{"id":26208,"date":"2018-10-01T16:20:26","date_gmt":"2018-10-01T10:50:26","guid":{"rendered":"https:\/\/blog.forumias.com\/?p=26208"},"modified":"2018-10-01T16:20:26","modified_gmt":"2018-10-01T10:50:26","slug":"antimicrobial-resistance-amr","status":"publish","type":"post","link":"https:\/\/forumias.com\/blog\/antimicrobial-resistance-amr\/","title":{"rendered":"Antimicrobial Resistance (AMR)"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">\u201cWithout urgent action we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.\u201d &#8211; WHO<\/span><\/p>\n<p><b>Why in news?<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Kerala &#8211; the first state to adopt a comprehensive policy on AMR in 2016 to fight growing antibiotic resistance \u2013 is now taking a big leap.<\/span><\/p>\n<p><b>What is AMR?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><b>Antimicrobial resistance<\/b><span style=\"font-weight: 400;\"> occurs when microbes (bacteria, viruses, fungi and parasites) become resistant to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Microorganisms that develop antimicrobial resistance are sometimes referred to as \u201csuperbugs\u201d.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">While <\/span><b>antibiotic resistance<\/b><span style=\"font-weight: 400;\"> specifically covers resistance to antibiotics, <\/span><b>antimicrobial resistance<\/b><span style=\"font-weight: 400;\"> is a broader term that also covers drugs that are used to treat conditions caused by other microbes, including parasites, fungi, and viruses. These conditions include malaria, HIV, and candida.<\/span><\/li>\n<\/ul>\n<p><b>What causes Antimicrobial resistance<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Misusing antibiotics breeds drug resistance among the bacteria that normally live in our bodies \u2013 even though these bacteria are harmless, they can pass resistance on to other, more dangerous species. <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">An antibiotic targets a particular characteristic of the infectious bacteria, so by specifically killing all bacteria that have this characteristic, any that happen <\/span><i><span style=\"font-weight: 400;\">not<\/span><\/i><span style=\"font-weight: 400;\"> to have it gain an advantage and are left free to multiply and spread. This creates a population of resistant bacteria that cannot be killed by that antibiotic.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The term drug-resistant infections makes it clearer that it is the infectious species that is resistant to drug not the patient.<\/span><\/li>\n<\/ul>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-26209\" src=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/whitin.jpg?resize=500%2C176&#038;ssl=1\" alt=\"\" width=\"500\" height=\"176\" srcset=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/whitin.jpg?w=500&amp;ssl=1 500w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/whitin.jpg?resize=150%2C53&amp;ssl=1 150w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/whitin.jpg?resize=300%2C106&amp;ssl=1 300w\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" \/><\/p>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-26210\" src=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/antibiotic.jpg?resize=527%2C539&#038;ssl=1\" alt=\"\" width=\"527\" height=\"539\" srcset=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/antibiotic.jpg?w=527&amp;ssl=1 527w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/antibiotic.jpg?resize=147%2C150&amp;ssl=1 147w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/antibiotic.jpg?resize=293%2C300&amp;ssl=1 293w\" sizes=\"auto, (max-width: 527px) 100vw, 527px\" \/><\/p>\n<p><b>Antimicrobial Resistance in India: <\/b><b><i>Scoping Report on Antimicrobial Resistance in India<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400;\">The report was prepared for Department of Biotechnology and Research Councils United Kingdom (RCUK) by the Center for Disease Dynamics, Economics &amp; Policy, India (CDDEP).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">According to the Report:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">In 2014, India was the highest consumer of antibiotics, followed by China and the United States. However, the per capita consumption of antibiotics in India is much lower than in several other high income countries.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">India has some of the highest antibiotic resistance rates among bacteria that commonly cause infections in the community and healthcare facilities. <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Resistance to carbapenem class of antibiotics (the group of antibiotics available against antimicrobial resistant pathogens) was the highest.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">There is an increasing trend of antibiotic resistance among neonates. <\/span><\/li>\n<\/ul>\n<p><b>Concerns due to Antimicrobial Resistance<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Due to growing resistance of pathogens to antimicrobial drugs we are losing our first-line antibiotics making a broad range of common infections much more difficult to treat.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Second- and third-choice antibiotics are more costly, more toxic, need much longer durations of treatment, and may require administration in intensive care units.