Antimicrobial resistance: A silent pandemic

Antimicrobials are medicines that kill/slow the growth of bacteria, virus, fungus that cause diseases. Antibiotics are the most prescribed antimicrobial.

Antimicrobial resistance (AMR) occurs when some of the bacteria, virus, or fungus that cause infections resist the effects of the medicines that are used to treat them, leading to treatment failure.

The microorganisms that develop resistance to antimicrobials; bacteria – to antibiotics, viruses – to antiviral medicines, fungi – to antifungal medicines.

AMR is a much broader term and includes all microorganisms that develop resistance to antimicrobial medicines.

How does it happen:

Many of us at some point in time, knowingly or unknowingly have taken antibiotics without a doctor's prescription. The excessive use/misuse of antibiotics has resulted in AMR to become a critical global health issue. If antibiotics are taken when they are not needed, bacteria can adapt and become resistant, resulting in infections difficult to treat. There is a need to address AMR, unless we enter a post-antibiotic era, when even minor infections that could be treated with antibiotics become deadly, resulting in prolonged illness, higher risk of spreading diseases to others.

Antimicrobials are recommended only for treatment of bacterial infections, most viral illnesses like common cold or flu are self-limited.

Beyond human health, antimicrobials are also used in agriculture, livestock and aquaculture, contributing to their widespread presence in the environment.

Combating AMR

The first step is prevention. Last September, the United Nations General Assembly achieved a milestone. A political declaration of high-level meeting on AMR, an urgent public health threat, was adopted by 193 countries. To address this, 'silent pandemic', an emphasis was given, prevention first, will work for all, especially for the low and middle income countries. The declaration emphasised on generating awareness among the communities and health providers about the dangers of the misuse of antibiotics and the importance of preventing infections.

Access to good quality clean and safe drinking water and it be ensured even for animals. Ensuring good quality antimicrobials and vaccines in supply chain for humans and animals; reducing antimicrobial use in agriculture; minimum use in livestock and aquaculture; avoiding unnecessary use of antibiotics, adherence to established guidelines for use and treatment and to ensure that antibiotics don't go into the environment.

One world one health: According to One Health High Level Expert Panel (OHHLEP), it is an integrated unifying approach that aims to sustainably balance and optimise health of the people, animals and ecosystems. The health of humans, domestic and wild animals, plants and ecosystems are closely linked and interdependent.

The Indian scenario

In 2021, 4.7 million deaths were linked to antibiotic resistance and 1.15 million deaths were directly caused by it. Around three lakh deaths in India were attributed to, and over one million deaths associated with bacterial AMR or antibiotic resistance in 2019. It is estimated that AMR will kill 39 million people between 2025 and 2050.

In October 2024, FSSAI notified food safety and standards, prohibiting antibiotics at any stage of production of milk, milk products, meat and meat products, poultry and eggs, aquaculture and its products. Specifically, three classes of antibiotics - glucopeptides, nitrofurans and nitroimidazoles and five antibiotics - carbadox, chloramphenicol, colistin, streptomycin and sulphamethoxazole have been prohibited in food animal production. It is an important development as only colistin (used in poultry) was prohibited in 2019 by the Ministry of Health and Family Welfare.

In addition to such bans, India should phase out antibiotics used as growth promoters, used in animal rearing. One such prominent case is that of poultry chicken feed. We need to develop ways to know how much antibiotics are used in food-animal sectors, to plan measures of intervention and to avoid mass use of antibiotics to control diseases.

Local initiatives

In 2018, Kerala launched Antimicrobial Resistance Strategic Action Plan on AMR, under the aegis of Antibiotic Literate Kerala Campaign. The important initiatives taken; Establishing Smart Hospital, Operation Antimicrobial Resistance Intervention for Total Health-eliminating Over the Counter antibiotic sales without prescription, awareness committees in all districts, removal and safe disposal of unused expired drugs-to avoid risk of recycling etcetera. The state has made the campaign people-centric and is gaining positive results.

The way forward

The Global High-level Ministerial Conference on AMR is a step in the right direction. Held at Jeddah last November, it has drawn a comprehensive framework for global actions to combat AMR. It aims at one health approach, an integrated unified approach to sustainably balance and optimise health of people, animals and ecosystems.

We need to have a national AMR coordinating mechanism to implement and monitor the national action plans and promote global data sharing. The member countries, through this declaration, have committed to strive to meaningfully reduce the quantity of antimicrobials used globally in the agri-food system from the current level by 2030.

On the government level - initiatives like promoting public education on the dangers of self-medication and the importance of responsible antimicrobial use are vital in curbing this concerning trend and preserving the effectiveness of antibiotics in future generations.

The government needs to emphasize the public, private health facilities for humans and animals – domestic/wild and aquaculture to prescribe antibiotics only where they are required. In addition to such initiatives, India needs to prioritize a new AMR national action plan.

On the individual and community-level, we must ensure that the animal-farm waste as manure in agriculture fields is used only after treating it to make it AMR-free, to avoid spread of resistance.

Focus should be on the interconnectedness of human, animal and environmental health, and the holistic 'one health' approach to address this complex issue of AMR. By embracing community empowerment and responsible use, we need to collectively work towards a healthier future where antimicrobials remain effective, ensuring a safer world for generations to come.