[Editorial] The growing scourge of anti-microbial resistance needs urgent attention
- Ever since the pandemic struck, concerns have been raised about the improper use of antimicrobials amongst Covid-19 patients.
- The GRAM report, released last month, reinforces the urgent requirement to scale-up efforts to combat antimicrobial resistance, highlighting essential actions that policymakers must implement to avert further substantial deaths and protect health systems.
What the editorial is about?
The reason why addressing antimicrobial resistance (AMR) requires a multipronged and multisectoral approach.
Concerns associated with antimicrobial resistance (AMR)
- The “Global burden of bacterial antimicrobial resistance in 204 countries and territories in 2019 (GRAM)” report, released last month, 4.95 million people died from drug-resistant bacterial infections in 2019, with 3,89,000 deaths in South Asia alone.
- AMR directly caused at least 1.27 million of those deaths.
- Lower respiratory infections accounted for more than 1.5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome.
- Amongst pathogens, E Coli was responsible for the most deaths in 2019, followed by K pneumoniae, S aureus, A baumannii, S pneumoniae, and M tuberculosis.
Concerns for India
- Unnecessary prescription of antimicrobials will lead to a further increase in the already high levels of drug resistance in most parts of the world.
- In the past few years, alarmingly high resistance rates in pathogens of public health importance have been reported from Indian hospitals.
- Unfortunately, the resistance rates reported by the hospitals and laboratories do not automatically translate to disease burden unless each resistant isolate is correlated with the clinical outcomes in the patients from whom they were isolated.
- This has to do with inadequate hospital information systems in most public sector funded healthcare facilities in India and many low-middle income countries.
- As per the yearly trends reported by the Indian Council of Medical Research since 2015, India reports a high level of resistance in all these pathogens, especially E Coli and K pneumonia.
- Only a fraction of the Indian data, available through the WHO-GLASS portal, has been included in the GRAM report.
- India has been reporting high levels of resistance to fluoroquinolones, cephalosporins and carbapenems across the Gram-negative pathogens that cause almost 70 per cent of infections in communities and hospitals.
- Therefore, the Indian data on the AMR burden may not look very different from the estimates published in the report.
- Now that we know that AMR’s burden surpasses that of TB and HIV, a sense of urgency in containing such resistance is called for.
- With no new drugs in the pipeline for drug-resistant infections, time is running out for patients.
- Addressing AMR requires a multipronged and multisectoral approach.
Use existing antimicrobials judiciously
- The urgency to develop new drugs should not discourage us from instituting measures to use the existing antimicrobials judiciously.
Infection control, quality diagnostics and educating people
- Improved infection control in communities and hospitals, availability and utilisation of quality diagnostics and laboratories and educating people about antimicrobials have proved effective in reducing antimicrobial pressure — a precursor to resistance.
A comprehensive plan and suitable funding
- All this requires a comprehensive plan, driven by a designated coordinating agency backed with suitable funding.
The National Action Plan for AMR
- The National Action Plan for AMR, approved in 2017, completes its official duration this year. The progress under the plan has been far from satisfactory.
- There is enough evidence that interventions like infection control, improved diagnosis and antimicrobial stewardship are effective in the containment of AMR.
- The GRAM report has underlined that postponing action could prove costly.