Antibiotic Resistance (Completely Explained)

Why in the News?

1. Antimicrobial resistance (AMR) is a growing public health threat in India, flagged by WHO as one of the top 10 global health risks, with projections of 10 million annual deaths worldwide by 2050.
2. India’s position as the 2nd highest antibiotic consumer, with a 47% rise between 2010 and 2020, combined with over-the-counter access and poor sanitation which significantly accelerates resistance.

What is Antibiotic or Antimicrobial Resistance (ABR or AMR)?

Antibiotic resistance (ABR) occurs when bacteria evolve mechanisms to resist the effects of drugs that once killed them or inhibited their growth.

What are the causes of ABR?

1. Human Misuse: Bacteria become resistant when antibiotics are misused (like Self-medication, incomplete antibiotic courses, and unnecessary prescription).
2. Healthcare System Gaps: Inadequate diagnostics, poor infection control, and overcrowded hospitals facilitate the spread of resistant infections.
3. Environmental Factors: Pharmaceutical waste, untreated sewage, and antibiotic residues in water bodies contribute to environmental resistance.
4. Agricultural Practices: The use of antibiotics in agriculture, particularly as growth promoters, accelerates resistance development.
5. Global Movement: International travel and trade facilitate the spread of resistant strains across borders.

Impact and Consequences

1. Health: Increased mortality and morbidity due to treatment failures and prolonged illnesses.
2. Economic: Higher healthcare costs, loss of productivity, and economic strain on families, especially in low-income settings.
3. Social: Erosion of trust in medical systems and a rise in alternative medicine practices.
4. Global: Threatens the effectiveness of surgeries, cancer treatments, and maternal care, undermining medical advancements.
5. Examples: Some bacteria are becoming hard to treat, including:
   1. Tuberculosis (TB): Multi–Drug Resistant (MDR – resistant to some key drugs) and Extensively Drug Resistant (XDR – resistant to almost all drugs) strains.
   2. Gonorrhea, Pneumonia, and Urinary Tract Infections: Increasing resistance makes standard treatments less effective.
   3. Superbugs: Certain bacteria resist multiple antibiotics. The NDM-1 gene, discovered in India, makes some infections nearly untreatable with last-resort drugs like carbapenems.

Government Initiatives and Policy Framework

1. National Action Plan on AMR (2017–2021): Launched by the Ministry of Health and Family Welfare (MoHFW), this plan focuses on surveillance, awareness, and regulation to combat AMR.
2. Red Line Campaign: Introduced to mark antibiotics that are prescription- only, aiming to curb over-the-counter sales.
3. AMR Surveillance Network: ICMR leads a national network monitoring resistance patterns across hospitals.
4. FSSAI Regulations: The Food Safety and Standards Authority of India (FSSAI) has set norms to limit antibiotic use in food-producing animals.
5. One Health Approach: Integrating human, animal, and environmental health to address AMR comprehensively.

Global Efforts and Best Practices

1. WHO’s Global Action Plan on AMR: Provides a strategic framework for countries to combat AMR through surveillance, stewardship, and innovation.
2. Tripartite Collaboration: WHO, FAO, and World Organisation for Animal Health (OIE) work together to coordinate global efforts against AMR.
3. Antibiotic Stewardship Programs: Implemented in hospitals worldwide to optimize antibiotic use and reduce resistance.
4. EU Regulations: The European Union has banned the use of antibiotics as growth promoters in livestock.
5. Global Surveillance Systems: Systems like GLASS monitor resistance patterns and inform policy decisions.

Ethical and governance considerations in tackling ABR

1. Access vs. Regulation: Balancing antibiotic availability with strict controls is vital. Over-regulation can hurt vulnerable groups; under-regulation fuels resistance.
2. Equity in Treatment: Marginalized communities face limited access to effective care. Ethical governance must ensure no one is left behind.
3. Pharmaceutical Responsibility: Companies must avoid overpromotion, ensure quality, support stewardship (responsible management and use of antibiotics to preserve their effectiveness.), and invest in new treatments.
4. Civil Society’s Role: NGOs, media, and communities are key to spreading awareness, promoting hygiene, and supporting responsible antibiotic use.

Challenges and Way Forward

Conclusion

Antibiotic resistance is a pressing public health challenge that requires immediate and sustained action. A coordinated, multi-sectoral approach, integrating policy, education, and research, is essential to combat this threat. Future administrators must prioritize AMR in health governance to safeguard public health and ensure the efficacy of antibiotics for future generations.