Antimicrobial Resistance, lest not addressed effectively, will render useless the progress made in the field of medicine to counter diseases caused by microbes and will put life in any form at severe risk in addition to putting medical researchers at neck-breaking stress.
Antimicrobial Resistance (AMR) arises when bacteria, viruses, fungi and parasites metamorphose with the passage of time to cope with the action produced by the antibiotic (antagonist), with the result they no longer respond to antibiotics, making infections nearly impossible to treat. This escalates the threat of disease spread, chronic illness and fatalities.
AMR is a universal health threat and the need of the hour is multispectral, multi-sectoral and multilateral action so as to attain the Sustainable Development Goals (SDGs). The WHO has affirmed that AMR is one of the top 10 universal public health threats which humans will have to face or are facing. The paucity of access to clean water sources, hygiene and inadequate infection prevention and control enhances the spread of microbes, leading to the population of those microbes whose gene pool lies at the threshold of spectrum of ineffective antibiotics.
The causes of AMR span antimicrobial misuse or inclusive overuse, self-medication, prescription sharing, non-compliance with the prescribed treatment, over-the-counter sale of antimicrobials, poor infection prevention and control, etc. Also, mishandling, injudicious use and overuse of pharmacological formulations are the main drivers in the development of next-generation drug-resistant pathogens.
Our country India has one of the highest populations of drug-resistant pathogens globally, including the highest numbers of multidrug-resistant tuberculosis and an alarmingly high resistance for Gram-negative and Gram-positive bacterial infections. More than 50,000 and counting newborns die from sepsis annually due to pathogens resistant to first-line antibiotics. It is due to lack of proper studies and assessments in public and private sector that there do not exist accurate estimates of the effect of AMR in India, though it is understood that neonates and the elderly are at greater risk and already worst affected.
It is projected that in India alone, over two million deaths may occur due to AMR by 2050. The cost of AMR in the very near future will put the economy at great stress due to large budgetary allocations. In addition, greater mortality rates and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines, and financial challenges for those impacted are other main concerns. Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk.
When the Covid-19 surfaced and was declared a pandemic and a major health concern by WHO, alarm bells have been raised concerning the improper use of antimicrobials amongst Covid-19 patients. What worries health experts is that the avoidable prescription of antimicrobials will lead to a further enhancement in already existing high levels of drug resistance in most parts around the globe. In the past few years, alarmingly high resistance rates in pathogens of public health importance have been reported from Indian hospitals. Sorry to say, the resistance rates reported by the primary health care facilities, hospitals and laboratories do not automatically translate to disease burden, except each resistant isolate is correlated with the clinical outcomes in the patients from whom they were isolated. This has to do with inadequate hospital information systems in most public sector funded healthcare facilities in India and many low-middle income countries.
The use of antibiotics in India increased twofold in the first two decades of the 21st century, leading to increase in antibiotic resistance, making common infectious diseases caused by microorganisms E. Coli like bronchopneumonia, Streptococcal septic sore throat and Mycobacterium Phthisis more difficult to treat. According to recent findings by the National Academy of Sciences (PNAS), antibiotic use shot up from 3.2 billion DDDs (Defined Daily Doses) to 6.5 billion DDDs in 2015. The study further elaborates that this reflects increasing economic growth and more access to antibiotics in both the public and private sectors. In 2015, the total universal antibiotic usage was 35 billion DDDs, a 65% increase from 2000, according to the analysis of antibiotic use across 76 nations.
Dr Rayees Ahmad Bhat works at the Department of Chemistry, Babasaheb Bhimrao Ambedkar University, Lucknow. Dr Sajood Maqbool Bhat works at Department of Chemistry, Govt S.G.S, P.G College, Sidhi, Madhya Pradesh.