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

[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.

 

Antibiotics Resistance

Fish samples in Chennai test positive for formalin

Note4students

Mains Paper 3: Environment | Conservation, environmental pollution and degradation, environmental impact assessment

From UPSC perspective, the following things are important:

Prelims level: Formalin

Mains level: Contamination of food items is a cause of concern.


News

Formalin – a carcinogen, traces in Fishes

  1. As many as 11 out of 30 samples of fish species purchased from two major fish markets in Chennai, on two different days, have tested positive for formalin, a cancer-inducing chemical used illegally to preserve fish.
  2. Both big and small lizardfish or Panna or kezhanga and paarai (Malabar trevally) were found to have formalin content of above 20 ppm (parts per million).
  3. Other varieties such as sura, octopus, eri vavvaal, ottu kanava, peikanava and kelithi had formalin of around 5 ppm.

Particulars of the Test

  1. For the test, a two-gram piece of meat from the fish was taken and put inside four ml of diluent and shaken so that the formalin will get into it.
  2. Then this diluent was poured into the bottle containing the reagent that turned yellow revealing that it had tested positive.
  3. It is a very sensitive reagent and can detect up to 0.5 milligram per kilo. The actual test takes only 10 minutes.
  4. Food Safety and Standards Authority of India (FSSAI) have been undertaking tests at fish markets and harbours across the State to test for formalin following a scare in neighbouring Kerala that fish sourced from here were chemically contaminated.

Why use Formalin?

  1. Usually, people who buy fish check the gills for freshness, if it is red it denotes freshness when formalin is used the gills remain red for longer periods.
  2. In some cases, fishermen also apply kumkum to retain redness.

Back2Basics

Formalin

  1. Formalin is 30-45% aqueous solution of Formaldehyde with water.
  2. Formaldehyde is a simple chemical compound made of hydrogen, oxygen and carbon.
  3. All life forms – bacteria, plants, fish, animals and humans – naturally produce formaldehyde as part of cell metabolism.
  4. Formaldehyde is perhaps best known for its preservative and anti-bacterial properties, but formaldehyde-based chemistry is used to make a wide range of value-added products.
  5. Formalin causes irritation in the eyes, throat, skin and stomach. In the long run, continued exposure causes harm to the kidneys, liver and can even cause cancers.
  6. In the fishing industry, formalin or formaldehyde is sprayed on the fish or injected into the fish or the fish is dipped into the solution. This helps keep the fish fresh for a longer time.

Antibiotics Resistance

A game of chicken: how India’s poultry farms are spawning global superbugs

Note4students

Mains Paper 3: Science & Technology | developments & their applications & effects in everyday life

From UPSC perspective, the following things are important:

Prelims level: Colistin, MCR-1, NDM-1,

Mains level: Rising threat of drug resistance


Towards worldwide drug resistance

  1. India has been called the epicenter of the global drug resistance crisis
  2. Chickens in numerous poultry farm are being given Colistin, to protect them against diseases or to make them gain weight faster
  3. Doctors call Colistin the ‘last hope’ antibiotic
  4. It is used to treat patients critically ill with infections which have become resistant to nearly all other drugs
  5. It is the only drug to treat critically ill patients with a carbapenem-resistant infection

WHO ban 

  1. The World Health Organisation has called for the use of such antibiotics to be restricted to animals
  2. These should be banned as growth promoters

Why stopping their use is necessary?

  1. Their continued use in farming increases the chance that bacteria will develop resistance to them
  2. They would be useless when treating patients

Easy access enabling overuse?

  1. There is no legal requirement (prescription etc.) for buying Colistin in the country
  2. In Europe, colistin is available to farmers only if prescribed by a vet for the treatment of sick animals

Colistin-resistant gene

  1. MCR-1 is one such gene discovered recently
  2. It could be transferred within and between species of bacteria
  3. This means that microbes did not have to develop resistance themselves, they could become resistant just by acquiring the MCR-1 gene
  4. The resistance could be passed to bugs which are already multi-drug resistant
  5. This could lead to untreatable infections
  6. Another such gene is New Delhi Metallo-beta-lactamase 1 (NDM-1), which makes bugs resistant to carbapenem antibiotics

Drug resistance a big threat

  1. Drug resistance has been called one of the biggest threats to global health, food security, and development
  2. If antimicrobials stop working, doctors won’t have effective drugs to treat deadly infections
  3. Common procedures like joint replacements, Caesarean sections, organ transplants and chemotherapy could also become too risky to carry out

Antibiotics Resistance

[op-ed snap] Living in a world of emerging microbial resistance

Image source

Note4students

Mains Paper 3: Science & Technology | developments & their applications & effects in everyday life

From UPSC perspective, the following things are important:

Prelims level: Antimicrobial Resistance, ANSWER, NDM-1

Mains level: 2017 National Action Plan on Antimicrobial Resistance


Context

2017 National Action Plan on Antimicrobial Resistance

  1. For the first time, the 2017 National Action Plan on Antimicrobial Resistance talks about limiting antibiotics in effluent being dumped by drug makers into the environment
  2. This is because when these drugs taint soil and water, the scores of microbes that live there grow drug-resistant
  3. Until now, India’s fight against antibiotic-resistance was focussed on getting people to cut down on unnecessary antibiotic consumption

Why is resistance among microbes a problem?

