Recommendations
1. Avoiding emergence. Effective interventions for
rationalising antimicrobial consumption include stewardship programmes
to educate healthcare personnel and prevent excessive use of
Antimicrobial, awareness campaigns, as well as enhanced immunisation
programmes [15]. Price policies and behavioural approaches (e.g. delayed
prescriptions) are increasingly considered as potential tools to
decrease unnecessary consumption [15].
2. Avoiding spread. Large scale implementation of
strategies for early detection of resistant microbial infections and
enhanced hospital-based care with complete course of treatment can
effectively preventing and control transmission in larger population [25]. Local physicians through CME can be trained to properly consult patients
to take full course of antibiotics, they can also be trained to handle
resistant cases (i.e. by referring them to higher centre of care) [26], [27]. Another strategy to increase complete use of antibiotics can be
implementing the five WHO principles on hand washing, coupled with goal
setting, incentives or accountability [15].
3. Encouraging R & D. With limited research and
development pharmaceutical industries in India have been marketing for
ages old antimicrobial drugs – most of which have developed resistance
and proved to be in-effective [1], [5], [28]. There is need to boost expenditure on
research that will develop plants based indigenous antimicrobial drugs
to prevent or cure infectious conditions [29], [30]. Also, there is need to invent
newer treatment regimens that can be more effective and simultaneously
more cost-effective than antibiotics use [31].
According to several research studies, particularly the one conducted in
Boston, after three billion years of bacterial evolution, the world’s
infecting bacteria had almost no antibiotic resistance genes, but a half
century of antibiotic use then spread many into more than a quarter of
them [32]. People or animals receiving Antimicrobial as well as countries
that use more Antimicrobial have been found to have more antibiotic
resistant bacteria [33]. From all we know, the progression of antibiotic
resistance would appear to be ultimately some cumulative function of how
many bacteria have encountered an antibiotic [34].
4. Innovative policy supporting intersectoral
coordination. The existing national policy on antimicrobial resistance
has been formulated in 2011 [35]. Antimicrobial resistance is a serious
threat to global public health that requires action across all
government sectors and society and is driven by many interconnected
factors [5]. Single, isolated interventions have limited impact and
coordinated action is required to minimize the emergence and spread of
antimicrobial resistance [1]. Therefore, it is crucial to alter the
existing policy to encourage inter-sectoral coordination between
different ministries concerning health like – ministry of chemical and
fertilisers which regulates the pharma industry, ministry of health and
family welfare which monitors the quality and cost of drugs. However
existing policy do not encourage practice of inter disciplinary work.
Hereby we recommend the due policy change in that will ultimately
favours the inter sectoral coordination and also encourages the linkages
between the existing research and development and drug procurement
through proper channel. Also considering cost component, there is strong
need to re-design pharmaceutical policy that will provide free and
quality drugs, so that over the counter drug purchase can be controlled
and this will be a greater measure to combated anti-microbial
resistance.
5. Multidisciplinary approach to control progression of
antibiotic resistance. Antimicrobial resistance (AMR) is a global
health and development threat [5]. It requires urgent multi-sectoral action
in order to achieve the Sustainable Development Goals (SDGs) [5]. To
control this serious public health issue and to save human and animal
lives; multi-disciplinary approaches across health care settings as well
as environment and agriculture sectors are required [36].
Use of Antimicrobial in food animal production in inappropriate over
dosage has aggravated the issue [8]. Also use of antimicrobial should be
limited for the treatment of severely infected animals’ birds and should
not be used for non-therapeutic purposes like - convert feed to muscle [37],
growth promotion [38], or to cope up with load on transportation and
situation of crowding and poor hygiene [37], [38]. Wherever possible other modes
of preventing infection should be adopted. Third generation
cephalosporins, fluoroquinolones, other antimicrobial used for
controlling diseases, should be limited for treating refractory
infections in individual animals [5]. Policy recommendations from FAAIR can
be adopted to limit antimicrobial administration to animals only on
prescription by a veterinarian [39]. To assess the human health risk and
inform public health policy, quantitative data on antimicrobial use
(in-depth measurements) in agriculture should be made available by
pharmaceutical manufacturers, importers and end users [8], [40], [41]. Regulatory
agencies should consider the ecology of antimicrobial resistance –the
processes of spread and complex interactions between bacteria – both
pathogens (disease causing) and non-pathogens (commensals), food
animals, humans, and their environments [39]. Surveillance programs for
antimicrobial resistance should be harmonized to permit integrated
analysis of human and animal data [39].
6. Restrict over the counter purchase (OCT) of drugs and
controlling hospital acquired infections. India has one of the highest
rates of antimicrobial resistance (AMR) worldwide [42]. Despite being
prescription drugs, antibiotics are commonly available over-the-counter
(OTC) at retail pharmacies [42]. Further rampant urbanization and
unregulated industrialization have failed to provide quality of life to
the overall human population [43], resultantly most of Indians live in
poverty. All these factors contribute to the lack of knowledge about
proper use of medicines among urban poor population and inadequate
guidance to use antibiotics by physicians.
Some of the unhygienic practices at hospitals and health care facilities
also contributes to AMR due to hospital acquired infections [36]. Therefore,
restricting OCT by pharmacists and a few precautions for hospital-based
workers such as —practicing simple control measures such as the hand
hygiene changing gloves after examining the patient, can be monumental
in controlling the spread of resistant bugs, as well as
hospital-acquired infections [37], [44]. There are few studies that shows that
only 30 per cent of doctors and health workers do hand wash after they
examine each patient [45]; this increases the spread of resistant microbes
to other ill patients with poor immunity. The current policy brief
therefore recommends the policy change in existing guidelines that
assures the standard operating procedures are being practiced among
health care workers in health care facilities that ultimately controls
hospital acquired infections and spread of resistant microbes.
Figures and Tables
Figure 1. Key facts about anti-microbial resistance