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Context
A recent NCDC study found that over 50% of patients in tertiary care hospitals received antibiotics for prophylaxis, not treatment. This raises concerns about antibiotic overuse and the rise of Antimicrobial Resistance (AMR) in India.
Source
The Hindu | Editorial dated 12- January 2024
NCDC Findings
The NCDC survey mentioned in the article found several worrying trends regarding antibiotic use in Indian hospitals:
- Over 55% of patients surveyed were prescribed antibiotics for prophylaxis (prevention) rather than to treat existing infections.
- Only 45% were prescribed antibiotics to actually treat infections.
- Of them, only 6% were prescribed the drugs after identifying the specific bacteria.
- Variations across hospitals: There were wide discrepancies in antibiotic prescribing practices between different hospitals, ranging from 37% to 100% of patients receiving antibiotics.
- Nearly 75% of the surveyed patients who had an E. coli or a Klebsiella infection in hospital were resistant to third or fourth generation antibiotics.
Antimicrobial Resistance (AMR)
Defined as the resistance of microorganisms to antimicrobial agents. The present serious concern about AMR is that multiple types of bacteria, particularly in the Indian context — E. coli, Klebsiella, Acinetobacter, Staphylococcus aureus, enterococcus — have even become resistant to some of the latest generation antibiotics.
Patients who get infections with these resistant strains of bacteria have a higher possibility of poorer health outcomes due to the resistance.
Factors behind rise of AMR
India faces a particularly high burden due to factors like:
- Inappropriate antibiotic use:
- Lack of proper diagnosis
- Over-the-counter availability,
- Prescription practices contribute to unnecessary antibiotic use.
- Inadequate laboratory facilities:
- Limited access to rapid diagnostic tests hinders accurate identification of bacterial infections, leading to broader-spectrum antibiotic use.
- Lack of information for clinicians about what would be an appropriate antibiotic even in bacterial infections, based on cultures.
- Lack of training and awareness:
- Doctors often lack proper training on antibiotic stewardship, while patients may have misconceptions about their effectiveness.
- Weak enforcement of regulations:
- Existing guidelines on antibiotic use are not effectively implemented.
- Both the NCDC and the Indian Council for Medical Research (ICMR) have guidelines for the use of antibiotics. There is no scarcity of guidelines, but implementation is a different story.
- In 2011, the first National Policy for Containment of Antimicrobial Resistance banned over the counter use of antibiotics (H1 rule), but this was not implemented.
- In 2013, inspired by the Chennai Declaration, a new H1 rule banning only second and third line antibiotics was brought out. Even this modified rule has not been implemented.
- Incentivisation of prescribing practices by the pharmaceutical industry
- Overcrowded hospitals leading to poor quality treatment and diagnosis
- Socioeconomic factors:
- Poverty, poor sanitation, and inadequate access to clean water also contribute to AMR.
- A course of antibiotics is cheaper than any blood culture and investigation
Consequences of AMR
- Increased risk of treatment failure and complications for patients.
- Eg. Cancer patients, who are the most immune-compromised patients are losing their lives because of AMR
- Increased healthcare costs due to longer hospital stays and need for more expensive drugs.
- Potential emergence of untreatable superbugs, posing a major public health threat.
Measures to address AMR
- Strengthen public health systems and public health delivery:
- Improve sanitation, hygiene practices, and access to clean water.
- Highest per capita in antibiotic usage is seen in countries with the highest privatised healthcare. This trend clearly indicates need in improving public health systems.
- Improve diagnostic facilities:
- Invest in rapid diagnostic tests.
- Establish a robust laboratory network:linking of labs to all levels of clinical setups and the fast transmission of infection related data between the lab and the clinician.
- Promote antibiotic stewardship:
- Train healthcare professionals on appropriate antibiotic use and implement guidelines for prescribing and dispensing.
- Work with all the stakeholders, including patients.
- Raise public awareness:
- Educate patients about the dangers of unnecessary antibiotic use and encourage responsible practices.
- Strengthen regulatory mechanisms:
- Implement stricter laws and ensure effective enforcement to control antibiotic availability and use.
- While health is State subject, to control AMR we need strong Centre-State coordination.
- One Health approach:
- Address AMR holistically across human, animal, and agricultural sectors
- The 2019 ban by the Indian government on the use of colistin as a growth promotional agent in poultry farming is a significant step in regulating antibiotic use.
Conclusion
The fight against AMR demands immediate and concerted action. By prioritizing public health, investing in diagnostics, promoting responsible use, and strengthening regulations, we can work towards curbing this growing threat and protecting the effectiveness of life-saving antibiotics for future generations. The time to act is now, and the stakes could not be higher.
RELATED TOPICS
The National Centre for Disease Control (NCDC)
- The National Centre for Disease Control (NCDC), formerly National Institute of Communicable Diseases (NICD), had its origin as the Central Malaria Bureau, established at Kasauli (Himachal Pradesh) in 1909.
- NICD was transformed into the National Centre for Disease Control (NCDC) with a larger mandate of controlling emerging and re-emerging diseases in 2009.
- It functions as the nodal agency in the country for disease surveillance facilitating prevention and control of communicable diseases.
- It is also a national level institute for training specialized manpower for public health, laboratory sciences and entomological services and is involved in various applied research activities.
- The Institute is under administrative control of the Director General of Health Services, Ministry of Health and Family Welfare.
- The Institute has its headquarters in Delhi.
The Chennai Declaration: A Roadmap for Combating Antibiotic Resistance in India
The Chennai Declaration is a landmark document outlining a plan to tackle the growing threat of Antimicrobial Resistance (AMR) in India. It emerged from the first-ever joint meeting of medical societies in India held in 2012, addressing antibiotic resistance as a serious public health concern.
Aim:
- To formulate and implement a national policy on rationalizing antibiotic usage in India.
- To encourage regional and local frameworks for combating AMR.
- To promote collaboration between medical societies, policymakers, and other stakeholders.
Key aspects:
- Emphasis on responsible antibiotic use. The declaration promotes practices like:
- Prescribing antibiotics only when necessary and based on appropriate diagnostic tests.
- Adhering to guidelines for antibiotic selection, dosage, and duration.
- Avoiding unnecessary prophylactic use.
- Strengthening laboratory facilities: The document highlights the need for:
- Rapid and accessible diagnostic tests to identify specific bacterial pathogens.
- Improving laboratory infrastructure and expertise.
- Raising awareness and education: The declaration emphasizes the importance of:
- Educating healthcare professionals on antibiotic stewardship principles.
- Engaging patients and communities in awareness campaigns about responsible antibiotic use.
- Enhancing surveillance and monitoring: The document calls for:
- Robust data collection and analysis of antibiotic use and resistance patterns.
- Effective surveillance systems to track emerging AMR threats.
- Multi-sectoral collaboration: The Chennai Declaration underscores the need for collaboration between:
- Human and animal healthcare sectors to control antibiotic use across domains.
- Government, academia, and pharmaceutical industry to develop research and policy initiatives
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6618210/
https://ncdc.mohfw.gov.in/index1.php?lang=1&level=1&sublinkid=145&lid=74
https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1738156
https://www.ncdc.gov.in/WriteReadData/l892s/File645.pdf
http://chennaideclaration.org/
To read more Antimicrobial Resistance | AMR
Practice Question
Critically analyze the findings of the NCDC survey on antibiotic use in Indian hospitals, highlighting its implications for Antimicrobial Resistance (AMR) in India. Suggest measures to promote rational antibiotics use. [250 words]