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Diseases like smallpox that have been eradicated may come back. <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The <\/span><b>infection are becoming more difficult to treat<\/b><span style=\"font-weight: 400;\">, giving rise to new forms of previously treatable disease: <\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Multidrug-resistant typhoid fever is affecting parts of Asia and Africa.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Only 50% of all patients with <\/span><b>multi-drug resistant tuberculosis<\/b><span style=\"font-weight: 400;\"> can be cured.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Resistance is an emerging concern for treatment of HIV infection.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">In the case of <\/span><span style=\"font-weight: 400;\">malaria<\/span><span style=\"font-weight: 400;\">, spread of artemisinin resistant strains, or the independent emergence of artemisinin resistance in other regions, could jeopardize important recent gains in malaria control.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Gonorrhoea, a sexually transmitted disease, is now resistant to multiple classes of drugs.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">5. Organ transplantation, joint replacements, cancer chemotherapy, and care of pre-term infants, will become more difficult or even too dangerous to undertake.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">6. T<\/span><span style=\"font-weight: 400;\">he British government commissioned a series of reports on AMR, estimating that <\/span><b>by 2050, as many as 10 million people could die <\/b><span style=\"font-weight: 400;\">annually from AMR complications.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">7. The <\/span><b>economic impact<\/b><span style=\"font-weight: 400;\"> of \u201csuperbug\u201d outbreaks could top $100 trillion; low-income countries would suffer disproportionately.<\/span><\/p>\n<p><b>8. Fewer inventions of new antibiotics <\/b><span style=\"font-weight: 400;\">in last two decades due to lack of R&amp;D and high cost of investments, \u00a0making increasing resistance to available drugs a concern. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">9. New resistance mechanisms, such as the <\/span><b>New Delhi metallobeta-lactamase NDM-1<\/b><span style=\"font-weight: 400;\">, have emerged among several gram-negative bacilli. <\/span><\/p>\n<p><b>Note<\/b><span style=\"font-weight: 400;\">: <\/span><i><span style=\"font-weight: 400;\">New Delhi metallo-beta-lactamase 1 (NDM-1) is an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics. These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infections.<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400;\">10. \u201c<\/span><b><i>Nosocomial infections<\/i><\/b><span style=\"font-weight: 400;\">\u201d or, \u201c<\/span><i><span style=\"font-weight: 400;\">Hospital-associated infections<\/span><\/i><span style=\"font-weight: 400;\">\u201d can involve some pathogenic bacteria that developed resistance to antibiotics:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\"> \u00a0<\/span><i><span style=\"font-weight: 400;\">Staphylococcus aureus<\/span><\/i><span style=\"font-weight: 400;\"> resistant to methicillin,<\/span><\/li>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Enteroccocci<\/span><\/i><span style=\"font-weight: 400;\"> resistant to vancomycin causing heart valve infections,<\/span><\/li>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Acinetobacter baumannii<\/span><\/i><span style=\"font-weight: 400;\"> resistant to carbapenems producing surgical site and wound infections.<\/span><\/li>\n<\/ul>\n<p><b>11. Resistance to last resort antibiotics<\/b><span style=\"font-weight: 400;\"> on rise:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Resistance to <\/span><b>carbapenem class of antibiotics<\/b><span style=\"font-weight: 400;\">, one of the last-resort antibiotics to treat serious bacterial infections in humans, among various gram-negative bacteria is on rise.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">With increasing use of Colistin, last resort antibiotic in human medicine, for treatment of carbapenem-resistant gram-negative bacterial infections, <\/span><b>Colistin resistance<\/b><span style=\"font-weight: 400;\"> among gram-negative bacteria has emerged in India .<\/span><\/li>\n<\/ul>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-26211\" src=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/death.jpg?resize=498%2C350&#038;ssl=1\" alt=\"\" width=\"498\" height=\"350\" srcset=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/death.jpg?w=498&amp;ssl=1 498w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/death.jpg?resize=150%2C105&amp;ssl=1 150w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/death.jpg?resize=300%2C211&amp;ssl=1 300w\" sizes=\"auto, (max-width: 498px) 100vw, 498px\" \/><\/p>\n<p><b>Major Reasons for spread of Antimicrobial Resistance<\/b><\/p>\n<ul>\n<li><strong>Antibiotic Consumption<\/strong>: The main origin of resistance to antibiotics is their misuse. As underlined by the European Centre for Disease Prevention and Control (ECDC) there are three main types of misuse:<\/li>\n<li>The unnecessary prescription of antibiotics for viral infections like flu, influenza, against which they have no effect;<\/li>\n<li>The too frequent prescription of \u201cbroad-spectrum antibiotics\u201d, in place of a better targeted antibiotic, through more precise diagnosis;<\/li>\n<li>The inadequate use by the patient, not respecting either dosage or duration of the treatment, which means that some of the bacteria may survive and become resistant.