Controling AMR

Context: A One Health approach is necessary to control antimicrobial resistance.

More on news:

• India an important locus for the generation of resistance genes: The multi-drug resistance determinant, New Delhi Metallo-beta-lactamase-1 (NDM-1), emerged from this region and spread globally.
• The containment of antimicrobial resistance (AMR) in India: It is central to the global effort to address this threat.
• In India, over 56,000 newborn deaths each year occur due to sepsis, caused by organisms that are resistant to first line antibiotics.

How are antibiotics categorised?

• Categories: WHO has categorised antibiotics into
  • “Access” which should be widely available,
  • “Watch” to be limited to specific indications,
  • “Reserve”, to be used as a last-resort.
• In 2015, India had the highest consumption rate worldwide for oxazolidinones, which have been defined by WHO as “Reserve” antibiotics.

What are the reasons for prevalence of AMR in India?

• Lack of formal training: Many medical practitioners lack formal training in India and 70 per cent of primary healthcare is delivered by such individuals.
• Sales companies target both doctors as well as those acting in a medical capacity without required qualifications.
• Biased information: Pharmaceutical sales representatives are a key source of updates and information for prescribers, but the information they provide may be biased and motivated by commercial considerations to promote antibiotic sales.
• Sale of antibiotics without prescription: The sale of antibiotics without a prescription is prohibited under Schedule H1, which has been supported by the red line campaign but it is not widely enforced.
• The lack of access: The lack of access, due to geographical distance or affordability, to medical professionals and prescribers, in rural areas of India, leads 50 per cent of people to buy antibiotics directly from the pharmacy as a first choice.
• Falsified, substandard or counterfeit antimicrobials: It can worsen AMR in several ways. They can leave patients under-dosed and bacteria that are only partially suppressed may be more likely to evolve resistance.
• Contamination: Effluents from multinational pharmaceutical companies contain active antibiotics, resistant bacteria and resistant genes.
  • They contaminate rivers, streams and wells, including waters which are used for drinking and bathing. This increases both the emergence of resistant bacteria in local populations and also their spread.

What can be done?

• Access to basic antibiotics: An estimated 170,000 deaths from pneumonia in children under five can be prevented with timely access to effective antibiotics.
• Balance excessive and inappropriate use: It is a key driver of antibiotic resistance, while ensuring live-saving medicines are available to those who need them.
• Adequate sanitation: Half of the South Asian population lacked access to basic sanitation in 2018. The Swachh Bharat Mission in India has improved access to toilets in many areas.
• Improvement in infrastructure: Improvements in the infrastructure required for and access to clean water, adequate sanitation and quality hygiene in India could result in a reduction of 590 million diarrheal cases by 2020 that would have been treated with antibiotics.
• Vaccination coverage: Vaccination has shown to reduce the transmission of AMR infections and the volume of antibiotics consumed.
  • Mission Indradhanush to address low vaccination coverage strengthened micro-planning and additional mechanisms to improve monitoring and accountability.

Way forward

• One objective of the Indian National Action Plan (NAP) on AMR is to develop standards to ensure that access to effective antibiotics.
• Sustainable antibiotic production methods need to be developed and adopted by manufacturers.