India among nations overusing “Watch” group antibiotics

Subject: S&T

Section: Health

Context:

In the Data Point published from a government survey (“Over 38% patients on more than one antibiotic”), which shows that an overwhelming number of inpatients are prescribed antibiotics by hospitals across India.

Antimicrobial Resistance

Antimicrobial Resistance is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs that are used to treat infections.
It occurs when a microorganism changes over time and no longer responds to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
The World Health Organisation (WHO) has identified AMR as one of the top ten threats to global health.
Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.

Reasons for the Spread of AMR

Antibiotic consumption in humans: Unnecessary and injudicious use of antibiotic fixed dose combinations could lead to emergence of bacterial strains resistant to multiple antibiotics.
Social factors: 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, Antibiotics which are critical to human health are commonly used for growth promotion in poultry.
Pharmaceutical Industry Pollution: The wastewater effluents from the antibiotic manufacturing units contain a substantial amount of antibiotics, leading to contamination of rivers and lakes.
Environmental Sanitation: 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 hands after contact with patients.

Initiatives taken to Prevent AMR

National Programme on AMR containment: Launched in 2012. Under this programme, AMR Surveillance Network has been strengthened by establishing labs in State Medical College.
National Action Plan on AMR: It focuses on One Health approach and was launched in April 2017 with the aim of involving various stakeholder ministries/departments.
AMR Surveillance and Research Network (AMRSN): It was launched in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
AMR Research & International Collaboration: Indian Council of Medical Research (ICMR) has taken initiatives to develop new drugs /medicines through international collaborations in order to strengthen medical research in AMR.
Antibiotic Stewardship Program: ICMR has initiated Antibiotic Stewardship Program (AMSP) on a pilot project across India to control misuse and overuse of antibiotics in hospital wards and ICUs.
DCGI had banned 40 Fixed Dose Combinations (FDCs) which were found inappropriate.

Ministry of Health and Family Welfare (MoHFW) has taken following initiatives to promote judicious use of antimicrobials:

Red Line awareness campaign on Antimicrobials Resistance, urging people not to use medicines marked with a red vertical line, including antibiotics, without a doctor’s prescription. Indian Council of Medical Research (ICMR) has released treatment guidelines for antimicrobial use in common syndromes which contain guidelines for use of antibiotics for viral bronchitis and low-grade fever.
Antibiotics are included in Schedule H and H1 of the Drugs Rules, 1945. These drugs have specific caution labeling requirements and are sold only under the prescription of a Registered Medical Practitioner.
The supply of a drug specified in Schedule H1 are recorded in a separate register at the time of the supply and such records are maintained for three years and are open for inspection. Central Drugs Standard Control Organisation (CDSCO) has placed 24 hi-end antimicrobials under schedule H1 by issuing notification.

What are the Global Measures?

World Antimicrobial Awareness Week (WAAW): Held annually since 2015, WAAW is a global campaign that aims to raise awareness of antimicrobial resistance worldwide and encourage best practices among the general public, health workers and policy makers to slow the development and spread of drug-resistant infections.
The Global Antimicrobial Resistance and Use Surveillance System (GLASS): WHO launched the GLASS in 2015 to continue filling knowledge gaps and to inform strategies at all levels.

AWaRe

The AWaRe tool was developed by the WHO Essential Medicines List to contain rising resistance and make antibiotic use safer and more effective by providing guidelines (over the effective use of antibiotics) to the policy-makers and health workers.
It classifies antibiotics into three groups:
- Access— first or second choice antibiotics, offer the best therapeutic value while minimizing the potential for resistance, these antibiotics used to treat the most common and serious infections. E.g. Amoxicillin.
- Watch— first or second choice antibiotics, only indicated for specific and limited number of infective syndromes, more prone to be a target of antibiotic resistance and thus prioritized as targets of stewardship programs and monitoring. E.g. Ciprofloxacin.
- Reserve— antibiotics to be used sparingly or preserved and used only as a last resort.