<\/li>\n<li>Indiscriminate use of antibiotic FDCs even without the knowledge of a proven advantage over single compounds, leading to emergence of bacterial strains resistant to multiple antibiotics. Approximately 118 antibiotic FDCs are available in India.<\/li>\n<\/ul>\n<ol start=\"2\">\n<li><b> Social factor: <\/b><span style=\"font-weight: 400;\">Among the general public, social factors include self-medication, access to antibiotics without prescription, use of pharmacies and informal healthcare providers as sources of healthcare, and lack of knowledge about when to use antibiotics. the practice of Over-The -Counter (OTC) dispensation of antibiotics without any prescription is common.<\/span><\/li>\n<li><span style=\"font-weight: 400;\"> \u00a0<\/span><b>Animal Protein: <\/b><span style=\"font-weight: 400;\">Although direct antibiotic sales data in food animals are not available for India, it is estimated that India was the fifth-largest consumer of antibiotics in food animals (poultry, pigs, and cattle) in 2010. Antibiotics such as colistin, tetracycline, doxycycline, and ciprofloxacin, which are critical to human health, are commonly used for growth promotion in poultry<\/span><\/li>\n<li><b> Cultural Factors:<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">One of the major cultural activities associated with potential acquisition and spread of antibiotic-resistant bacteria is mass bathing in rivers as part of religious mass gathering occasions.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">For example, according to a study, Mass-bathing in the Ganga during pilgrimages may be contributing to anti-microbial resistance (AMR)<\/span><\/li>\n<\/ul>\n<ol start=\"5\">\n<li><b> Pharmaceutical Industry Pollution:<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">In India, the Central Pollution Control Board (CPCB) established effluent standards for pharmaceutical industry waste, and all state pollution control boards use the same standards. The current standards do not include antibiotic residues, and thus they are not monitored in the pharmaceutical industry effluents<\/span><\/li>\n<\/ul>\n<ol start=\"6\">\n<li><b> Sanitation:<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Poor sanitation plays a major role in the spread of antibiotic-resistant bacteria and ARGs. According to the World Bank, more than 50% of the Indian population does not have access to sanitation facilities for safe disposal of human waste (World Bank 2017).<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">In addition, a large proportion of sewage is disposed untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms<\/span><\/li>\n<\/ul>\n<ol start=\"7\">\n<li><b> Poor Infection Control Practices in Healthcare system:<\/b><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The prevalence of various health care associated infections (HAIs) among Indian hospitals ranges from 11% to 83%, in contrast to the WHO estimate of about 7% to 12%.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">This is primarily poor infection control practices. For example, a study in Mangalore which assessed hand-washing practices of nurses and doctors, found that only 31.8% of them washed hands after contact with patients.<\/span><\/li>\n<\/ul>\n<p>[table id=63 \/]<\/p>\n<ol>\n<li><strong>Chennai Declaration:<\/strong><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Formulation of an effective national policy to control the rising trend of antimicrobial resistance,<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">A ban on the over-the-counter sale of antibiotics, <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Changes in the medical education curriculum to include training on antibiotic usage and infection control<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Setting up of a National Task Force to guide and supervise the regional and State infection control committees.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">An Infection Control Team (ICT) be made mandatory in all hospitals.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Regulatory authorities and accreditation agencies such as the National Accreditation Board for Hospitals and ISO must insist on a functioning ICT during the licensing and accreditation process<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">National Accreditation Board for Hospitals &amp; Healthcare Providers (NABH) insist on strict implementation of hospital antibiotic and infection control policy, during hospital accreditation and re-accreditation processes.<\/span><\/li>\n<\/ul>\n<p><b>Actions Taken Under Chennai Declaration<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To meet the obligations of the declaration, the <\/span><b>National Programme on Containment of Antimicrobial Resistance <\/b><span style=\"font-weight: 400;\">was launched under the 12th Five-year Plan.