Antimicrobial resistance: clear and present danger


After years of doing little to tackle the silent but potentially deadly proliferation of antibiotic-resistant bacteria in India, all hell broke loose in 2008, when New Delhi was tacked onto the name of a one such bug.

The New Delhi Metallo-beta-lactamase-1 was an enzyme that rendered bacteria resistant to a broad spectrum of antibiotics. A strain of the NDM1 had crossed the shores and spread resistance in the U.K. as well.

Despite its outrage over being associated with a resistant bug the nation sat up to the danger of anti-microbial resistance within its boundaries, and is beginning to understand the disastrous societal consequences of rendering certain life-saving drugs impotent.
Prior to the detection of the NDM, isolated calls for regulating antibiotics use were being made by doctors in surgeries and those manning Intensive Care Units.

It was in 2011 that the Union government came up with a National Policy for Containment of Antimicrobial Resistance in India, seeking to reverse what seemed to be spiralling healthcare concern.

The policy makes no bones about recognising the real threat: “Antimicrobial resistance in pathogens causing important communicable diseases has become a matter of great public health concern globally including our country. Resistance has emerged even to newer, more potent antimicrobial agents like carbapenems.”

A March 2016 paper on ‘Antibiotic Resistance in India: Drivers and Opportunities for Action’ in PLOS Medicine makes a convincing case for action against resistance: “Antibiotic resistance is a global public health threat, but nowhere is it as stark as in India. The crude infectious disease mortality rate in India today is 416.75 per 100,000 persons… twice the rate in the U.S. (200) when antibiotics were introduced.”
Among the key factors responsible are the widespread use and availability of practically all the antimicrobials across the counter, increasing and wanton use of antibiotics in livestock production, inappropriate doses, and irrational use of antibiotics in hospitals.

Attempts have begun to regulate at least the human consumption of antibiotics: there are now guidelines for appropriate antibiotics usage which have revised Schedule H drugs to make over-the-counter availability of certain antibiotics nearly impossible.

Stringent enforcement of drugs control, making the dispensing of some antibiotics over the counter punishable, is the need of the hour.

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