The escalating issue of Antimicrobial resistance (AMR) is gaining global attention, potentially exacerbated by the ongoing Covid-19 pandemic. The reprioritization of resources away from antimicrobial stewardship along with an increase in antibiotic use among Covid-19 patients and the potential impact of escalating poverty on resistance levels due to a faltering economy are all contributing factors. As such, the threat posed by AMR remains substantial.
Understanding Antimicrobial Resistance
Antimicrobial resistance refers to the phenomenon whereby microorganisms, such as bacteria, viruses, fungi, and parasites, develop resistance against antimicrobial drugs. These drugs, which include antibiotics, antifungals, antivirals, antimalarials, and anthelmintics, are designed to combat infections. When resistance develops, standard treatment options become ineffective, infections persist, and may spread to others. Microorganisms that develop antimicrobial resistance are commonly referred to as “superbugs”.
The Foundation of Antimicrobial Resistance
Resistance to antimicrobials can be either intrinsic or acquired. Certain bacteria possess resistance genes making them intrinsically resistant; they thus survive even when exposed to antibiotics. Additionally, bacteria can acquire resistance either through sharing and transferring resistance genes present within the population or via genetic mutations that aid survival when exposed to antibiotics.
The Spread of Antimicrobial Resistance
The inappropriate use of antimicrobials in human medicine and agriculture are key contributing factors to the spread of AMR. Environmental contamination, particularly around pharmaceutical manufacturing sites which release untreated waste containing active antimicrobials, is also a significant problem.
The Worrying Consequences of AMR
AMR is estimated to directly cause up to 700,000 deaths each year. It poses a risk not only to the treatment of infections but also medical procedures such as organ transplantation, chemotherapy, diabetes management, and major surgery. AMR is escalating healthcare costs due to longer hospital stays, additional tests, and the use of more expensive drugs. It endangers the achievement of the Sustainable Development Goals and threatens the gains made under the Millennium Development Goals.
The Crisis of Antibiotic Development
In the past three decades, no new classes of antibiotics have reached the market, largely due to insufficient incentives for their development and production. Without urgent action, we face an antibiotic apocalypse—a future where bacteria are completely resistant to treatment and common infections and minor injuries could become fatal.
AMR in India
India is considered a hotbed for generating resistance genes owing to its large population, easy accessibility to antibiotics, a high burden of infectious diseases, and rising incomes that facilitate the purchase of antibiotics. A multi-drug resistance determinant, New Delhi Metallo-beta-lactamase-1 (NDM-1), emerged from this region and has spread globally. Over 56,000 newborn deaths in India each year are caused by organisms resistant to first-line antibiotics.
Efforts to Combat AMR
The Ministry of Health & Family Welfare (MoHFW) has identified AMR as one of the top ten priorities for the ministry’s collaborative work with the World Health Organisation (WHO). Several activities have been undertaken including Mission Indradhanush, which addresses low vaccination coverage, and the National Action Plan on AMR resistance 2017-2021.
Looking Ahead: Tackling AMR
As microbes continue to evolve and develop resistance to even new antimicrobials, there is a need for sustained investment and global coordination to detect and combat new resistant strains. Measures such as controlling prescription of antimicrobials, educating consumers to reduce inappropriate demand, issuing standard treatment guidelines, providing point-of-care diagnostics to aid clinical decision-making, and expanding surveillance measures are all part of an effective strategy. In addition to developing new antimicrobials, infection-control measures can reduce antibiotic use. Ensuring access to antimicrobials for all who need them is equally critical.