Make sure regulations are followed in order to fight antibiotic resistance

The Union Government has instructed physicians to include in their prescriptions the precise reason for the use of antibiotics. Additionally, it told pharmacists and chemists not to give out antibiotics without a prescription from a physician. These guidelines were released with consideration for the nation’s increasing prevalence of antimicrobial resistance (AMR). The World Health Organization (WHO), which is now the global center for antimicrobial resistance (AMR), highlighted the strikingly high rates of AMR in India in its 2014 report.

Unsettling information was obtained from a study that the National Center for Disease Control (NCDC) carried out at 20 hospitals between November 2021 and April 2022. Seventy-two percent of the nearly 9,600 patients polled got at least one antibiotic, and 25 percent received two or more. Notably, antibiotics were prescribed to 55% of patients to avoid infection rather than to treat any illness. The data summarizes the national standard practice. Most viral infections, which do not need antibiotics, are the cause of cough, cold, sore throat, and severe diarrhea. These symptoms often go away on their own.

Data from 70,000 patients who visited clinics during the Kumbh Mela in Allahabad (Prayagraj) and Nashik in 2013 and 2015, respectively, was collected for Harvard University and UNICEF research. Antibiotic prescriptions were written for almost one-third of the individuals who entered the clinics. Almost 70% of the patients at Prayagraj who had respiratory symptoms were given antibiotics.

One of the main issues for global public health is AMR. According to the World Health Organization, the emergence of antibiotic-resistant microbes that are resistant to traditional antibiotics might represent a “global threat” to public health. In 2019, these resistant illnesses claimed the lives of at least three lakh people in India and 1.27 million people globally. The toll is predicted to reach 50 million by 2050. Due to the ease of travel, the globe is becoming a “global village,” and as the emergence of Covid-19 has shown, illnesses and resistant organisms may spread quickly across continents.

Antibiotics are categorized by the WHO into three groups (AWaRe): access, watch, and reserve. The latter two are only recommended when necessary. First-line antibiotics that are highly targeted and unlikely to lead to antimicrobial resistance are administered under the “access” category. According to the NCDC report, 60% of antibiotic prescriptions in India fell into the “watch” or “reserve” category. It is counterproductive to provide more antibiotics since this might cause antibiotic resistance in the population and make treating the resulting illnesses more challenging.

According to Schedule H/H1 of the Drugs and Cosmetics Rules, 1945, antibiotics are only permitted to be marketed with a prescription issued by licensed medical professionals. In India, however, regulations are not strictly enforced, and pharmacists often prescribe antibiotics on their own.

India developed an antimicrobial surveillance program, an antibiotic stewardship program, and drug resistance monitoring in 2017, in line with the WHO’s 2015 “global action plan.” However, an examination of the strategy revealed execution flaws. The WHO advises consulting infectious disease experts before administering stronger antibiotics, but there are sadly not enough of these professionals in India.

The effects of AMR extend well beyond the common overuse of antibiotics by humans. Livestock is often administered antibiotics for several purposes. Therefore, it is not shocking that drug-resistant organisms often develop in bacterial cultures from fish, poultry, and milk. Similarly, it has been claimed that resistant microbes might reach water sources via sewage, home waste, hospital effluents, and pharmaceutical waste. Because the antibiotics excreted in urine and stool damage groundwater, open defecation is also a significant factor. Therefore, the proliferation of resistant germs is sustained when people and cattle drink water tainted with excrement.

The use of antibiotics has decreased in hospitals where antibiotic stewardship has been implemented, but things are worse in smaller hospitals and rural locations. Both good labs and staff with training are in short supply. The first point of contact is with quacks and semi-trained medical personnel; non-allopathic physicians also administer antibiotics. While basic or “access” antibiotics may be the sole ones provided in rural regions, stronger and often numerous antibiotics are used indiscreetly in urban areas.

AMR may have far-reaching effects, including extended hospital stays, higher costs, and deadly hospital-acquired infections. A few years back, a bacterium known as the “Delhi superbug” (Klebsiella spp.) developed a mutation that made it resistant to the majority of antibiotics. Antibiotics destroy the good bacteria in our intestines, known as the microbiome, in addition to the pathogens that cause illness. The protective lining of the gut is harmed by changes in the microbiome, which is now linked to disorders including autoimmune, inflammatory, neurological, and degenerative illnesses.

To control AMR, the “One Health” concept—which recognizes the connection of environmental, animal, and human parameters—should be used. Along with evolving medication resistance patterns, monitoring of antimicrobial resistance (AMR) in various patient groups is also necessary. Testing should be done on hospital, industrial, and water supplies on a regular basis.

Public education initiatives using media campaigns are crucial. The necessity to inform physicians at smaller hospitals and clinics is more crucial. The Indian Council of Medical Research needs to draft and broadly distribute recommendations for the selection and indications of antibiotics for various disorders. Antimicrobial stewardship should take advantage of the Indian Medical Association’s extensive network. Simply advising pharmacists not to sell antibiotics over theounter will not stop it from happening. Although it is challenging to implement, the government’s recommendation to prominently include the indication of antibiotics in the prescription is a positive move.

We need immediate action in the form of public awareness campaigns, healthcare professional training, microbiological monitoring, new guidelines, and stringent rule execution to stop the catastrophic spread of AMR.