Anti-Microbial Resistance (AMR) in India
Prime Minister, Home Minister, and Health Minister have raised awareness about the growing threat of Anti-Microbial Resistance (AMR) due to antibiotic overuse, indicating a significant public health crisis in India.
Health Impact and Statistics
- According to the Institute of Health Metrics and Evaluation, Washington University, an estimated 267,000 deaths were attributed to AMR in India in 2021.
- High resistance rates are observed, with 83% of Indians found carrying resistant bacteria in certain studies.
Challenges with Antibiotic Use
- There is a massive treatment gap and misuse of antibiotics, rendering common infections untreatable and threatening modern medicine's efficacy.
- Dr. Kamini Walia from ICMR states that one in ten hospital-admitted patients in India with infections are resistant to last-resort antibiotics.
- The global antibiotic pipeline is running dry, with few new antibiotics approved, and none representing new classes or mechanisms of action.
AMR as a Silent Pandemic
- AMR is often seen as a hospital-acquired complication, but its impact was evident during COVID-19 when patients suffered from drug-resistant infections.
- Hospital environments, with high antibiotic usage, pressure bacteria to develop resistant genes, which can be transferred to other bacteria.
Community and Behavior Influences
- Community-acquired infections like typhoid, diarrhoea, and pneumonia are becoming drug-resistant.
- There is a prevalent practice of reaching for antibiotics for common ailments like coughs and colds, often without confirming whether the infection is viral or bacterial.
Efforts in Antibiotic Stewardship
- Kerala launched an antimicrobial stewardship program in 2015 to rationalize antibiotic prescription and awareness.
- OTC sales of antibiotics were banned in Kerala, achieving reasonable success after several years.
Resistance and Treatment Strategies
- Salmonella typhi strains have shown resistance to fluoroquinolones, previously used for treatment.
- Reduction in the use of certain drugs has led to the regained sensitivity of pathogens to those drugs.
Diagnostics and Healthcare Initiatives
- The National Health Mission provides free drugs and diagnostics, which has reduced reliance on unqualified practitioners.
- ICMR's ongoing research aims to develop tests for simultaneously detecting multiple infections.
Environmental and Animal Contributions
- A study by ICMR found a significant overlap of antibiotic resistance genes between human and environmental samples, highlighting the environmental impact.
Data Collection and Research
- ICMR's data from 25 tertiary care hospitals is published annually but may not represent the national trend due to limited sampling.
Alternative Therapies
- Phage therapy, involving bacteria-eating viruses, and monoclonal antibodies are potential alternatives but are still in the experimental stages.
Overall, addressing AMR in India requires a multifaceted approach involving rational antibiotic use, improved diagnostics, environmental and animal health considerations, and ongoing research into alternative therapies.
