There is an unmet need to fight against antibiotic resistance. World Health Organization is playing its role in reducing the phenomenon by creating awareness and developing various strategies. However, the onus is also on the respective countries for developing the policies and execute them as strictly as possible. 

NEED FOR GLOBAL CAMPAIGN TO PREVENT ANTIBIOTIC RESISTANCE

The antibiotic pipeline is drying very fast, and only a few antibiotics are on the list of new drug development. Thus, it is essential to safeguard the efficacy of last-resort antibiotics against hard-to-treat infections. There must be a global campaign to curb the menace of antibiotic resistance. It not only includes robust strategies but a set of guidelines for effectively executing them.

World Health Organization is the pioneer in promoting various campaigns throughout the world for reducing the use of antibiotics. The strategies include creating awareness about antibiotic resistance in public and healthcare professionals. Further, the organization has also developed a list containing Critically Important Antimicrobials. It helps in prioritizing the infection treatment and reducing antibiotic resistance. 

Studies indicate that the campaigns to manage antibiotic use helps in reducing the overall antibiotic resistance. Campaigns done between 1997 to 2007 in Europe reduces the mean level of antibiotic use by 6.5 to 28.3%. The global plans formulated by World Health Organization include Global Action Plan on AMR, WHO global strategy for containment of Antimicrobial Resistance, World Antimicrobial Awareness Week (WAAW), The Global Antimicrobial Resistance and Use Surveillance System (GLASS), Global Research and Development priority setting for AMR, and Global Antibiotic Research and Development Partnership (GARDP).

In a survey conducted on behalf of the World Health Organization, 78% of the awareness campaigns in various countries used the message “Misuse/overuse of antibiotics causes resistance", while 72% of the campaign used the message, "If we misuse antibiotics, we will lose them/they will become ineffective”. The other messages used during the campaigns include “antibiotics do not work against cold/flu”, "Handwashing can reduce the spread of infection” and “Judicious use of antibiotics is important". The most common method for spreading awareness among the public was distributing the communication material (77% online and 87% offline). The other awareness interventions include training for prescribers, public activities, and press conferences. 

COMMITMENT FROM HEALTHCARE PROFESSIONALS

Healthcare professionals play an essential role in preventing antibiotic resistance. Hospitals must take proper care to reduce the spread of infection. There is a significant risk of nosocomial infection in a similar healthcare facility and in a different healthcare facility when the patient is transferred. The infections, sometimes, maybe severe, resulting in sepsis and death. Spreading is related to an increased risk of antibiotic resistance. Several studies conclude that pathogen survives for a significant period in the hospital environment. Some of the common pathogens responsible for nosocomial infections are E. coli, Pseudomonas aeruginosa, Candida, Acinetobacter, and Clostridium difficile. 

World Health Organization has recommended five action plans, for healthcare professionals, including nurses, physicians, dentists, and pharmacists, for preventing antibiotic resistance. These are:

• If the patient needs antibiotics, advise the tests to determine the best antibiotic to cure the infection.
• Prescribe antibiotics only when there is a need.
• Prescribe the right antibiotics with the right dose and dosing schedule for the correct duration.
• Follow the measures to prevent nosocomial infection, such as proper hygiene and frequently disinfecting the instruments.
• Prepare a vaccination chart for your patients and monitor it regularly.

IMPLEMENTING NON-ANTIBIOTIC TREATMENT FOR INFECTIONS

The healthcare personnel should implement the non-antibiotic treatment for infection as far as possible. There is a custom to prescribe or self-medicating the antibiotics in the mildest of infection. However, various treatment options may help in managing infections and reducing antibiotic resistance problems. Apart from probiotics, vaccines, and phytomedicines, research-based pharmaceutical companies develop treatment options to contain the infection. Following are some of the possibilities for non-antibiotic treatment for infection:

Anti-virulent strategies: Anti-virulent strategies make the work of the immune system easier in combating bacterial infection. These strategies prevent the virulent factors released by the bacteria from damaging the tissues. The examples of drugs under these strategies are raxibacumab and bezlotoxumab. 

Vaccine: Vaccines of various infections are available, and many more are in the pipeline. Vaccines under development include a vaccine for Clostridium difficile, S. aureus, P. aeruginosa, and Acinetobacter species. 

Phytomedicine: Various ayurvedic and herbal drugs are also effective against bacterial infections. These are methylglyoxal (Manuka honey), Allicin (garlic), and quercetin, and kaempferol (red pepper).

