Antimicrobial resistance (AMR), also known as drug
resistance, occurs when microorganisms such as bacteria, viruses, fungi,
and parasites evolve in ways that render the medications used to cure
the infections they cause ineffective . When the microorganisms become
resistant to most antimicrobials, they are often referred to as
“superbugs” . AMR is a major public health concern because a resistant
infection may kill, can spread to others, and imposes a huge cost on
individuals and society . Therefore, this policy brief presents a
situational analysis of AMR and advocates for a multi-disciplinary
approach to control AMR in India. The most recent and relevant
publications on AMR in India were reviewed and analyzed to recommend a
comprehensive health policy framework. The study recommends an
innovative health policy framework for avoiding emergence, supporting
research and development (R&D) for new drugs, and encouraging
multi-sectoral coordination. Further amendments to the existing health
policy with a targeted approach to prevent the growing epidemic of AMR
are required. Failure to do so may cause irreversible damage with high
morbidity, mortality, and disability in India.
Keywords: antibiotics; resistance; global burden, ICD-10 code
Z16, superbugs, AMR, MDR TB
Introduction
The antibiotics have represented a great revolution for humankind, the
development after the World War II of a magic bullet (the antibiotic
molecule), as imagined by Paul Erlich, the pioneer of chemotherapy, with
the property to kill or inhibit the growth of microorganisms by hitting
the microbial structures with low toxicity for host cells and tissues,
has determined a new era in the treatment and prophylaxis of infectious
disease and in the quality of human life .
The antibiotic era revolutionized the treatment of infectious diseases
worldwide . Antimicrobial usage has brought remarkable improvements in
human life. Administering antimicrobial right from birth (especially for
pre-term and low birth weight neonates) has increased life expectancy at
birth, it has greatly reduced death rates due to communicable diseases ,
injuries and most importantly reduced incidences of fatal diseases like
cholera, diphtheria, pneumonia, typhoid fever, plaque, tuberculosis,
typhus, syphilis, etc. to an extent of complete eradication .
However irrational use of antimicrobial has introduced new forms of
public health challenges – resistance to ages long invented
antimicrobial by evolving microbes; where microbes do not respond to
antibiotic dosage and continues to threaten human life . Practices like
over prescription of Antimicrobial, lack of counselling before
prescribing them, and improper dosage taken by patients thanks to
temporary relief are making situation worse than before . Besides, fear
of frequent epidemics of veterinary diseases like bird flu; as a result,
on large scale Antimicrobial are administered to chickens in large
poultry houses . Similar situation does exist in pig farms, where
irrational use of Antimicrobial indirectly releases resistant microbes
into food chain . There is need to regulate – private partners, drug
distribution systems of chemists, and provide capacity building to
employees in poultry and pig farms to use Antimicrobial as per need and
that only if prescribed by veterinary doctor.