Tue, Mar 27, 2018 - Page 9 News List

India’s war on microbial resistance

India has begun to address the impending health crisis that could result as indiscriminate use of antibiotics leads to resistance in bacteria, but developed countries must follow

By Abdul Ghafur

Illustration: Yusha

Last year, a 30-year-old teacher suffering from a severe bloodstream infection arrived in my emergency room for treatment. The woman had been in and out of local clinics with a stubborn chest infection and fever, and by the time I examined her, she was receiving chemotherapy for blood cancer.

Instinctively, I treated her infection with an antibiotic from a group of drugs known as “carbapenems,” strong medicines commonly prescribed to people who are hospitalized, but after further tests, I discovered that she was carrying a strain of bacteria that is resistant to most antibiotics in our therapeutic arsenal. There was no option but to treat her with drugs that I knew would be largely ineffective; she was lucky to recover.

UNRESPONSIVE

Sadly, many patients are not so fortunate. Around the world, people are being admitted to hospitals with infections that do not respond to antibiotics, and relatively benign germs — like Klebsiella and Escherichia coli — have become potent killers, shrugging off medicines that in the past easily contained them.

Antibiotics are different from almost every other class of drug in one important and dangerous respect: The more they are used, the less effective they become. When microbes are repeatedly exposed to antibiotics, the bacteria eventually win.

Each year, an estimated 750,000 people die from antimicrobial-resistant (AMR) infections, and the death toll will climb unless the global health community acts decisively.

‘SUPERBUGS’

In the absence of detailed and reliable reporting from all countries, the British government commissioned a series of reports on AMR, estimating that by 2050, as many as 10 million people could die annually from AMR complications. Moreover, the economic impact of “superbug” outbreaks could top US$100 trillion; low-income countries would suffer disproportionately.

Uneven and unregulated antibiotic usage is one of the most important reasons behind the AMR crisis. In developed countries, doctors prescribe antibiotics for even the most basic maladies, like the common cold. Stronger regulations of antibiotics prescriptions in these countries, like those implemented in Finland several decades ago, could help to mitigate resistance.

Yet such rules alone will not be enough, because in much of the developing world, antibiotics can be obtained without a prescription. Inequalities in access to medicine, excessive use and poor sanitation services complicate the problem further. And when farmers use antibiotics to speed the growth of chickens and other livestock, drug-resistant germs find new ways to enter the environment.

GUIDANCE

In an effort to address these challenges, the WHO last year classified antibiotics into three groups and issued guidance for how each class of drugs should be used to treat 21 of the most common infections.

For example, the first of these groups consists of medicines that should always be available to patients, preferably by prescription. Amoxicillin, the preferred medicine for respiratory-tract infections in children, is in this group. The second tier includes carbapenems, which, as my patient last year discovered, are increasingly ineffective. And the third group, including colistin and other “last resort” antibiotics, are drugs that must be used sparingly and only for medical emergencies.

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