Pandemic worsens antibiotic resistance in India

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During the weekly COVID-19 briefings chaired by Dr. Rajeev Jayadevan in Ernakulam, located in the southern Indian state of Kerala, a worrying complaint kept coming up. Doctors at several local hospitals in the district were reporting an increase in hard-to-treat bacterial infections. The pathogens, they said, no longer seemed to respond to common antibiotics.

Data observed by Jayadevan in the district also showed a clear trend: An increase in drug resistant infections since the start of the COVID-19 pandemic.

“It’s going to affect the survival of critically ill patients in intensive care. That’s the part that really worries me,” Jayadevan told DW.

Antimicrobial resistance

Same before the pandemic, on the rise antimicrobial resistance (AMR) – which occurs when pathogens become resistant to drugs such as antibiotics – was an issue of global concern.

A report Posted in The Lancet earlier this year estimated that drug-resistant infections were directly responsible for nearly 1.3 million deaths in 2019. Now experts are warning that the COVID-19 pandemic may have accelerated the trend, with a new report showing a drastic increase in resistance to several important antibiotics and antifungals in India over the past year.

The research, published by the Indian Council of Medical Research (ICMR) last month, found that resistance to carbapenems – a class of drugs primarily given to treat common infections such as pneumonia in intensive care settings – has increased in 2021, limiting the availability of treatment options.

“We lack drugs to treat sepsis or to treat very serious infections caused by highly drug-resistant pathogens,” said Kamini Walia, senior scientist at ICMR and lead author of the report.

Antimicrobial resistance is largely caused by unnecessary overuse of antibiotics

Drug abuse

Antimicrobial resistance arises naturally during the process of evolution, but drug abuse can accelerate the process. If a patient takes the wrong antibiotic or takes the medication incorrectly, there is a risk that some bacteria will not be eliminated. The remaining bacteria then spread, leading to an increase in drug-resistant pathogens in the environment.

In India, a high burden of infectious diseases and a chronically underfunded healthcare system have contributed to rising levels of antimicrobial resistance.

“Poor infection control [in hospitals] and the lack of diagnostic support are the two key factors,” Walia said.

India spends only 1.25% of its GDP on public health care, fifth lowest in the world, according to 2020 report published by Oxfam.

Antimicrobial abuse, and in particular the indiscriminate use of broad-spectrum antibiotics, has also played a major role in increasing drug resistance in the country, Walia said.

To research Posted in The Lancet earlier this year warned that the widespread use of unnecessary antibiotics was a major contributor to AMR in India, with more than 47% of antibiotics used in the private sector in 2019 not approved by the central drug regulatory body of India. country.

Little or no supervision

Distribution regulations, where they exist, are also poorly enforced. When Jayadevan first returned to India after studying abroad, he recalled being shocked by the ready availability of over-the-counter antibiotics.

“You could walk into a pharmacy and ask for amoxicillin, ciprofloxacin, whatever,” he said. “It’s like buying oranges, grapes or apples from a fruit vendor. It’s unacceptable.”

The COVID-19 pandemic has exacerbated the problem, spurring both patient demand and hospital administration of antimicrobials in a preventative attempt to limit secondary infections. An estimated 216 million overdoses of antibiotics were consumed in India between June and September 2020 only.

“Antibiotics have flown off the shelves. It is clear that the pandemic has contributed to the rampant overuse of antibiotics in the country,” Jayadevan said.

High patient numbers in hospitals, combined with overburdened medical staff, meant that infection control measures such as hand washing were also compromised, leading to an increase in secondary infections. Vaccination and sanitation programs, aimed at preventing infections in the first place, have also been suspended.

Sale of antibiotics not well regulated in India, doctors say

Sale of antibiotics not well regulated in India, doctors say

New guidelines, but little commitment

To address the threat of rising antimicrobial resistance, ICMR introduced National Antimicrobial Stewardship Guidelines in 2018, which outlined best practices for physicians, technological solutions for better monitoring of use of antimicrobials and aimed to expand access to tools for rapid diagnosis and antimicrobial susceptibility.

While the efforts so far have been well received in most hospitals, “funding, getting the skilled workforce and maintaining that momentum and focus is going to be the main challenge,” Walia said. “Sustained action and continued efforts are needed.”

Fighting infections at their source is also essential, she added, focusing on infection control measures in hospitals, sanitation programs and vaccinations. Earlier this year, the World Health Organization issued an “urgent” advisory call to boost research and development of vaccines to combat antimicrobial resistance.

However, the biggest drawback of the AMR program in India so far, Walia said, was the lack of audience engagement. The latest ICMR report could help change that, raising awareness among policy makers and the public about the growing threat of antimicrobial resistance.

“Without evidence, we cannot engage decision makers,” Walia said.

Edited by: Clare Roth

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