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India Confronts Antimicrobial Resistance Crisis

This report delves into the AMR issue in India, exploring its causes, impacts, and the measures being taken to combat it, with a focus on both national and international efforts.

• By PharmaNews Live Desk
• New Delhi
• May 27, 2024

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A recent study published in The Lancet reveals the alarming global mortality rate linked to antimicrobial-resistant (AMR) bacteria, which is responsible for nearly five million deaths annually.

This issue is particularly severe in India, where over a million deaths in 2019 were associated with AMR. This report delves into the AMR issue in India, exploring its causes, impacts, and the measures being taken to combat it, with a focus on both national and international efforts. 

The Scope of the AMR Crisis: Indian and Global Challenge

Global Impact of AMR Antimicrobial resistance has emerged as a significant threat to global health, causing nearly five million deaths annually. According to The Lancet, these deaths are part of the estimated 7.7 million deaths due to bacterial infections, now the second largest cause of mortality worldwide. 

The rising death toll underscores the urgent need for a comprehensive global strategy to combat AMR, including both preventative and therapeutic measures. 

India reported approximately 1,043,500 deaths in 2019 linked to AMR, highlighting a severe public health emergency. India’s high rates of AMR are not only a local concern but also a significant contributor to the global burden. 

The country's diverse healthcare challenges and widespread misuse of antibiotics exacerbate the problem, making it imperative for India to adopt and enforce stringent measures to combat AMR. 

Understanding Antimicrobial Resistance 

What is AMR? Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve to withstand the effects of antimicrobial medicines, including antibiotics, antivirals, antifungals, and antiparasitics. 

This adaptation renders standard treatments ineffective, leading to persistent infections and increased risk of disease spread, severe illness, disability, and death. 

As Professor Ramanan Laxminarayan of Princeton University explains, AMR results from the failure of antibiotics due to bacterial evolution driven by the widespread and often inappropriate use of these drugs. 

Causes of AMR 

The primary drivers of AMR are the misuse and overuse of antimicrobials in humans, animals, and agriculture. This misuse accelerates the development of drug-resistant pathogens, putting the achievements of modern medicine at risk. 

The World Health Organization (WHO) identifies additional factors such as inadequate laboratory testing, poor surveillance, and limited access to effective antibiotics, particularly in low- and middle-income countries (LMICs). 

In India, over-the-counter sales of antibiotics without prescriptions contribute significantly to this issue, highlighting the need for stricter regulation and public education. 

The AWaRe Classification System 

In 2017, WHO introduced the AWaRe classification system for antimicrobial drugs, categorizing them into three groups: -

• Access: Drugs that are less likely to contribute to resistance and should be widely accessible.

• Watch: Drugs that should be used sparingly due to their higher likelihood of contributing to resistance.

• Reserve: Last-resort drugs for severe, multi-drug-resistant infections. This system aims to guide the appropriate use of antibiotics and curb the development of resistance by prioritizing the use of less resistance-prone drugs. 

Recent Policy Developments in India 

In response to the growing AMR threat, the Director-General of Health Services (DGHS) in India has urged pharmacists to adhere strictly to regulations that restrict the over-the-counter sale of antibiotics. This move aims to curb the rampant misuse of antibiotics, a significant factor in the rise of AMR. 

The enforcement of Schedules H and H1 of the Drugs and Cosmetics Rules, 1945, which mandates that antibiotics be sold only on prescription, is a critical step in this direction. 

India’s Efforts Towards Curbing AMR 

• National Action Plan (NAP) for AMR: India's National Action Plan (NAP) for AMR, launched in 2017, aims to increase awareness, strengthen surveillance, promote research, and improve infection prevention and control. The plan represents a comprehensive strategy to tackle AMR on multiple fronts. Key objectives include improving antibiotic stewardship, enhancing regulatory frameworks, and fostering collaboration across sectors. 

• Delhi Declaration on AMR: The Delhi Declaration on AMR is an inter-ministerial agreement aimed at addressing AMR through coordinated efforts involving research institutes, civil society, and industry. The declaration emphasizes public-private partnerships and a mission-mode approach to combating AMR. It calls for a multi-sectoral response, integrating human, animal, and environmental health under the One Health framework. 

• Antibiotic Stewardship Program (AMSP): The Indian Council of Medical Research (ICMR) has initiated the AMSP to control the misuse and overuse of antibiotics in hospital settings. This program is critical in reducing the development of resistance in healthcare facilities. The AMSP focuses on optimizing antibiotic use, educating healthcare providers, and implementing evidence-based guidelines to ensure the rational use of antibiotics. 

• Regulatory Measures: The Drug Controller General of India (DCGI) has banned inappropriate fixed-dose combinations (FDCs) and the use of Colistin as a growth promoter in animal feed. These regulatory measures are essential steps in curbing the misuse of antibiotics. By restricting the availability of high-risk antibiotics and promoting their judicious use, India aims to slow the spread of resistance. 

• One Health Approach: India is adopting the One Health approach, promoting interdisciplinary collaboration at the human-animal-environment interface. This strategy focuses on zoonotic diseases, food safety, and antibiotic resistance, emphasizing the interconnectedness of health issues across sectors. The One Health approach seeks to address AMR holistically, considering the complex interactions between humans, animals, and the environment.  

Conclusion

The AMR crisis in India is a multifaceted public health challenge requiring urgent and coordinated action. With over a million deaths attributed to AMR annually, the country must strengthen its regulatory frameworks, enhance surveillance, and promote responsible antibiotic use. 

Collaborative efforts at national and international levels, informed by successful global examples, are essential to curb the spread of AMR and safeguard public health for future generations. The stakes are high, but with sustained effort and commitment, India could possibly make significant strides in mitigating the impact of antimicrobial resistance.