What are the factors driving antimicrobial resistance in India?
Antimicrobial resistance (AMR) can be attributed to the irresponsibility of doctors and the pharmaceutical industry, sanitation issues and inadequate sensitisation on the subject in the media. Irrational prescription of broad-spectrum antibiotics, poor regulation of sales, self-medication and the lack of education and awareness regarding responsible use of antibiotics are all driving forces behind the rise of AMR.
Not just in India, we are seeing across several countries that more and more higher-end antibiotics are being used to treat lower-end infections. In India, particularly, even high-end antibiotics can be purchased without a doctor’s prescription. The problem lies not only with service providers, but also with patients, who seek instant cure for an ailment, instead of letting the treatment take its due course. Besides, in our country, weather specificities—such as being warm and rainy—allow various microbes to grow, which over time, mutate and become resistant to antibiotics. To prevent infections from these ever-mutating microbes, we need to build our immunity as well.
How is the government dealing with the situation?
Last September, we established the regional anti-microbial resistance hub, developed in collaboration with the United States at the ICMR’s National Institute of Cholera and Enteric Diseases (NICED) in Kolkata. The AMR hub will act as a regional resource for well-characterised drug-resistant strains which can be useful for researchers and pharma companies for their research and development of new diagnostics, therapeutics and epidemiological studies.
Since 2017, ICMR is running the AMR-stewardship programme (AMSP), which aims to create a culture of prescribing anti-microbials responsibly by creating awareness among doctors and in hospitals. The AMSP also includes guidelines that contain detailed instructions on drug selection, dosage and duration for anti-microbial drugs, especially inside intensive care units. Right now, ICMR provides funding and human resource to support this activity. Hospitals would need to make AMSP an integral part of their routine activities and fund it from their own resources once the ICMR project is over. Currently, 28 hospitals across the country are part of this programme.
You said most hospitals did not follow processes. How can that be remedied?
It is true that most hospitals do not follow processes. However, the industry, including hospitals, cannot be compelled to do anything, whether it is about following the guidelines or manufacturing irrational antibiotic combination drugs. Self-regulation has to be stressed upon. There is also a need to initiate more awareness drives to educate doctors, the industry and the general population.
The ICMR is researching on alternatives such as phage therapy, where bacteriophages (a virus that infects and replicates within bacteria) are used to treat bacterial infections.
Phage therapy can be useful for treating infections with drug resistant pathogens. Research on application of phage therapy in the Indian context is one of the research areas for the AMR hub at the NICED.
What other measures are needed to tackle the issue?
Last year, the Union health ministry banned the manufacture, sale and distribution of the antibiotic colistin [one of the last resort antibiotics] and its formulations for food producing animals, poultry, aqua farming and animal feed supplements. We need more legislations like this. We are also deliberating on the list of antibiotics in the National List of Essential Medicines, 2015, to decide which ones need to be retained or removed. We will make recommendations to the health ministry for further action. We might also need to bring back some of the old antibiotics such as penicillin, which remains effective in many conditions.