Antibiotics Resistance

Antibiotic resistance in foodborne germs is a growing challenge that is made worse by overuse of antibiotics in humans and food animals. What are the latest challenges and opportunities in the field?

Antibiotics Resistance

Antimicrobial resistance

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Factors responsible for anti-microbial resistance

Mains level : Paper 2-Threats posed by anti-microbial resistance

The article highlights the challenges posed by anti-microbial resistance (AMR) and suggests ways to deal with it.

Understanding the severity of challenges posed by AMR

  • Antimicrobial resistance (AMR) is the phenomenon by which bacteria and fungi evolve and become resistant to presently available medical treatment.
  • AMR represents an existential threat to modern medicine.
  • Without functional antimicrobials to treat bacterial and fungal infections, even the most common surgical procedures, as well as cancer chemotherapy, will become fraught with risk from untreatable infections.
  • Neonatal and maternal mortality will increase.

How AMR will affect low and middle-income countries

  • All these effects will be felt globally, but the scenario in the low- and middle-income countries (LMICs) of Asia and Africa is even more serious.
  • LMICs have significantly driven down mortality using cheap and easily available antimicrobials.
  • In the absence of new therapies, health systems in these countries are at severe risk of being overrun by untreatable infectious diseases.

Factors contributing to AMR

  • Drug resistance in microbes emerges for several reasons.
  • These include the misuse of antimicrobials in medicine, inappropriate use in agriculture, and contamination around pharmaceutical manufacturing sites where untreated waste releases large amounts of active antimicrobials into the environment.

Stagnant antibiotics discovery

  •  The Challenge of AMR is compounded by fact that no new classes of antibiotics have made it to the market in the last three decades.
  • This has happened on account of inadequate incentives for their development and production.
  • A recent report from the non-profit PEW Trusts found that over 95% of antibiotics in development today are from small companies, 75% of which have no products currently in the market.
  • Major pharmaceutical companies have largely abandoned innovation in this space.

Measures to deal with the challenge of AMR

  •  In addition to developing new antimicrobials, infection-control measures can reduce antibiotic use.
  • A mix of incentives and sanctions would encourage appropriate clinical use.
  • To track the spread of resistance in microbes, surveillance measures to identify these organisms need to expand beyond hospitals and encompass livestock, wastewater and farm run-offs.
  • Finally, since microbes will inevitably continue to evolve and become resistant even to new antimicrobials, we need sustained investments and global coordination to detect and combat new resistant strains on an ongoing basis.

Way forward

  •  A multi-sectoral $1 billion AMR Action Fund was launched in 2020 to support the development of new antibiotics.
  • The U.K. is trialling a subscription-based model for paying for new antimicrobials towards ensuring their commercial viability.
  • Other initiatives focused on the appropriate use of antibiotics include Peru’s efforts on patient education to reduce unnecessary antibiotic prescriptions.
  • Australian regulatory reforms to influence prescriber behaviour, and initiatives to increase the use of point-of-care diagnostics, such as the EU-supported VALUE-Dx programme.
  • Denmark’s reforms to prevent the use of antibiotics in livestock have led to a significant reduction in the prevalence of resistant microbes in animals and improved the efficiency of farming.
  • Finally, given the critical role of manufacturing and environmental contamination in spreading AMR there is a need to curb the amount of active antibiotics released in pharmaceutical waste.
  • Regulating clinician prescription of antimicrobials alone would do little in settings where patient demand is high and antimicrobials are freely available over-the-counter in practice, as is the case in many LMICs.
  • Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines.
  • Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.
  • AMR must no longer be the remit solely of the health sector, but needs engagement from a wide range of stakeholders, representing agriculture, trade and the environment with solutions that balance their often-competing interests.
  •  International alignment and coordination are paramount in both policymaking and its implementation.

Consider the question “Anti-microbial resistance (AMR) represents an existential threat to modern medicine. What are the factors contributing to AMR? Suggest the measures to deal with it.”

Conclusion

With viral diseases such as COVID-19, outbreaks and pandemics may be harder to predict; however, given what we know about the “silent pandemic” that is AMR, there is no excuse for delaying action.

Antibiotics Resistance

Looming heath crisis in the form of antimicrobial resistance

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Factors responsible for AMR

Mains level : Paper 3- Link between pollution and AMR

Rapidly rising antimicrobial resistance (AMR) poses the threat of the next health crisis if not addressed with urgency. The article examines the severity of the issue.