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The <\/span><b>Drugs and Cosmetic Rule, 1945<\/b> <b>were amended in 2013 <\/b><span style=\"font-weight: 400;\">to incorporate a <\/span><b>new Schedule H1. \u00a0<\/b><span style=\"font-weight: 400;\">It contains certain 3rd and 4<\/span><span style=\"font-weight: 400;\">th<\/span><span style=\"font-weight: 400;\"> generation antibiotics, certain habit forming drugs and anti-TB drugs. This rule is meant to regulate over-the counter dispensing of drugs. Pharmacists not only have to insist on a prescription from a registered medical practitioner, but they also need to enter details in a register. Drug inspectors will monitor compliance. First-line antibiotics will not come under the strict monitoring as those are excluded from the list, at least initially. The new H1 list is based on a step-by-step strategy of Chennai declaration<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Under the Drugs &amp; Cosmetics Rules, drugs specified under <\/span><b>Schedule H <\/b><span style=\"font-weight: 400;\">and <\/span><b>Schedule X <\/b><span style=\"font-weight: 400;\">are required to be sold by retail on the prescription of a Registered Medical Practitioner only. <\/span><\/li>\n<\/ul>\n<p><b>2. National Action Plan on Antimicrobial Resistance- Delhi Declaration<\/b><\/p>\n<p><span style=\"font-weight: 400;\">The plan calls for coordinated efforts by government agencies involving health, education, environment, and livestock to change prescription practices and consumer behaviour and to scale up infection control and antimicrobial surveillance. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The objectives of the plan include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To establish a<\/span><b> laboratory-based surveillance system<\/b><span style=\"font-weight: 400;\"> by strengthening laboratories<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To generate <\/span><b>quality data on AMR<\/b><span style=\"font-weight: 400;\"> for pathogens of public health <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To generate <\/span><b>awareness <\/b><span style=\"font-weight: 400;\">among healthcare providers and in the community regarding the rational use of antibiotics<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">To <\/span><b>strengthen infection control guidelines <\/b><span style=\"font-weight: 400;\">and practices and promote rational use of antibiotics<\/span><\/li>\n<\/ul>\n<p><b>3. Red Line Campaign on Antibiotics 2016<\/b><span style=\"font-weight: 400;\">: The campaign \u00a0was launched to:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Raising awareness about how to identify a drug that should be dispensed only with a prescription from a licensed doctor <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Limiting the practice of self-medication<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Making the public aware of the potential harms that may result from the misuse of antibiotics.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">4. In 2017, FSSAI released certain guidelines limiting the antibiotics in food products such as fish and honey- The <\/span><b>Food Safety and Standards (Contaminants, Toxins and Residues) Regulations in food animals.<\/b><\/p>\n<p><span style=\"font-weight: 400;\">5. Kerala became the first state to adopt a comprehensive policy on AMR in 2016, which is now being implemented comprehensively . To curb anti-microbial resistance (AMR), government has prepared an all-inclusive action plan involving human health, animal, food and environment. <\/span><\/p>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-26212\" src=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/what.jpg?resize=534%2C516&#038;ssl=1\" alt=\"\" width=\"534\" height=\"516\" srcset=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/what.jpg?w=534&amp;ssl=1 534w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/what.jpg?resize=150%2C145&amp;ssl=1 150w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/what.jpg?resize=300%2C290&amp;ssl=1 300w\" sizes=\"auto, (max-width: 534px) 100vw, 534px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><b>International Initiatives:<\/b><\/p>\n<p><b>Global Action Plan on AMR:<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The May 2015, <\/span><b>World Health Assembly of WHO <\/b><span style=\"font-weight: 400;\">adopted a global action plan on antimicrobial resistance, which outlines five objectives:<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">to improve awareness and understanding of antimicrobial resistance through effective communication, education and training;<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">to strengthen the knowledge and evidence base through surveillance and research;<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures;<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">to optimize the use of antimicrobial medicines in human and animal health;<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">to develop the economic case for sustainable investment that takes account of the needs of all countries and<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">to increase investment in new medicines, diagnostic tools, vaccines and other interventions.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">2. In 2017, <\/span><b>WHO launched new guidelines on use of medically important antimicrobials in food-producing animals<\/b><span style=\"font-weight: 400;\">, recommending that farmers and the food industry stop using antibiotics routinely to promote growth and prevent disease in healthy animals. These guidelines aim to help preserve the effectiveness of antibiotics that are important for human medicine by reducing their use in animals.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">3. WHO has also grouped antibiotics into three categories \u2013 ACCESS, WATCH and RESERVE \u2013 with recommendations on when each category should be used. Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of &#8220;last resort&#8221; antibiotics that are needed when all others fail.<\/span><\/li>\n<\/ul>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-26213\" src=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/access.jpg?resize=506%2C288&#038;ssl=1\" alt=\"\" width=\"506\" height=\"288\" srcset=\"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/access.jpg?w=506&amp;ssl=1 506w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/access.jpg?resize=150%2C85&amp;ssl=1 150w, https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/access.jpg?resize=300%2C171&amp;ssl=1 300w\" sizes=\"auto, (max-width: 506px) 100vw, 506px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><b>Way Ahead:<\/b><\/p>\n<p><b>Infection Prevention and control within health-care facilities:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Establishing an infection prevention and control committee (IPC).<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Good hand hygiene practices.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Effective diagnosis and treatment of infection.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Rational antimicrobial use.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Surveillance of antibiotic resistance and antibiotic use.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Improving the antimicrobial quality and supply chain.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Good Microbiology Practices.<\/span><\/li>\n<\/ul>\n<p><b>Innovation in new Drug and Technology:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Concerns of increased antibiotic resistance lead to the urgent need of concentrating on the issue of new drugs and vaccines development to combat AMR. Collaborated efforts of national, international, government and academic networks are needed to identify new classes of antibiotics and diagnostic technologies.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">For example, the EU, the UK, the US and Canada have moved forward on projects to fill knowledge gap by directly funding basic and clinical research by scientists; working with pharmaceutical companies; and offering monetary prizes for new diagnostics needed to use antibiotics more responsibly<\/span><\/li>\n<\/ul>\n<p><b>Awareness:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Educate and aware people to ensure rational use of antimicrobial drugs. Further, health-care practitioners should not prescribe or dispense antibiotics unless they are truly necessary.<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Awareness on not prescribing antibiotics for common viral infections, pharmacists selling antibiotics over the counter and a few precautions for hospital-based workers \u2014 using a hand rub before and after examining the patient, for instance \u2014 will go a long way in controlling the spread of resistant bugs, as well as hospital-acquired infections.<\/span><\/li>\n<\/ul>\n<p><b>Agriculture and Livestock:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It is important to ensure that antibiotics given to animals are used only to control or treat infectious diseases and under veterinary supervision.<\/span> <span style=\"font-weight: 400;\">Last resort\u201d antibiotics should never be used as growth promoters in livestock farming, but achieving this will require significant changes to current practices.<\/span><\/li>\n<\/ul>\n<p><b>Surveillance:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Weak surveillance and regulatory system is also an important determinant of antimicrobial resistance. Thus appropriate surveillance mechanisms in the health and veterinary sectors to generate reliable epidemiological information, baseline data, trends on antimicrobial resistance, utilization of antimicrobial agents and impact on the economy and health should be implemented<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>\u201cWithout urgent action we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.\u201d &#8211; WHO Why in news? Kerala &#8211; the first state to adopt a comprehensive policy on AMR in 2016 to fight growing antibiotic resistance \u2013 is now taking a big leap. What is AMR?&hellip; <a class=\"more-link\" href=\"https:\/\/forumias.com\/blog\/antimicrobial-resistance-amr\/\">Continue reading <span class=\"screen-reader-text\">Antimicrobial Resistance (AMR)<\/span><\/a><\/p>\n","protected":false},"author":61,"featured_media":26218,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"categories":[27],"tags":[],"class_list":["post-26208","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-featured-editorials","entry"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/forumias.com\/blog\/wp-content\/uploads\/2018\/10\/background-concept-wordcloud-illustration-of-antimicrobial-resistance-F41DTB.jpg?fit=1014%2C555&ssl=1","views":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/26208","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/users\/61"}],"replies":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/comments?post=26208"}],"version-history":[{"count":0,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/posts\/26208\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media\/26218"}],"wp:attachment":[{"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/media?parent=26208"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/categories?post=26208"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/forumias.com\/blog\/wp-json\/wp\/v2\/tags?post=26208"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}