Article on Antimicrobial Resistance (AMR)

ARTICLE ON ANTIMICROBIAL RESISTANCE (AMR):- Occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death. Also, known as AR (Antibiotic Resistance).

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Antibiotic resistance is one of the biggest public health challenges of our time. Each year at least 4.8 million people get an antibiotic-resistant infection, and more than 95,000 people die. Fighting this threat is a public health priority that requires a collaborative global approach across sectors.

Antibiotic resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Infections caused by antibiotic-resistant germs are difficult and sometimes impossible, to treat.

Antibiotic resistance does not mean the body is becoming resistant to antibiotics; it is that bacteria have become resistant to the antibiotics designed to kill them.

Antimicrobial resistance (AMR) is a potential pandemic of the future. It is silent and slow-moving and can have a devastating impact on all of us.

ANTIMICROBIAL RESISTANCE (AMR)

Causes:- The causes of AMR include antimicrobial misuse or overuse, self-medication, prescription sharing, over-the-counter sale of antimicrobials, non-compliance with the prescribed treatment, poor sanitation and hygiene in hospitals and the community, poor infection prevention and control, as well as overuse and misuse in food animals and crops.
Reasons for Spread of AMR Antibiotic consumption in humans
Unnecessary and injudicious use of antibiotic fixed-dose combinations could lead to the emergence of bacterial strains resistant to multiple antibiotics.

Factors contributing to the emergence of antibiotic resistance

Microorganisms are exposed to antibiotic drugs, leading to the natural phenomenon of antibiotic resistance. Under the selective pressure of antibiotics, susceptible bacteria are killed or inhibited, while bacteria that are naturally (or intrinsically) resistant or that have acquired antibiotic-resistant traits have a greater chance to survive and multiply. Not only the overuse of antibiotics but also the inappropriate use (inappropriate choices, inadequate dosing, poor adherence to treatment guidelines) contribute to the increase of antibiotic resistance.

Picture 1 shows a schematic representation of factors involved in the emergence and spread of antibiotic resistance. We identified four main sectors involved in the development of antibiotic resistance: human medicine in community and in hospital, animal production and agriculture, and the environmental compartment.

Include self-medication.
Access to antibiotics without prescription.
Lack of knowledge about when to use antibiotics.

Cultural Activities

Mass bathing in rivers as part of religious mass gathering occasions.
Antibiotic Consumption in Food Animals
Farmers commonly use antibiotics that are critical to human health for growth promotion in poultry.

Pharmaceutical Industry Pollution

The wastewater effluents from the antibiotic manufacturing units contain a substantial amount Environmental Sanitation of antibiotics, leading to the contamination of rivers and lakes.
Untreated disposal of sewage water bodies – leading to contamination of rivers with antibiotic residues and antibiotic-resistant organisms.
Infection Control Practices in Healthcare Settings a report on hand-washing practices of nurses and doctors found that only 31.8% of them washed their hands after contact with patients.

The environment and the spread of resistance

In recent years, there has been widespread recognition of the importance of the environment in the spread of antibiotic resistance.

Scientists regard the soil as a reservoir of antibiotic resistance genes because soil microorganisms, which are intrinsically resistant to the antibiotics they produce, serve as the source for most antibiotics. In addition, water potentially contaminated with faecal microorganisms and organic fertilisers used on food crops may disseminate drug-resistant bacteria in the soil.

Water is a major way of dissemination of bacteria between different environmental compartments. Incomplete metabolism in human beings or the disposal of unused antibiotics leads to the release of large amounts of antibiotics into municipal wastewater. Some available data show that antibiotic-resistant bacteria and antibiotic-resistant genes can be detected in wastewater samples and that the conditions in wastewater treatment plants are favourable for the proliferation of resistant bacteria. In the last decade, several studies have reported high concentrations of tetracycline and sulphonamide-resistant bacteria and sulphonamide-resistant genes in WWTPs.

Way Forward

Addressing this public health issue requires a collaborative, multi-sectoral, and transdisciplinary ‘One Health’ approaches at the local, regional, national, and global levels.

The engagement of sectors outside human health — such as animal health, food, agriculture, and the environment — had been a challenge that is slowly being addressed through the ‘One Health’ collaborations on AMR.

WHO India has been engaging with all health partners including the India offices of the Food and Agriculture Organization (FAO) and United Nations Environment Programme (UNEP) to address the complex multi-factorial public health challenge of AMR.

The WHO India has supported the MoHFW in establishing the governance mechanisms on AMR— the Intersectoral Coordination Committee, Technical Advisory Group, and the Core Working Group on AMR

The Inter-Ministerial Consultation on Antimicrobial Resistance endorsed the Delhi Declaration on Antimicrobial Resistance in April 2017. India has a National Action Plan on Antimicrobial Resistance.

Health is a state subject, the focus of action should also include the development of State Action Plans for Containment of Antimicrobial Resistance or SAP CAR in all states and Union territories (UTs) of India.