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Insights into Editorial: Pill talk — On antibiotic resistance

Insights into Editorial: Pill talk — On antibiotic resistance


Around the time the UN Climate Change Conference drew to a close in Bonn last week, so did the World Antibiotic Awareness Week, a World Health Organisation campaign to focus attention on antibiotic resistance. The global threats of climate change and antibiotic resistance have much in common. In both cases, the actions of people in one region have consequences across the globe. Also, tackling both requires collective action across multiple focus areas.

World Antibiotic Awareness week

World Antibiotic Awareness Week is celebrated from 16th- 22nd November. The event was established by the World Health Organisation (WHO) to raise awareness of antibiotic resistance and judicious use of antibiotics.

This year the theme of the event is “Antibiotics: Handle with Care”.

  • A global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the 68th World Health Assembly in May 2015.
  • One of the key objectives of the plan is to improve awareness and understanding of antimicrobial resistance through effective communication, education and training

At least 2 million people get infected with antibiotic-resistant bacteria each year, resulting in at least 23,000 deaths, according to the US Centres for Disease Control.

WHO has called antibiotic resistance is a major global threat to public health.

What is antibiotic resistance?

Antibiotics are medicine used to treat infections caused by bacteria. Antibiotic Resistance refers to resistance developed by bacteria against antibiotics or the ability of bacteria to mutate or change so as to resist the effects of antibiotics. The more we use them, and the more we abuse them, the less effective they become.

Antibiotics are unquestionably useful against bacterial infections. However, indiscriminate use has resulted in development of resistance in patients with bacterial infections thereby leading to long lasting illnesses.

Thanks to that annoying thing called evolution, bacteria are constantly adapting to counter-attack antibiotics. Antibiotic resistance is one of the most significant threats to patients’ safety. It is driven by overusing antibiotics and prescribing them inappropriately.

Negative effect:

  • Antibiotic resistance causes people to be sick for longer and increases the risk of death.
  • Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.
  • Antibiotic-resistant bacteria increase the chance and severity of illness and ultimately death.
  • Few new antibiotics are being developed, which is exacerbating the situation as more antibiotic resistant bacteria adapts and arises.

Therefore, rational use of antibiotics is essential in order to minimize antibiotic resistance.

Antimicrobial Resistance in India

AMR is of particular concern in developing nations, including India, where the burden of infectious disease is high and healthcare spending is low. The country has among the highest bacterial disease burden in the world. Antibiotics, therefore, have a critical role in limiting morbidity and mortality in the country. The 2015 WHO multi-country survey revealed widespread public misunderstanding about antibiotic usage and resistance.

  • AMR has huge implications for India. There is a need to have in place a good comprehensive AMR National Action Plan in line with the Global AMR action plan.
  • For resistance, this means cutting the misuse of antibiotics in humans and farm animals, fighting environmental pollution, improving infection control in hospitals, and boosting surveillance.
  • While most of these goals need government intervention, individuals have a critical part to play too.
  • This is especially true for India, which faces a unique predicament when it comes to restricting the sale of antibiotics — some Indians use too few antibiotics, while others use too many.
  • Many of the 410,000 Indian children who die of pneumonia each year do not get the antibiotics they need, while others misuse drugs, buying them without prescription and taking them for viral illnesses like influenza.
  • Sometimes this irrational use is driven by quacks. But just as often, qualified doctors add to the problem by yielding to pressure from patients or drug-makers.

This tussle — between increasing antibiotic use among those who really need them, and decreasing misuse among the irresponsible — has kept India from imposing blanket bans on the non-prescription sale of these drugs.

When policymakers did propose such a ban in 2011, it was met with strong opposition. Instead, India turned to fine-edged tools such as the Schedule H1, a list of 24 critical antibiotics such as cephalosporins and carbapenems, whose sale is tightly controlled.

What are Schedule H drugs?

Schedule H is a class of prescription drugs in India appearing as an appendix to the Drugs and Cosmetics Rules, 1945 introduced in 1945.

Why hasn’t Schedule H1 accomplished much?

Enforcement of Schedule H laws in India is lax, compared to the more restrictive Schedule X, for which a mandatory documentation trail must be maintained.

  • Pharmacists often flout rules, and drug controllers are unable to monitor them. Thus, the power to purchase antibiotics still remains in the hands of the consumer.
  • It is up to consumers now to appreciate the threat of antibiotic resistance and exercise this power with care.
  • These miracle drugs form the bedrock of modern medicine today, and are needed for everything from prophylaxis for a complicated hip surgery to treatment for an infected knee scrape.
  • Losing these drugs would mean that even minor illnesses could become killers, and the cost of health care will soar.

How can we prevent antibioticresistant infections?

It is important to understand that, although they are very useful drugs, antibiotics designed for bacterial infections are not useful for viral infections such as a cold, cough, or the flu.

  • Before taking any antibiotic ask the physician if it is required and beneficial.
  • Always take antibiotics as prescribed by the physician.
  • Take antibiotics to treat only bacterial infections.
  • Do not take antibiotics in viral infections such as cold, cough, or flu
  • Do not repeat the same antibiotic for the next time you get sick.
  • Do not stop antibiotic before complete prescribed course of treatment.
  • Do not skip doses.
  • Do not copy the antibiotic with the same diseases which is prescribed for someone else.

Way Forward

Consumers need to remember that not all illnesses need antibiotics and the decision on when to take them and for how long are best left to a doctor.

Multi-resistance in some tertiary-care hospitals to bugs like Staphylococcus aureus has grown to dangerous levels. But the experience of countries like Australia shows that cutting down on antibiotics can reverse such trends. The National Action Plan on Antimicrobial Resistance aims to repeat such successes in India.

Meanwhile, awareness must be built among consumers so that they see the coming crisis and take up the baton.