- This misuse increases antibiotic resistance.
- Since doctor visits can be expensive or inconvenient, people often rely on recommendations from local chemists.
- DOCTORS: A National Centre for Disease Control (NCDC) survey found that 71.9% of hospital patients are prescribed antibiotics, often preventively rather than for active infections.
- Overuse has rendered some antibiotics, like Norfloxacin for diarrhoea, ineffective, and resistance to stronger antibiotics, such as carbapenems for typhoid, is rising.
- DIAGNOSTICS: Empirical prescriptions based on symptoms rather than tests also drive resistance.
- PHARMA COMPANIES: Pharmaceutical waste can lead to drug-resistant bacteria, threatening global health.
Most common resistant pathogens in India
- According to the recent ICMR report, the three most common pathogens found in patient samples from tertiary care centres are E. coli, which causes gut infections; Klebsiella pneumoniae, responsible for pneumonia and urinary tract infections; and Acinetobacter baumannii, commonly linked to hospital-acquired infections.
Steps taken in India
National Action Plan (NAP) for AMR, 2017: The NAP aligns with the World Health Organization’s Global Action Plan on AMR and emphasises a One Health approach, integrating human, animal, and environmental health.
Antibiotic Stewardship Program (AMSP): The Indian Council of Medical Research (ICMR) initiated this program on a pilot basis in 20 tertiary care hospitals to control the misuse and overuse of antibiotics in clinical settings.
Ban on Inappropriate Fixed Dose Combinations: Following ICMR recommendations, the Drug Controller General of India (DCGI) banned 40 fixed dose combinations deemed inappropriate for use.
Colistin Ban: The use of Colistin as a growth promoter in animal feed has been prohibited, a decision made in collaboration with various agricultural and health authorities.
Global Actions
United Nations Action: In 2016, the UN General Assembly adopted a political declaration calling for action to address AMR at national and international levels.
AMR has been recognised as one of the necessary objectives to reach the UN’s Sustainable Development Goals (SDGs).
Quadripartite Collaboration: The UN Environment Programme (UNEP), Food and Agriculture Organisation (FAO), World Health Organization (WHO), and World Organisation for Animal Health (WOAH) joined forces in 2022 to advance a One Health response to AMR.
They developed a joint strategic framework for collaboration on AMR and a common work plan.
Financing Mechanisms: The AMR Multi-Partner Trust Fund (AMR MPTF) supports countries in implementing AMR national action plans through a One Health approach.
Advocacy and Awareness: World AMR Awareness Week is an annual global campaign to raise the profile and understanding of AMR.
In September 2023, the Defeating Antibiotic Resistance through Transformative Solutions (DARTS) project was announced to develop rapid platforms to test for antibiotic resistance.
Way forward
- Prevention: Focus on preventing infections through better hygiene, improved sanitation, and encouraging vaccination.
- Education: Train doctors to use antibiotics appropriately, reserving stronger ones for hospital patients and ensuring patients undergo testing to identify the specific infection.
- Research: Conduct studies to understand how resistance develops from manufacturing facilities and implement regulations where needed.
- One Health Approach: Adopt an approach that recognizes the interconnectedness of human, animal, and environmental health.
- This includes monitoring antibiotic use in agriculture, promoting responsible veterinary practices, and ensuring that environmental factors are considered in public health strategies to combat antibiotic resistance effectively.