WHAT IS AMR (ANTIMICROBIAL RESISTANCE)?

Microbes, such as bacteria, fungi, viruses and parasites, are minute organisms that the naked eyes cannot see. Some microbes, also known as pathogens, can cause infections in humans, animals and plants. Antimicrobial agents (antibiotics, antivirals, anti-fungal and anti-parasitic) are used to treat such infections. Antimicrobial agents act primarily by killing or inhibiting the growth of these disease-causing microbes inside our body.  

Antimicrobial resistance occurs when the pathogenic organisms modify their structure or genetic material slowly over a period such that antimicrobial agents are no longer able to kill or prevents their growth. This modification of bacteria results in infections that are hard to treat, often leading to death and severe disability in humans.

THE GLOBAL CHALLENGE OF ANTIBIOTIC RESISTANCE

Antibiotic resistance, i.e., resistance to bacteria-killing agents, is a major global health challenge. The World Health Organization has declared antibiotic resistance as one of the top 10 health threats humans face. Like other pathogens, antibiotic-resistant bacteria can spread from person to person or through animals, food, plants, water, soil, and the air. In developed countries such as the US and Europe, it claims about 50,000 lives every year. With the current rate of growing AMR cases, there are estimated approximately 10 million deaths every year due to AMR by 2050. 

For instance, E. coli and K. pneumoniae have developed a resistance rate of 8.4% to 92.9% and 4.1% to 79.4%, respectively, to ciprofloxacin, a common antibiotic for urinary tract infection. 

WHAT CAUSES ANTIBIOTIC RESISTANCE?

Some of the most important causes of the growing number of antibiotic resistances globally include 

• Lack of awareness and knowledge  
• Availability of antimicrobial agents without prescription 
• Overuse or misuse of antibiotics
• Lack of clean water, hygiene and sanitation
 
• Poor infection control in farms and healthcare facilities

WHY IS ANTIBIOTIC RESISTANCE A PROBLEM?

The impact of AMR, more specifically antibiotic resistance, on human health is immense. 

• The risk of mortality is very high when infected with antibiotic-resistant bacteria, as they are complicated to treat
• The cost of treatment increases exponentially with AMR pathogens, as they need newer and costlier antimicrobial agents to treat the infections along with admissions to intensive care units. Prolonged hospital stays also add to the overall cost. 
• Availability of new and last-resort antibiotics varies throughout the world. People in underdeveloped and least developed countries have limited access to these antibiotics. 
• The lack of new and innovative antimicrobial products further adds to AMR concern. According to 2019 WHO report, out of the total 50 antibiotics in the clinical development pipeline, only 32 antibiotics were effective against priority pathogens. Six of these agents fulfil at least one of the innovation criteria, and only two of these are active against the critical Multi-drug resistance Gram-negative bacteria.

ANTIBIOTIC RESISTANCE- INDIAN CONTEXT

India has a high burden of infectious diseases, with an infection-related crude mortality rate of around 417 per 1,00,000 persons. Mounting evidence suggests that AMR is a growing concern in our country due to overpopulation, poor hygiene and sanitation practice, and the irrational use of antimicrobial use. India, in 2010, was the leading consumer of antibiotics, with around 12.9x109 units being sold.

• There has been a rapid rise of methicillin-resistant Staphylococcus aureus (MRSA) bacteria in India, with an estimated increase from 29% in 2008 to 47% in 2014. 
• Another data suggests about 78% of the N. gonorrhoeae isolates resistant to ciprofloxacin in India. 
• Resistance to fluoroquinolones in Salmonella typhi has increased from 8% in 2008 to 28% in 2014.   
• Studies report Carbapenem resistance in about 31–51% of Klebsiella species while 42% of the Pseudomonas isolates to be resistant to imipenem.  
• Evidence suggests that about 70% of the Acinetobacter isolates are resistant to tigecycline, while imipenem-meropenem resistance was 57-80%. 

HOW TO STOP ANTIBIOTIC RESISTANCE?

It is high time that the world, through coordination, should curb antibiotic resistance. 