  1. The answer lies in the intimacy shared between environmental bacteria and human pathogens
  2. A pathogen, say Klebsiella pneumoniae (K. pneumoniae), that causes pneumonia, can take two routes to antibiotic resistance
  3. The first is for its own genes to mutate spontaneously to help fight the drug
  4. The second route, a shortcut known as horizontal gene transfer, is for the bug to borrow resistance genes from its neighbours
  5. Scientists believe that many human pathogens today picked up their resistance genes from the environment through this shortcut

Phenomenon of anti-microbial resistance not new

  1. Phylogenetic studies suggest that the earliest antibiotic-resistance genes in nature are millions of years old
  2. But when humans started manufacturing antibiotics in the 1950s, a dramatic shift occurred
  3. Large doses of these drugs seeped into the environment through poultry and human excreta, and waste water from drug makers and hospitals
  4. This led to an explosion of resistance genes in soil and water microbes

European project ANSWER

  1. It stands for ‘Antibiotics and mobile resistance elements in wastewater reuse applications: risks and innovative solutions’
  2. This project studies technologies to remove antibiotic-resistance germs from wastewater along with other research

Need to worry

  1. If India doesn’t move quickly, wastewater in pharma clusters could give rise to new genes as dangerous as NDM-1
  2. New Delhi metallo-beta-lactamase 1 (NDM-1) was a deadly resistance gene
  3. Once such genes jump to humans, they will, no doubt, blaze their way across the planet
  4. It will be a death sentence for Indians as well as thousands across the globe

We had covered a similar op-ed in November that talked about antibiotic resistance rising in Hyderabad due to phrama companies dumping drugs in water bodies. Read it here

Antibiotics Resistance

Babies fall victim to antibiotic resistance

  1. Source: The Lancet
  2. Infected with superbugs in birth facilities within 72 hours of being born, thousands of Indian babies are dying due to an alarming degree of drug resistance
  3. Nearly 26% of babies with sepsis died, as multi drug resistance made the ailment untreatable
  4. Three superbugs: Klebsiella, Acinetobacter and E. coli are associated with more than half (53%) of the infections
  5. Why? This worrying epidemic-like situation is a result of overuse of antibiotics in humans, agriculture and livestock

Discuss: What is anti-microbial resistance? What are the reasons for it? What steps has been taken in India and what more needs to be done?

Antibiotics Resistance

India lauded for Red Line Campaign on antibiotics

  1. Context: The global Review on Antimicrobial Resistance, a report on tackling drug resistant infection
  2. Finding: 20-30 per cent of antibiotics are consumed without prescription in south and east Europe and up to 100 per cent in parts of Africa
  3. India’s Red line campaign: (launched in Feb 2016) is finding recognition, and could be adopted globally
  4. It should be considered as starting point of restriction over use of antibiotics
  5. Aim: To decrease the use of Red line antibiotics without prescription, create awareness of danger of taking antibiotics
  1. Context: The global Review on Antimicrobial Resistance, a report on tackling drug resistant infection
  2. Finding: 20-30 per cent of antibiotics are consumed without prescription in south and east Europe and up to 100 per cent in parts of Africa
  3. India’s Red line campaign: (launched in Feb 2016) is finding recognition, and could be adopted globally
  4. It should be considered as starting point of restriction over use of antibiotics
  5. Aim: To decrease the use of Red line antibiotics without prescription, create awareness of danger of taking antibiotics

