The Grave Threat from Antimicrobial Resistance

What’s in today’s article?

• Why in the News?
• Brief History of Antibiotics and Resistance
• Antimicrobial Resistance (AMR)
• Causes of AMR
• Prevention & Control
• What are the Most Common Resistant Pathogens in India?
• Major initiatives taken by India to combat AMR

Why in the News?

• Ahead of the September 26 UN General Assembly High-Level Meeting on antimicrobial resistance, the World Health Organization last week published its first-ever guidance on antibiotic pollution from manufacturing.

Brief History of Antibiotics and Resistance

• Penicillin, the first commercialized antibiotic, was discovered in 1928 by Alexander Fleming.
• Ever since, there has been discovery and acknowledgement of resistance alongside the discovery of new antibiotics.

Antimicrobial Resistance (AMR)

• Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitic – are medicines used to prevent and treat infections in humans, animals and plants.
• Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
• As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

Causes of AMR

• Selective Pressure:
  • In the presence of an antimicrobial, microbes are either killed or, if they carry resistance genes, survive.
  • These survivors will replicate, and their progeny will quickly become the dominant type throughout the microbial population.
• Mutation:
  • Most microbes reproduce by dividing every few hours, allowing them to evolve rapidly and adapt quickly to new environmental conditions.
  • During replication, mutations arise and some of these mutations may help an individual microbe survive exposure to an antimicrobial.
• Inappropriate Use:
  • Unnecessary and injudicious use of antibiotic fixed dose combinations could lead to emergence of bacterial strains resistant to multiple antibiotics.
• Hospital Use:
  • Critically ill patients are more susceptible to infections and, thus, often require the aid of antimicrobials.
  • However, extensive use of antimicrobials and close contact among sick patients creates a fertile environment for the spread of antimicrobial-resistant germs.
• Agricultural Use:
  • Scientists also believe that the practice of adding antibiotics to agricultural feed promotes drug resistance.

Prevention & Control

• Steps can be taken at individual as well as State level to reduce the impact and limit the spread of resistance:
• Individuals:
  • Only use antibiotics when prescribed by a certified health professional.
  • One should always follow the health worker’s advice while using antibiotics.
  • One can prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, and keeping vaccinations up to date.
• Policy Makers:
  • Ensure a robust national action plan to tackle antibiotic resistance.
  • 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.

What are the Most Common Resistant Pathogens in India?

• The three most common pathogens isolated in patient samples from tertiary care centres in the ICMR surveillance network are:
  • E. coli - can cause gut infections;
  • Klebsiella pneumoniae - can cause pneumonia and urinary tract infections; and
  • Acinetobacter baumannii- mainly associated with hospital acquired infections
  • Major initiatives taken by India to combat AMR
• National Action Plan on Antimicrobial Resistance (NAP-AMR):
  • Government of India launched National Action Plan in 2017, two years after the World Health Organisation (WHO) launched its Global Action Plan on AMR.
  • The Indian NAP focuses on six strategic priority areas:
    • Awareness and understanding through education, communication and training,
    • Strengthening knowledge and evidence through surveillance,
    • Infection prevention and control,
    • Optimised antimicrobial use in health, animals and food,
    • AMR-related research and innovation and
    • Strengthened leadership and commitment at international, national and sub-national levels.
    • National Centre for Disease Control (NCDC), New Delhi is the focal point for implementation and coordination of the NAP-AMR.
• Red Line Campaign:
  • Under the Red Line Campaign, the Government of India urges people not to use medicines marked with a red vertical line, without a doctor’s prescription.
  • To check the irrational use of antibiotics, the ‘red line’ will help the users to differentiate them from other drugs.

This campaign is aimed at discouraging unnecessary prescription and over-the-counter sale of antibiotics causing drug resistance for several critical diseases including TB, malaria, dengue, etc.

Q1. What is the difference between Antimicrobial & Antibiotics?

Antimicrobials refer to a group of agents that share the common aim of reducing the possibility of infection and sepsis. Antibiotics are often derived from moulds or are made synthetically and are absorbed into the body with the aim of killing bacteria (bactericidal) or preventing their multiplication (bacteriostatic).

Q2. Why Antibiotics are ineffective against viruses?

Antibiotics are ineffective against viruses because viruses have different structures and ways of surviving than bacteria.

Source: The grave threat from AMR