The severity of the antimicrobial resistance (AMR)

  • Globally, about 35% of common human infections have become resistant to available medicines.
  • About 700,000 people die every year because available antimicrobial drugs — antibiotics, antivirals, antiparasitic and antifungals — have become less effective at combating pathogens.
  • Resistance to second- and third-line antibiotics — the last lines of defence against some common diseases — are projected to almost double between 2005 and 2030.
  • In India, the largest consumer of antibiotics in the world, this is a serious problem.

Responsible factors

  •  Microorganisms develop resistance to antimicrobial agents as a natural defence mechanism.
  • Human activity has significantly accelerated the process.
  • The misuse and overuse of antimicrobials for humans.
  • Livestock and agriculture but other factors also contribute.

Research points  to role of environment and pollution

  • Once consumed, up to 80% of antibiotic drugs are excreted un-metabolised, along with resistant bacteria.
  • Their release in effluents from households and health and pharmaceutical facilities, and agricultural run-off, is propagating resistant microorganisms.
  • Wastewater treatment facilities are unable to remove all antibiotics and resistant bacteria.
  • In India, there is capacity to treat only about 37% of the sewage generated annually.
  • Water, then, may be a major mode for the spread of AMR, especially in places with inadequate water supply, sanitation and hygiene.
  • Wildlife that comes into contact with discharge containing antimicrobials can also become colonised with drug-resistant organisms.

Initiative to tackle the AMR

  • The United Nations Environment Programme (UNEP) identified antimicrobial resistance as one of six emerging issues of environmental concern in its 2017 Frontiers Report.
  • UN agencies are working together to develop the One Health AMR Global Action Plan (GAP) that addresses the issue in human, animal, and plant health and food and environment sectors.
  • The Ministry of Environment, Forest and Climate Change (MoEF&CC) issued draft standards which set limits for residues of 121 antibiotics in treated effluents from drug production units.
  • The Ministry of Health and Family Welfare and MoEF&CC constituted the inter-ministerial Steering Committee on Environment and Health, with representation from WHO and UNEP.

Way forward

  • The Centre and State governments in India can strengthen the environmental dimensions of their plans to tackle antimicrobial resistance.
  • It is important to promote measures that address known hotspots such as hospitals and manufacturing and waste treatment facilities.

Consider the question “Being the largest consumer of antibiotics in the world, India faces a grave threat from growing anti-microbial resistance. What are the factors responsible for it? Suggest the ways to deal with it.”

Conclusion

We saw how quickly a pandemic can spread if we are not ready. This is an opportunity to get ahead of the next one.

Antibiotics Resistance

[pib] Global Antimicrobial Resistance Research and Development Hub

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AMR

Mains level : Not Much

  • India has joined the Global Antimicrobial Resistance (AMR) Research and Development (R&D) Hub as a new member.

Global AMR R&D Hub

  • The Hub was launched in May 2018 in the margins of the 71st session of the World Health Assembly, following a call from G20 Leaders in 2017.
  • It is supported through a Secretariat, established in Berlin and currently financed through grants from the German Federal Ministry of Education and Research (BMBF) and the Federal Ministry of Health (BMG).
  • It supports global priority setting and evidence-based decision-making on the allocation of resources for AMR R&D through the identification of gaps, overlaps and potential for cross-sectoral collaboration and leveraging in AMR R&D.
  • From this year onward, India will be the member of Board of members of Global AMR R&D Hub.
  • India looks forward to working with all partners to leverage their existing capabilities, resources and collectively focus on new R&D intervention to address drug resistant infections.

Back2Basics

Antimicrobial resistance

  • Antimicrobial resistance (AMR or AR) is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe
  • The term antibiotic resistance is a subset of AMR, as it applies only to bacteria becoming resistant to antibiotics.
  • Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines.
  • Bacteria, not humans or animals, become antibiotic-resistant.
  • These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
  • Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
  • A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
  • It leads to higher medical costs, prolonged hospital stays, and increased mortality.

Antibiotics Resistance

Study to check antibiotic resistance in Ganga

Note4Students

From UPSC perspective, the following things are important :

Prelims level : Anti-biotic resistance

Mains level : Microbial pollution of water bodies

  • The government has commissioned a study to assess the microbial diversity along the entire length of the Ganga.

About the project

  • The study will undertake tests entire stretches of the 2,500 km Ganga river if it contain microbes that may promote “antibiotic resistance”.
  • The aims of the research project are:
  1. To indicate the type of “contamination” (sewage and industrial) in the river and “threat to human health (antibiotic resistance surge)”,
  2. To identify sources of Escherichia coli, a type of bacteria that lives in the gut of animals and humans.
  • While largely harmless, some species have been linked to intestinal disease as well as aggravating antibiotic resistance.