There is an urgent need to develop novel antibiotics to fight novel infections. However, if rampant and non-monitored use of antimicrobials continues, new antibiotics will soon reach a similar fate. Implementing the following actions in India can help curb the menace of antibiotic resistance effectively:

Awareness: Increased awareness among the public and health workers regarding the reasonable and rational use of antimicrobials is perhaps the best way to fight antibiotic resistance. People should refrain from self-medicating with antimicrobials, and it is equally important to complete the prescribed course of the antibiotics without fail.   

Surveillance system:  The Government should prepare a system that collects, analyzes, interprets, and shares the data on AMR. It will help track a record of the type of pathogens that are developing resistance to antimicrobial drugs.  

Research and Development: Improved research on AMR for the identification of various resistant pathogens should be encouraged. The leading pharmaceutical companies, alone or through a partnership with the government, should develop newer antibiotics for antibiotic-resistant bacteria treatment.

International Collaborations:  India already collaborates with various countries, such as Australia, Norway, Japan, Sweden, the United Kingdom, and the United States of America, on AMR. There is a need to implement measures for curbing AMR through collaborative efforts.

Disease Control Programs:  : There are certain diseases in India, such as malaria and tuberculosis, that are highly drug-resistant. Measures should be in place to prevent drug resistance to these diseases. The measures may include rapid diagnosis, accessibility to effective treatment, and reducing the spread of infections. 

REFERENCES

• World Health Organization. Antibiotic Resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=What%20is%20antimicrobial%20resistance%3F,spread%2C%20severe%20illness%20and%20death. Accessed on 18th February 2021.
• World Health Organization. Antimicrobial Resistance and Its Containment in India. Available at: https://www.who.int/docs/default-source/searo/india/antimicrobial-resistance/amr-containment.pdf?sfvrsn=2d7c49a2_2. Accessed on 18th February 2021.
• Talebi Bezmin Abadi, A., Rizvanov, A.A., Haertlé, T. et al. World Health Organization Report: Current Crisis of Antibiotic Resistance. BioNanoSci. 2019; 9:778–788.
• Aslam B, Wang W, Arshad MI, et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018; 11:1645-1658.
• https://apps.who.int/iris/bitstream/handle/10665/330420/9789240000193-eng.pdf 2019 ANTIBACTERIAL AGENTS IN CLINICAL DEVELOPMENT an analysis of the antibacterial clinical development pipeline

FAQs

1. How do antibiotics used in farm animals contribute to antibiotic resistance?

Antibiotics help in the management of infections in farm animals. However, antibiotics are used without regulation for preventing disease and improving yield in farm animals. The uncontrolled use of antibiotics in animals may result in the emergence of resistant pathogens. These pathogens may affect humans either through the food chain or by spreading directly.   

2. What role does the public play in preventing antibiotic resistance?

The public plays a vital role in preventing antibiotic resistance. Some of the common ways include:

• Avoiding antibiotics without a doctor's prescription. 
• Following all the instructions of your doctor while taking antibiotics. . 
• Not discontinue antibiotic therapy without consulting your doctor, even when your symptoms disappeared.   
• Not taking antibiotics that the doctor had prescribed to others.  
• Not referring to the previous prescription for taking antibiotics if you suffer from similar symptoms anytime in future. . 

3. Why is it essential for us to act against AMR?

Antibiotic resistance is continuously a growing threat to the global healthcare system. The difficulty in treating infections is emerging rapidly with life-threatening consequences on both adults and children. Further, there is a shortage of innovative antibiotics that are effective against drug-resistant pathogens. Thus, we must act against AMR.

4. What is super-infection?

Super-infection emerges when a person unnecessary takes antibiotics. Because of uncontrolled antibiotic usage, the normal flora of the body gets imbalanced. This results in the emergence of new infection due to the growth of opportunistic pathogens. The risk of super-infection is high with broad-spectrum antibiotics than with narrow-spectrum antibiotics.   

5. What is a broad-spectrum antimicrobial? How does it contribute to AMR?

Broad-spectrum antimicrobials are effective against a variety of pathogens. There is an increased risk of AMR if broad-spectrum antibiotics are used to treat a specific infection, usually treated with pathogen-specific antibiotics.