Dangerous medical crisis

India’s antibiotics consumption rose by 103% between 2000 and 2015, the highest increase among low and middle-income countries, according to a study published in the Proceedings of the National Academy of Sciences, USA. The study tracked antibiotic consumption in 76 countries and also projected total global antibiotic consumption through 2030.

Antibiotic resistance — the ability of microbes to evolve and withstand the effects of an antibiotic, caused by the overuse of antibiotics — has emerged as one of the world’s deadliest health crises, according to the World Health Organisation (WHO). The spread of antibiotic-resistant bacteria is threatening the effectiveness of last-resort treatments for life-threatening infections.

According to a report published in Aetna International, seven lakh deaths (and counting) are attributed to antimicrobial resistance, every year. Without action, the death toll could reach one crore people every year by 2050.

According to the report, India also surpassed the United States’ antibiotic consumption rate for oxazolidinones (they are newer antibiotics which are used only as last-resort when the commonly used ones are ineffective) in 2012 to become the highest consumer.

According to Dr Anith Kumar Mambatta, professor of medicine at PSGIMSR, Coimbatore, “A major reason for this increase is that there are no laws to control the dispensing of antibiotics over the counter. They don’t require a valid prescription. Another reason is that purchasing power of our society has improved with time.”

The common man lives with false perceptions that antibiotics can cure illnesses like a common cold or gastroenteritis. This adds to the problem of increased use of antibiotics without proper diagnosis or prescription. Also, lack of laws or rigid surveillance preventing the purchase of drugs over the counter without prescription adds to the issue.

In India, anyone can purchase antibiotics from a drugstore without a prescription. This is mostly the case across the world, except in northern Europe and North America, where outpatient antimicrobials are largely restricted to prescription-only use. Says Bengaluru pharmacist Kiran Kumar, “We demand prescription for medicines that are fatal when consumed in overdoses. For antibiotics, an extra pill or two won’t cause much harm. So, we sometimes give antibiotics without a prescription.”

Bringing in stringent laws for the sale of over-the-counter drugs (only with prescription) is a primary step that the government can take to tackle the issue of antibiotic resistance. Doctors also need to educate their patients about the adverse effect of misusing an antibiotic and sensitise the common man with information. Doctors can educate patients on the dangers of self-prescribed medication and create more awareness about the same.

Dr Anith explains that “Doctors should also prescribe antibiotics only once the illness is confirmed to be bacterial and not for viral illnesses.” Explaining the adverse effects of antibiotic resistance, he says, “Antibiotic resistance causes the resistant bacteria to grow more in number and then you have to use a stronger antibiotic. A stage will come when the bacteria becomes resistant to all antibiotics. It can even result in death. Antibiotics should be taken in right doses for the right duration, and the course should be completed. Patients should not pressure doctors to prescribe antibiotics, nor should doctors succumb to such pressure.”

Again, the use of vaccines against organisms that cause antibiotic-treatable diseases should be encouraged. According to a report published by Global Antibiotic Resistance Partnership-India National Working Group, vaccines against Haemophilus influenzae type b (Hib) and S. pneumoniae, which causes pneumonia, are far more effective. Vaccines against other types of organisms — for example, rotavirus, which causes many cases of childhood diarrhoea — can also reduce antibiotic use.

According to Bengaluru-based paediatrician Dr Sandeep Jathanna, “Unethical use of antibiotics should be avoided. Resistance to an antibiotic can occur at any age. Vaccines help avoid the use of antibiotics to an extent. However, we often hear of cases of chicken pox despite taking the vaccine. So, vaccines have limitations, too”.

Education and public awareness programmes for pharmacists and consumers can go a long way. Hospitals, which are a thriving ground for bacteria, should have stringent regulations to control infection with safety checklists and by providing staff with guidelines and feedback.

Misuse and overuse of antibiotics in animals is also causing antibiotic resistance in humans who consume them. WHO has recommended farmers and the food industry to stop using antibiotics routinely to promote growth and prevent disease in healthy animals. Some countries are promptly taking action on this. In 2006, the European Union banned the use of antibiotics for growth promotion in animals. WHO has also published a list of critically important antimicrobials for human medicine to preserve their efficacy. But in India, we do not have government regulations to control antibiotic use in animal husbandry.

In October 2015, WHO launched the Global Antimicrobial Surveillance System (GLASS), working closely with WHO Collaborating Centres and existing antimicrobial resistance surveillance networks and based on the experience of other WHO surveillance programmes. Countries are encouraged to implement the surveillance standards and indicators gradually, based on their national priorities and available resources.

In January, this year, WHO released surveillance data and it shows high levels of antibiotic resistance to a number of serious bacterial infections in both high- and low-income countries. The most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. To date, 52 countries (including India) are enrolled in WHO’s Global Antimicrobial Surveillance System.

Without the combined action of government, doctors, pharmacists, livestock farmers and antibiotic consumers themselves to track and reduce the unnecessary use of antibiotics, we are at risk of creating a world with innumerable diseases that may never respond to antibiotic treatment.