[Answered] Bacterial antimicrobial resistance (AMR) offers humanity one of the most complex challenges that it has faced. Discuss the reasons behind increasing bacterial AMR in India. What are the initiatives offered by our Government to tackle this?

Antimicrobial Resistance (AMR) occurs when microbes like (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.

A Lancet report estimated that 4.95 million deaths were associated with bacterial AMR in 2019 alone. India has one of the highest burdens of AMR.

Reasons for increasing bacterial AMR in India

• Indiscriminate use of antibiotics: Unnecessary and unwise use of antibiotic fixed dose combinations leads to emergence of bacterial strains resistant to multiple antibiotics.
• Availability of antibiotics over the counter: Easy availability of antibiotics along with culture of self medication leads to increase in AMR.
• Poor hygiene and sanitation: Poor water, sanitation and hygiene (WASH) leads to the spread of infectious diseases, which in turn leads to increased use of antibiotics, increasing chances of AMR.
• Antimicrobial use in Livestock industry: Indiscriminate use of antibiotics results in antibiotic residues in animal-derived products, and eventually, antibiotic resistance.
• Lack of vaccines and newer antibiotics: Sustained spread of bacterial infections and unavailability of newer antibiotics to treat them could cause AMR.
• Poor infection control practices in hospitals: Spread of diseases from hospitals causes increased use of antibiotics, leading to AMR.
• Pharmaceutical Industry Pollution: The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.

Government of India has taken the following steps for tackling AMR.

• India released its own AMR action plan in 2017, and announced a task force for implementation.
• National Action Plan on AMR resistance 2017-2021 was formulated to tackle AMR.
• In 2012, India’s medical societies adopted the Chennai Declaration, a set of national recommendations to promote antibiotic stewardship.
• Colistin was banned in the poultry, aqua farming and animal feeds supplements sectors. The government has also capped the maximum levels of drugs that can be used for growth promotion in meat and meat products
• India’s Red Line campaign demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics.
• Since March 2014 a separate Schedule H-1 has been incorporated in Drug and Cosmetic rules to regulate the sale of antimicrobials in the country.

AMR is a complex challenges that would require combined efforts of scientific community and the government. While the scientific community looks for solutions, governments must raise the standard of living for citizens, provide them accessible and affordable quality health care, besides regulating the sale and use of antibiotics.