Discuss the issue of Antibiotic resistance, with special focus on the unique socio-economic conditions in India. What are the challenges India faces in combating the issue of Drug resistance? (15 Marks)

Mentor’s Comments:
1. Define Antibiotic resistance.
2. What makes it a significant issue for India?
3. What challenges do we face in combating it?
4. Provide solutions.
Answer:

The term antibiotic resistance is a subset of antimicrobial resistance or AMR which is the ability of a microbe to resist the effects of medication. AMR is facilitated by the inappropriate use of medicines, for example, using antibiotics for viral infections such as the flu.

Antibiotic resistance is a global phenomenon. But the epicenter of this catastrophe is India because of the following reasons-

  1. Uneven and unregulated antibiotic usage is one of the most important reasons behind the AMR crisis. In developed countries, doctors prescribe antibiotics for even the most basic maladies, like the common cold.
  2. Poor sanitation, corruption, and low public health spending have a bigger role in pushing up drug-resistant infections in low- and middle-income countries, including India, according to a study published in Lancet Planetary Health.
  3. More than vegetables, chicken carries a lot of antimicrobial-resistant organisms. In India, the problem could only get worse as the growing demand for meat and livestock products is expected to double the consumption of antimicrobials in India by 2030.
  4. Improper disposal of residual antibiotics that eventually enter the food chain.

Challenges- 

  1. Despite these emerging threats from multiple fronts, India has no public database of mortality caused due to antimicrobial resistance.
  2. But even as the old and existing arsenal of antibiotics is being lost to a growing array of resistant bacteria, no new drugs are entering the market. No new antibiotic has been discovered in the last three decades, especially not against the gram-negative strain of bacteria prevalent in India.
  3. Overuse and misuse of antibiotics have long been believed to fuel antimicrobial resistance (AMR), but new research shows that simply lowering consumption is not enough.  Providing sanitation, clean water, and good governance, increasing public health expenditure and better regulating the private health sector are all necessary to reduce antimicrobial resistance.
  4. Most pharmaceutical companies generally do not consider antibiotics to be a good source for revenue generation. The R&D focus, therefore, is more on lifestyle-related drugs, ranging from diabetes to cardiovascular diseases.

Way forward

  1. India’s medical societies adopted the Chennai Declaration, a set of national recommendations to promote antibiotic stewardship.
  2. India’s Red Line campaign – which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics– is a step forward.
  3. “Last resort” antibiotics should never be used as growth promoters in livestock farming, but achieving this will require significant changes to current practices.
  4. A national policy for containment of AMR was introduced in 2011. The policy aims to understand the emergence, spread, and factors influencing AMR.
  5. To set up an antimicrobial program to rationalize the use of antimicrobials and to encourage the innovation of newer and effective antimicrobials.
  6. WHO launched the global antimicrobial surveillance system (GLASS) to work closely with WHO collaborating centers and existing antimicrobial resistance surveillance networks.

Antibiotic resistance is not a problem that can be solved by any one country or even one region. Since, we live in a connected world, where people, animals and food travel and microbes travel with them, global action is essential to make progress in the long run. Increasing public awareness and understanding is, therefore, the most crucial pillar towards tackling antimicrobial resistance.

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