D.Bankim
The convergence of factors such as poor public health infrastructure, rising incomes, a high burden of disease and unregulated sales of antibiotics has created ideal conditions for a rapid rise in resistant infections in India.
A person cannot become resistant to antibiotics. Resistance is a property of the microbe, not a person or other organism infected by a microbe. Antimicrobial resistance occurs naturally over time. Again random, irrational use of antimicrobial has led to antimicrobial resistance becoming increasingly more prevalent.
Antibiotics are a core tool of modern medicine since the discovery of Penicillin in 1928, at St. Mary’s Hospital, London, Alexander Fleming. Despite their essential value in modern medicine, antibiotics are also the only class of drugs that lose their efficacy with large-scale use as bacteria develop antibiotic resistance. Infections such as those occurring after transplantation and surgical procedures, caused by these highly antibiotic-resistant pathogens, are threatening all progress in medicine. Ironically antibiotics are increasingly being rendered ineffective by the ability of bacteria to develop resistance. Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR). A very known example is antibiotic resistance in Mycobacterium tuberculosis has led to the emergence of multi-drug resistant tuberculosis and extensively drug-resistant (XDR) strains causing tuberculosis (XDR-TB). We cannot treat diseases like gonorrhoea because the bacteria has acquired resistance to all antibiotics.
Drug-resistant infections are already estimated to kill at least 7 lakhs people a year, and could kill 10 million people a year by 2050 if left resistant to multiple antimicrobials (MDR). Persistent misuse and overuse of antibiotics in humans, animals and plants have encouraged the pace at which resistance develops to accelerate. Environmental pollution by means of pharmaceutical waste, waste from livestock, and hospitals is another dimension contributing to the crisis of antibiotic resistance. We now urgently need to reverse it.
Antimicrobial resistance is mainly caused by the overuse of antimicrobials. Some new study suggests that toxic industrial contaminants, especially heavy metals like cadmium and lead, can also contribute to the spread of antibiotic resistance.
All classes of microbes can evolve resistance. Fungi evolve antifungal resistance. Viruses evolve antiviral resistance. Protozoa evolve antiprotozoal resistance and bacteria evolve antibiotic resistance. Those bacteria that are considered extensively drug resistant (XDR) or totally drug-resistant (TDR) are sometimes called “superbugs”. Extended use of antimicrobials appears to encourage selection for mutations which can render antimicrobials ineffective. Resistance in bacteria can arise naturally by genetic mutation, or by one species acquiring resistance from another.
Rising drug resistance is caused mainly by use of antimicrobials in humans and other animals. Drug resistance is caused again by the spread of resistant strains between the two. Growing resistance has also been linked to releasing inadequately treated effluents from different industry, especially in third world countries like ours, due to lack of strict regulations – strong diagnostic and surveillance system and mainly due to the super-profit mentality of the industrialists . Resistance is therefore a complex problem that also affects food and the environment, and it transcends borders. There are no regulations governing the discharge of antimicrobial waste into the environment. Environmental antibiotic pollution encourages the transfer of resistance genes to human commensal and pathogenic bacteria.
Antimicrobial resistance is increasing globally due to increased prescription and dispensing of antibiotic drugs in developing countries. Taking of medicines on one’s own initiative or on another person’s suggestion, who is not a certified medical professional is known as Self Medication and it has been identified as one of the primary reasons for the evolution of antimicrobial resistance. Many people have a limited amount of money to see a doctor, or in many developing countries a poorly developed economy and lack of doctors are the cause of self-medication. Another major concern is the large-scale use of antibiotics in food-producing animals which is barely mentioned. Role of industry in promoting excessive use of antibiotics is undoubtedly increassing the problem by leaps and bound.
In 2010, India was the world’s largest consumer of antibiotics for human health at 12.9 x 10 9 units (10.7 units per person). The next largest consumers were China at 10.0 x10 9 units (7.5 units per person) and the US at 6.8 x10 9 units (22.0 units per person) . Seventy-six percent of the overall increase in global antibiotic consumption between 2000 and 2010 was attributable to BRICS countries, i.e., Brazil, Russia, India, China, and South Africa. In BRICS countries, 23% of the increase in the retail antibiotic sales volume was attributable to India, and up to 57% of the increase in the hospital sector was attributable to China. A total of 16,290 million doses of antibiotics were sold in India in 2020, which is slightly less than the amount in 2018 and 2019. COVID-19 likely contributed to about 216 million excess doses of total antibiotics and 38.0 million excess doses of azithromycin between June and September 2020 (i.e., after the lockdown and until the epidemic peak).
Unethical commercial practices to promote the sale of antibiotics in large quantities by the drug multinationals and empirical but incorrect use of antibiotics ( antibiotics continue to be prescribed or sold for diarrheal diseases and upper respiratory infections for which they have limited value ), simultaneous use of more than a single antibiotic when actually not necessary, not de-escalating when possible, inefficiency in the review of the response to antibiotics by the treating doctors escalating the alarming situation day by day. Doctors routinely receive compensation from pharmaceutical companies and pharmacists in exchange for antibiotic prescriptions .
There are concerns that the widespread and often inappropriate use of antibiotics has been aggravated by the COVID-19 pandemic,About 75% of healthcare in India is private, and this unregulated and fragmented private sector accounts for 90% of antibiotic consumption, raising major concerns about the potential effects of COVID-19 on prescribing and dispensing practices.
Courtsey:
Anup Sengupta, M.Pharm.
Feel free to contact at:
Email ID: dbankim1@gmail.com
