Antimicrobial resistance (AMR), also known as drug resistance, occurs when microorganisms such as bacteria, viruses, fungi, and parasites evolve in ways that render the medications used to cure the infections they cause ineffective . When the microorganisms become resistant to most antimicrobials, they are often referred to as “superbugs” . AMR is a major public health concern because a resistant infection may kill, can spread to others, and imposes a huge cost on individuals and society . Therefore, this policy brief presents a situational analysis of AMR and advocates for a multi-disciplinary approach to control AMR in India. The most recent and relevant publications on AMR in India were reviewed and analyzed to recommend a comprehensive health policy framework. The study recommends an innovative health policy framework for avoiding emergence, supporting research and development (R&D) for new drugs, and encouraging multi-sectoral coordination. Further amendments to the existing health policy with a targeted approach to prevent the growing epidemic of AMR are required. Failure to do so may cause irreversible damage with high morbidity, mortality, and disability in India.
Keywords: antibiotics; resistance; global burden, ICD-10 code Z16, superbugs, AMR, MDR TB
Introduction
The antibiotics have represented a great revolution for humankind, the development after the World War II of a magic bullet (the antibiotic molecule), as imagined by Paul Erlich, the pioneer of chemotherapy, with the property to kill or inhibit the growth of microorganisms by hitting the microbial structures with low toxicity for host cells and tissues, has determined a new era in the treatment and prophylaxis of infectious disease and in the quality of human life .
The antibiotic era revolutionized the treatment of infectious diseases worldwide . Antimicrobial usage has brought remarkable improvements in human life. Administering antimicrobial right from birth (especially for pre-term and low birth weight neonates) has increased life expectancy at birth, it has greatly reduced death rates due to communicable diseases , injuries and most importantly reduced incidences of fatal diseases like cholera, diphtheria, pneumonia, typhoid fever, plaque, tuberculosis, typhus, syphilis, etc. to an extent of complete eradication .
However irrational use of antimicrobial has introduced new forms of public health challenges – resistance to ages long invented antimicrobial by evolving microbes; where microbes do not respond to antibiotic dosage and continues to threaten human life . Practices like over prescription of Antimicrobial, lack of counselling before prescribing them, and improper dosage taken by patients thanks to temporary relief are making situation worse than before . Besides, fear of frequent epidemics of veterinary diseases like bird flu; as a result, on large scale Antimicrobial are administered to chickens in large poultry houses . Similar situation does exist in pig farms, where irrational use of Antimicrobial indirectly releases resistant microbes into food chain . There is need to regulate – private partners, drug distribution systems of chemists, and provide capacity building to employees in poultry and pig farms to use Antimicrobial as per need and that only if prescribed by veterinary doctor.