Q. What do you understand by antimicrobial resistance? Discuss India’s National action plan on antimicrobial resistance.
India’s National Action Plan
Antibiotic Resistance refers to resistance developed by bacteria against antibiotics or the ability of bacteria to mutate or change so as to resist the effects of antibiotics. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others. Phylogenetic studies suggest that the earliest antibiotic resistance genes in nature are millions of years old. But when humans starting manufacturing antibiotics in the 1950s, a dramatic shift occurred. Large doses of these drugs seeped into the environment through poultry and human excreta, and waste water from drug makers and hospitals. This led to an explosion of resistance genes in soil and water microbes.
Until now, India’s ﬁght against antibiotic-resistance was focussed on getting people to cut down on unnecessary antibiotic consumption. Having too many antibiotics causes bodily pathogens to resist these miracle drugs.
But, 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.
This is because when these drugs taint soil and water, the scores of microbes that live there grow drugresistant. But only a tiny proportion of these environmental microbes trigger disease in humans.
Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required
For developing countries like India the emergence of resistance is likely to cause a huge economic burden on account of negative externalities like health Antibiotic-resistant bacteria increase the chance and severity of illness and ultimately death
Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk
Few new antibiotics are being developed, which is exacerbating the situation as more antibiotic resistant bacteria adapts and arises
India’s National Action Plan
The Indian NAP focuses on six strategic priority areas, namely
1. Awareness and understanding through education, communication and training 2. Strengthening knowledge and evidence through surveillance 3. Infection prevention and control
4. Optimised antimicrobial use in health, animals and food 5. AMR-related research and innovation
6. Strengthened leadership and commitment at international, national and sub-national levels. The ambitious and comprehensive plan highlights the need for tackling AMR across multiple sectors such as human health, animal husbandry, agriculture and environment in consideration of the “One-Health” approach.
Education and training
• Revision of curriculum for professionals in food animal, agriculture and environment sector with focus on AMR
• Development of capacity through appropriate training on issues related to AMR among professionals in animal health, food industry, agriculture and environment
• Conducting national-level surveillance of antimicrobial resistance in animals, food and environment
• Conducting national-level surveillance of antimicrobial use (AMU) in animals, agriculture and food sectors
• Conducting national-level surveillance of antibiotic residues in food from animals and in environment, including waste from farms, factories making animal feed, processing meat, dairy, ﬁsh, veterinary and human health care settings, pharmaceutical industry
Infection prevention and control
• Establishment of infection prevention and control programmes in veterinary settings and animal husbandry
• Increased awareness, capacity building, training on bio-safety, biosecurity, hygiene, good production practices, infection prevention and control among relevant stakeholders
Responsible and optimised antibiotic use
• Restricting and phase-out of non-therapeutic
Focus on environment
• Reduction of environmental contamination with resistant pathogens and antimicrobial residues through strengthening of necessary laws and regulations, environment risk assessment; extended producer responsibility for expired/unused antibiotics
• National Action Plan for Antimicrobial Resistance is step in right direction. This would help in containing the rising anti-microbial resistance in India. As health is a state subject, all states must participate and contribute equally to ﬁght out the menace of microbial resistance
• Ensure a robust national action plan to tackle antibiotic resistance is in place and is being implemented well
• Improve surveillance of antibiotic-resistant infections
• Strengthen policies, programmes, and implementation of infection prevention and control measures
• Regulate and promote the appropriate use and disposal of quality medicines
• Make information available on the impact of antibiotic resistance