ANTIMICROBIAL RESISTANCE : Important Topics for UPSC Exams

• Antimicrobial resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective (WHO).
• This process has been accelerated due to high incidence of misuse of antibiotics.

Why is it of special concern to India?

• In India the infectious disease burden is among the highest in the world and inappropriate and irrational use of antimicrobial agents against these diseases, leads to increase in development of antimicrobial resistance. Burden of poor sanitation and malnutrition exacerbates these conditions. Ex: pneumonia accounts for almost 25% of all child deaths in india
• Health sector in India suffers from gross inadequacy of public finance which will result in the conditions favorable for development of drug resistance
• Various laboratories in India reveal an increasing trend of development of resistance to commonly used antimicrobials in pathogens like Salmonella, Shigella, Vibrio cholerae, Staphylococcus aureus, Neisseria gonorrhoeae, N. meningitidis, Klebsiella, Mycobacterium tuberculosis, HIV, plasmodium and others.

DECODED TERMS

• Carbapenems : Last mile of antibiotics that humans have currently access to, according to WHO.
• Superbugs : These are microbes that become resistant to the effects of antibiotics and hence are left unaffected by the influence of consumed antibiotics.
• NDM-1 (New Delhi Metallo-beta-lactamase-1) : is an enzyme that makes bacteria resistant to a wide range of powerful antibiotics, including the carbapenem class of antibiotics that are used to treat multidrug-resistant infections.

Causes of antimicrobial resistance(AMR)/How it spreads :

Image Source: WHO

1. Irrational administration of antibiotics to livestock which then gets passed off to humans through animal products such as meat.
2. Food crops grown in water and fertilizers containing animal feces and drug resistant bacteria when consumed leads to passage of resistant strains in humans.
3. Over the sale counter of drugs and improper consumption of antibiotics without prescription of medical practitioner.
4. Administration of broad spectrum antibiotics as an empirical therapy to the outpatients is another factor that leads to emergence of resistant strains.
   Unhygienic conditions near drug manufacturing centers and active pharmaceutical ingredients.

IMPACTS:

• In India, around 5% of GDP is spent on health out of which public health sector contributes to 0.9% and a major portion of the remaining is by the private health sector. Again around 80% share of private health sector contribution comes from out of pocket expenditure mostly for medicines.
• AMR can further increase out of the pocket expenditure and accelerate incidence of poverty.
• The patient remains sick for a longer period thus requiring prolonged treatment usually with expensive and at times toxic drugs which results in increased morbidity and mortality
• The burden on health system also increases
• Hospital acquired infection(NOSOCOMIAL INFECTIONS) in vulnerable patients with resistant strains is another major threat in the Indian context.
• This can undermine the thrust towards achieving SDG’s.

What can be done?

At individual level :

At Government level :

What has India done to tackle the problem of AMR :

• IIMAR (Indian Initiative for Management of Antibiotic Resistance) launched in March 2008, with WHO support, by a consortium of NGOs to promote prudent use of antimicrobials.
• INSAR (Indian Network for Surveillance of Antimicrobial Resistance) a network of 20 laboratories in the private as well as public sector across the country to generate quality data on AMR
• The government is urging hospitals to get accredited with the National Accreditation Board for Hospitals and Health Care Providers which will result in practices relating to judicious use of antibiotics.
• Amendments to drug and cosmetic rule to include no: of antibiotics in H1 schedule in pursuance of national policy for containment of AMR (Red line campaign)
• The National Health Policy 2017 highlights the problem of antimicrobial resistance and calls for a rapid standardization of guidelines regarding antibiotic use, limiting the use of antibiotics as over-the-counter medications, banning or restricting the use of antibiotics as growth promoters in animal livestock, and pharmacovigilance including prescription audits inclusive of antibiotic usage – in the hospital and community.
• Kerala is all set to become adopt a comprehensive policy to fight AMR. It has recently prepared a draft.
• In line with the WHO’s GLOBAL ACTION PLAN ON AMR, India has formulated NATIONAL ACTION PLAN ON ANTIMICROBIAL RESISTANCE with following components :

1. Improve awareness and understanding of AMR through effective communication, education and training.
2. Strengthen knowledge and evidence through surveillance
3. Reduce the incidence of infection through effective infection prevention and control
4. Optimize the use of antimicrobial agents in health, animals and food
5. Promote investments for AMR activities, research and innovations
6. Strengthen India’s leadership on AMR.

NOTE : The NAP-AMR outlines the priorities and interventions planned to be implemented over 2017 –2021 to tackle the public health challenge of AMR in India

Recent development:

Indian Researchers were able to combat antibiotic resistance in E. coli by blocking the enzyme that helped in production of hydrogen sulphide which protected the bacteria from antibiotics.

CHALLANGES :

• Strengthening of Surveillance Data
• Standard Operating Guidelines
• Improvement in antibiotic prescription practices
• Over the counter sale of antibiotics
• Poor sanitation, endemic infections, malnutrition
• Limited public awareness and government commitment
• Lack of coordination and fragmentation of effort
• Perverse incentives.

Way out lies in successfully overcoming the above mentioned challenges to tide over the impending harmful consequences. There should be more focus on research related to public health aspects of AMR at community and hospital level.

MCQ’S :

1. Which of the following statements related to Antimicrobial resistance is correct?

1. Using antibiotics−in people or in animals−can create drug resistance.
2. Drug resistant bacteria can survive and multiply in animal’s guts when they get antibiotics.
3. Unhygienic conditions aid antimicrobial resistance.

Which of the above statements are correct

a and b
b and c
a and c
All of the above

Correct Answer : D (All of the above)

2. Which of the following correctly describes the term “SuperBug”.

1. These are Microbes which have developed resistance to antibiotics.
2. These are insects which have undergone genetic mutations.
3. These are critical errors in software programs.
4. None of the above

Correct Answer : A

3. Schedule-H in the drug pricing control order is relevant for which of the following statements

A. Drugs mentioned in the schedule are priced as decided by the government.

B. Drugs under this scheduled need government approval for sale over the counter.

C. Drugs mentioned in the schedule can only be sold on prescription of registered medical practitioner.

D. This schedule is also associated with RED LINE campaign

Which of the above statements are correct?

1. a,d
2. a,b,c
3. c,d
4. b,c,d

Correct Answer : C (C &D)

MAINS Questions :

1. What do you understand by Anti microbial resistance? Should India worry about AMR? (10)
2. Antimicrobial resistance is threatening the already strained healthcare scenario. In light of the above statement enumerate government initiatives and possible solutions in this regard. (15)
3. How does National Action Plan on AMR seeks to address the challenges associated with AMR in Indian context? (15)

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