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. AMR occurs naturally over time, usually through genetic changes. Antimicrobial-resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air). They can spread from person to person or between people and animals, including from food of animal origin.
The main drivers of antimicrobial resistance include:
- -The misuse and overuse of antimicrobials,
- -Lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals,
- -Poor infection and disease prevention and control in healthcare facilities and farms,
- -Poor access to quality, affordable medicines, vaccines and diagnostics,
- -Lack of awareness and knowledge, and
- -Lack of enforcement of legislation.
Specifically with regards to India, inappropriate consumption of broad-spectrum (last resort) antibiotics is high because of changing prescription practice in the healthcare system due to the non-availability of a narrow spectrum of antibiotics. Also, there is prevalence of inappropriate antibiotic use among the general public like Self-medication to avoid the financial burden.
The large proportion of sewage is disposed of untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms.
- 1. Globally, countries committed to the framework set out in the Global Action Plan1 (GAP) 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of multi- sectoral national action plans.
- 2. Global Antimicrobial Resistance and Use Surveillance System (GLASS): launched in 2015 by WHO to continue filling knowledge gaps and to inform strategies at all levels. GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and the environment.
- 3. Global Antibiotic Research and Development Partnership (GARDP): A joint initiative of WHO and the Drugs for Neglected Diseases Initiative (DNDi), GARDP encourages research and development through public-private partnerships. By 2025, the partnership aims to develop and deliver five new treatments that target drug-resistant bacteria identified by WHO as posing the greatest threat.
- 4. World Antimicrobial Awareness Week (WAAW) global campaign aims to raise awareness of antimicrobial resistance worldwide. In 2022, WAAW concluded with the Muscat Ministerial Manifesto where three Global Targets were agreed upon:
- i) Reducing the total amount of antimicrobials used in agrifood systems by at least 30 per cent-50 per cent by 2030.
- ii) Preserving critically important antimicrobials for human medicine and ending the use of medically important antimicrobials for growth promotion in animals.
- iii) Ensuring that ‘Access’ group antibiotics (a category of antibiotics that are affordable, safe and have a low AMR risk) represent at least 60 percent of overall antibiotic consumption in humans by 2030.
- 1. To prevent the Over the counter sales of antibiotics, the central drug standard control organization(CDSO) prohibits medical stores from selling 24 key antibiotics without a doctor’s prescription.
- 2. India’s Red Line awareness campaign urges people not to use medicines marked with a red vertical line, including antibiotics, without a doctor’s prescription.
- 3. The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 has assigned coordinated tasks to multiple government agencies involving health, education, environment, and livestock to change prescription practices and consumer behaviour and to scale up infection control and antimicrobial surveillance.
- 4. FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.
Antibiotic resistance is emerging as the threat to successful treatment of infectious diseases, organ transplantation, cancer chemotherapy and major surgeries. The issue of AMR causes out of pocket expenditure on health care, especially on medicines. AMR is a silent and invisible pandemic that cannot be overshadowed by other competing public health priorities so should be made a priority. It is important to have political support and collaboration at the international, national and sub-national levels to tackle the challenge posed by AMR.