Drug resistance crisis

India must end indiscriminate use of antibiotics

Since 2008, concerns have been growing globally about resistance against antibiotics in bacteria and other disease-causing pathogens — though remedial action has been slow to emerge. The fear is that the unchecked growth of microbial resistance may hasten the end of the antibiotics era without offering any effective substitute for these wonder drugs. Simply put, even trivial infections may turn deadly for want of curative treatment. A highly worrisome economic dimension has now been appended to this menace with a UK government-sponsored study concluding that incurable infections could sap $100 trillion from the world economy between now and 2050, apart from killing over 10 million people every year by then. The study has caused a stir among the governments of several European countries and elsewhere. However, poorer countries, although at greater risk, are slow to react.

India is already home to several drug-resistant bugs which are spreading fast and have been noticed even in the operation theatres and intensive care units (ICUs) of several well-regarded hospitals. The country, moreover, has the unenviable distinction of having the first-ever scientifically proven discovery of drug-tolerant bug named after its capital New Delhi — the organism in question being NDM-1 (New Delhi metallo-beta-lactamase-1). The chances of the spread of this and similar other bugs, too, are relatively higher in India as people are inclined to self-medicate with antibiotics for minor infections. The doctors, too, tend to prescribe these drugs even in cases where these are not indicated, unmindful of the fact that indiscriminate use is the single-most potent factor for soaring antibiotics resistance.

Since there is no single solution in sight to combat this menace, a multi-pronged strategy is urgently needed. Europe has made a beginning in this direction by increasing awareness of this issue among public and health care workers to ensure rational use of antibiotics. India, too, had formulated a policy to rein in antimicrobial resistance in 2011 when the enormity of the threat began to be appreciated. Instructions went out under this policy to stop over-the-counter sale of antibiotics and to bar doctors from suggesting more potent antibiotics than are indicated by the disease. But these orders have remained on paper for want of effective enforcement. The new report, which outlines a series of initiatives to limit the damage, can serve as a useful guide in amending the country’s anti-drug resistance campaign. Improvement in sanitation is the foremost among the recommended measures, which is highly relevant to developing countries like India where hygiene and cleanliness are at a discount. Although India’s Swachh Bharat campaign is aimed broadly at achieving this objective, it falls short when it comes to laying adequate emphasis on personal hygiene, like washing of hands before eating — critical to prevent the spread of infection. This simple practice can obviate the need for taking antibiotics in many cases. Besides, higher investments are needed in research and development to invent new antibiotics, vaccines and other drugs to serve as effective alternatives to antibiotics. Equally important is the need to create a surveillance network to monitor the use of antibiotics and the growth of resilience among microbes. The underlying objective of all anti-drug resistance moves has to be to restrict the use of antibiotics by curbing the tendency to consume them even when other choices are available.