Probiotics: Various probiotics help in balancing the gut microflora by preventing the growth of harmful pathogens. Such probiotics include Saccharomyces boulardii and Bacillus clausii. 

CURRENT EFFORTS TO PREVENT ANTIBIOTIC RESISTANCE: GLOBAL CONTEXT

Several countries are making efforts in the fight against the continuously growing problem of antibiotic resistance. For example, various departments of Canada are working cooperatively against antibiotic resistance. The Public Health Agency of Canada works on regulating laboratory analysis and reducing the disease outbreak, while Health Canada is responsible for approving the antimicrobials in Canada. Canadian Institutes of Health Research assists in the development of new antibiotics. 

The United States of America observes Antibiotic Awareness week every year. The event will be started between November 18-24 in 2021. During the awareness week, the information regarding the threat of antibiotic resistance and various prevention measures is disseminated.

United Kingdom had set up a 5-year AMR plan to reduce the emergence of antimicrobial resistance. It emphasizes the reduced need for antibiotics, optimizing antibiotics use, and pharma research and development to discover new antibiotics. 

CURRENT EFFORTS TO PREVENT ANTIBIOTIC RESISTANCE: INDIAN CONTEXT

In April 2017, the Union Ministry of Health and Family Welfare of India released India's National Action Plan (NAP) for AMR. Following are some of the objections of this plan:

• Increasing awareness about AMR.
• Improving surveillance and enhancing knowledge and evidence.
• Preventing occurrence and spread of infection.
• Optimizing the use of antibiotics.
• Promoting research and development in the pharmaceutical industry.
• Promoting collaboration at all levels

REFERENCES

• World Health Organization. Antimicrobial resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=Held%20annually%20since%202015%2C%20WAAW,spread%20of%20drug%2Dresistant%20infections. Accessed on: 22nd February 2021.
• WHO Collaborating Centre on Patient Safety. Evaluation of antibiotic awareness campaigns. Available at: https://www.who.int/selection_medicines/committees/expert/21/applications/s6_antibiotic_awareness_campaigns.pdf?ua=1. Accessed on: 22nd February 2021.
• La Fauci V, Costa GB, Genovese C, Palamara MAR, Alessi V, Squeri R. Drug-resistant bacteria on hands of healthcare workers and in the patient area: an environmental survey in Southern Italy's hospital. Rev Esp Quimioter. 2019;32(4):303-310.
• European Antibiotic Awareness Day. European Antibiotic Awareness Day. Available at: https://antibiotic.ecdc.europa.eu/en/aboutpartners/campaigns-around-world. Accessed on: 22nd February 2021.
• Ruiz J, Castro I, Calabuig E, Salavert M. Non-antibiotic treatment for infectious diseases. Rev Esp Quimioter. 2017 Sep;30 Suppl 1:66-71. PMID: 28882020.
• Ranjalkar J, Chandy SJ. India's National Action Plan for antimicrobial resistance - An overview of the context, status, and way ahead. J Family Med Prim Care. 2019;8(6):1828-1834. doi:10.4103/jfmpc.jfmpc_275_19

FAQs

1. What steps should India take to control antibiotic resistance?

There are various ways through which India would be able to reduce antibiotic resistance. There should be improved vaccine coverage and proper sanitation, and hygienic measures. People should get clean drinking water, and Forming a regulatory board with a set of laws can prevent improper use of antibiotics.

2. How should a doctor treat antibiotic-resistant bacteria?

If the doctor determines that you suffer from a pathogen that is resistant to commonly used antibiotics, the doctor may opt for other antibiotics. However, the doctor should not follow a hit-and-trial method for selecting antibiotics against a particular organism.

3. What are the various methods through which bacteria become drug-resistant?

There are several methods through which bacteria become resistant to a particular drug. These are mutation, gene transfer, selective pressure, agricultural use of antibiotics, and inappropriate use.

4. What is Global Antimicrobial Resistance Surveillance System (GLASS)?

It is a data collection system developed by the World Health Organization. The system collects and analyses the data at a global level that helps the individual countries act as antibiotic resistance.

5. What is the Global Antibiotic Research and Development Partnership (GARDP)?

It is a joint initiative taken by the World Health Organization under the aegis of public-private partnerships. Through GARDP, the association is planning to deliver at least four new treatment options for infection management. It works either by improving the current antibiotics or through developing new antibiotics.