What is Antibiotic resistance?

  • Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines.
  • Bacteria, not humans or animals, become antibiotic-resistant.
  • These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
  • Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.
  • Antibiotic resistance is a consequence of evolution via natural selection.
  • Other factors contributing towards resistance include incorrect diagnosis, unnecessary prescriptions, improper use of antibiotics by patients, and the use of antibiotics as livestock food additives for growth promotion.

 Read this fantastic article by WHO on antibiotic resistance:

https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance

Antibiotics Resistance

AWaRe: A WHO tool for safer use of antibiotics

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AWARE tool by WHO

Mains level : Anti-microbial resistance


  • The WHO has launched a global campaign that urges countries to adopt its new online tool aimed at guiding policy-makers and health workers to use antibiotics safely and more effectively.

AWARE Tool

The tool, known as ‘AWaRe’, classifies antibiotics into three groups:

  • Access   — antibiotics used to treat the most common and serious infections
  • Watch    — antibiotics available at all times in the healthcare system
  • Reserve — antibiotics to be used sparingly or preserved and used only as a last resort

Antimicrobial resistance

  • Antimicrobial resistance (AMR or AR) is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe
  • The term antibiotic resistance is a subset of AMR, as it applies only to bacteria becoming resistant to antibiotics.
  • Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines.
  • Bacteria, not humans or animals, become antibiotic-resistant.
  • These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
  • Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
  • A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
  • It leads to higher medical costs, prolonged hospital stays, and increased mortality.

Antibiotics Resistance

[op-ed snap] The cost of antimicrobial resistance

Note4Students

From UPSC perspective, the following things are important :

Prelims level : AMR

Mains level : Steps to be taken to fightAntimicrobial Resistance in India.

CONTEXT

India must brace for the economic shocks from uncontrolled antimicrobial resistance.

Background

  • Even though antimicrobial resistance is acknowledged by policymakers as a major health crisis, few have considered its economic impact.
  •  Interagency Coordination Group on Antimicrobial Resistance (IACG) – Now, a report from the Interagency Coordination Group on Antimicrobial Resistance (IACG) puts the financial fall-out in perspective.
  • Titled “No Time to Wait: Securing The Future From Drug Resistant Infections”, it says in about three decades from now uncontrolled antimicrobial resistance will cause global economic shocks on the scale of the 2008-09 financial crisis.

Findings of the report

  • High human and economic cost – With nearly 10 million people estimated to die annually from resistant infections by 2050, health-care costs and the cost of food production will spike, while income inequality will widen.
  • GDP loss and poverty widening – In the worst-case scenario, the world will lose 3.8% of its annual GDP by 2050, while 24 million people will be pushed into extreme poverty by 2030.
  • Nations must acknowledge this eventuality, the IACG says, and act to fight it.
  • For high- and mid-income nations, the price of prevention, at $2 per head a year, is extremely affordable.
  • For poorer countries, the price is higher but still modest compared to the costs of an antibiotic apocalypse.

India’s efforts to fight resistance

  • India first published almost nine years ago the broad contours of a plan to fight antimicrobial resistance.
  • The difficulty has been in implementing it, given the twin challenges of antibiotic overuse and underuse.
  • On the one hand, many Indians still die of diseases like sepsis and pneumonia because they don’t get the right drug at the right time.
  • On the other hand, a poorly regulated pharmaceutical industry means that antibiotics are freely available to those who can afford them.
  • The IACG report acknowledges these obstacles, and calls for efforts to overcome them.

Steps required

  • Phasing out critical human-use antibiotics in the animal husbandry sector – Some steps can be initiated right away, it says, such as phasing out critical human-use antibiotics in the animal husbandry sector, such as quinolones.
  • Multi-stakeholder approach -But these steps cannot be driven by regulation alone.A multi-stakeholder approach, involving private industry, philanthropic groups and citizen activists is needed.
  • Responsibility of Private pharmaceutical – Private pharmaceutical industries must take it upon themselves to distribute drugs in a responsible manner.
  • Responsibility of Philanthropic charities – Philanthropic charities must fund the development of new antibiotics, while citizen activists must drive awareness.
  • These stakeholders must appreciate that the only way to postpone resistance is through improved hygiene and vaccinations.

Conclusion

It is a formidable task as India still struggles with low immunisation rates and drinking water contamination. But it must consider the consequences of a failure.

While the 2008-09 financial crisis caused global hardships, its effects began to wear off by 2011. Once crucial antibiotics are lost to humankind, they may be lost for decades.

 

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