Antibiotics Resistance

Report warns of mass death from superbugs

  1. Context: Review on Antimicrobial Resistance, commissioned by the British government
  2. Superbugs: Emerge when infections become immune to existing drug, allowing minor injuries and common infections to become deadly
  3. Emergency: Ten million people could die by 2050 unless sweeping global changes are agreed to tackle increasing resistance to antibiotics
  4. Threat: It needs to be seen as the economic and security threat that it is, and be at the forefront of the minds of heads of state
  5. Steps: The overuse of antibiotics should be reduced by cutting the vast quantities of medicines given to farm animals
  6. Also, improving diagnoses to stop unnecessary prescriptions, a global public awareness campaign
  1. Context: Review on Antimicrobial Resistance, commissioned by the British government
  2. Superbugs: Emerge when infections become immune to existing drug, allowing minor injuries and common infections to become deadly
  3. Emergency: Ten million people could die by 2050 unless sweeping global changes are agreed to tackle increasing resistance to antibiotics
  4. Threat: It needs to be seen as the economic and security threat that it is, and be at the forefront of the minds of heads of state
  5. Steps: The overuse of antibiotics should be reduced by cutting the vast quantities of medicines given to farm animals
  6. Also, improving diagnoses to stop unnecessary prescriptions, a global public awareness campaign

Antibiotics Resistance

New front opens in war on superbugs

  1. Context: Increasing anti-biotic resistance and shrinking range of antibiotics to treat a wide variety of ailments
  2. News: A newly-discovered antibiotic-resistant gene “mcr-1” is threatening to open a new front in the war against superbugs by rendering a last-resort drug impotent
  3. Reason: The gene is resistant to colistin, a life-saving medication which has been around for 60 years
  4. MCR-1: It is the resistance-conferring gene which easily transfers between bacteria found in humans, animals or the environment
  1. Context: Increasing anti-biotic resistance and shrinking range of antibiotics to treat a wide variety of ailments
  2. News: A newly-discovered antibiotic-resistant gene “mcr-1” is threatening to open a new front in the war against superbugs by rendering a last-resort drug impotent
  3. Reason: The gene is resistant to colistin, a life-saving medication which has been around for 60 years
  4. MCR-1: It is the resistance-conferring gene which easily transfers between bacteria found in humans, animals or the environment

Antibiotics Resistance

WHO urges action against antibiotic resistance

  1. Cautioning against the indiscriminate use of antibiotics and other drugs which leads to resistance to medicines and treatment failure.
  2. Resistance to antibiotics will make complex surgeries and management of several chronic illnesses like cancer, extremely difficult.
  3. Estimates said ,antibiotic resistance will be responsible for 10 million deaths annually by 2050.
  1. Cautioning against the indiscriminate use of antibiotics and other drugs which leads to resistance to medicines and treatment failure.
  2. Resistance to antibiotics will make complex surgeries and management of several chronic illnesses like cancer, extremely difficult.
  3. Estimates said ,antibiotic resistance will be responsible for 10 million deaths annually by 2050.
  4. Its economic cost will result in a 2 to 3.5-per cent decrease in global GDP to same year.
  5. Reduced productivity from persisting illness, and its cost of treatment, will add to the economic loss.

Antibiotics Resistance

Antibiotics in the food we eat

  1. This is an old article, sourced from Sept 2014 – but the issue of antibiotics in the food we eat has risen up again.
  2. Early ripening of Banganapalli mangoes (also called Benishan or spotless) is done by using calcium carbide, which generates the ripening gas ethylene.
  3. Oxytocin in milk – A hormone that supposedly increases milk output in cows.
  4. The use of antibiotics in the feed given to the chicken for faster growth and to prevent any infection during hatching.
  1. This is an old article, sourced from Sept 2014 – but the issue of antibiotics in the food we eat has risen up again.
  2. Early ripening of Banganapalli mangoes (also called Benishan or spotless) is done by using calcium carbide, which generates the ripening gas ethylene.
  3. Oxytocin in milk – A hormone that supposedly increases milk output in cows.
  4. The use of antibiotics in the feed given to the chicken for faster growth and to prevent any infection during hatching.

Antibiotics Resistance

52% Indians indulge in self-medication

  1. Over 52% Indians indulge in self-medication. Why? Either because of time constraints or the perception of doing away with the doctors’ fees.
  2. Un-prescribed medicines are known to make the body resistant to antibiotics besides causing health problems.
  3. Do you remember the term Antimicrobial Resistance (AMR)?
  4. It is a broader term for resistance in different types of microorganisms and encompasses resistance to anti (bacterial, viral, parasitic & fungal) drugs.
  5. What causes this? Taking substandard doses or not finishing a prescribed course of treatment.
  1. Over 52% Indians indulge in self-medication. Why? Either because of time constraints or the perception of doing away with the doctors’ fees.
  2. Un-prescribed medicines are known to make the body resistant to antibiotics besides causing health problems.
  3. Do you remember the term Antimicrobial Resistance (AMR)?
  4. It is a broader term for resistance in different types of microorganisms and encompasses resistance to anti (bacterial, viral, parasitic & fungal) drugs.
  5. What causes this? Taking substandard doses or not finishing a prescribed course of treatment.
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