National Action Plan to Combat Anti-Microbial Resistance

• Recently, the Ministry of Animal Husbandry and Dairying has organized a workshop on the National Action Plan to combat Antimicrobial Resistance (AMR), while celebrating World Antimicrobial Awareness Week (WAAW - November 18-24).
• This year's theme of WAAW was “Spread awareness, stop resistance”.
• During WAAW an International Colour Campaign, ‘Go Blue’ campaign, was launched by the AMR tripartite organisations (World Health Organization, Food and Agriculture Organization of the United Nations and the World organisation for Animal Health) to help spread awareness about AMR.

What are antimicrobials?

• Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitics – are medicines used to prevent and treat infections in humans, animals and plants.

What is antimicrobial resistance?

• 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. * As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

Why is antimicrobial resistance a global concern?

• The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten our ability to treat common infections. Especially alarming is the rapid global spread of multi- and pan-resistant bacteria (also known as “superbugs”) that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.
• The clinical pipeline of new antimicrobials is dry. In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative.
• Furthermore, a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health- care systems.
• Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally leading to more difficult to treat infections and death. New antibacterials are urgently needed – for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list. However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.
• The cost of AMR to national economies and their health systems is significant as it affects productivity of patients or their caretakers through prolonged hospital stays and the need for more expensive and intensive care.
• Without effective tools for the prevention and adequate treatment of drug-resistant infections and improved access to existing and new quality-assured antimicrobials, the number of people for whom treatment is failing or who die of infections will increase.
• Medical procedures, such as surgery, including caesarean sections or hip replacements, cancer chemotherapy, and organ transplantation, will become more risky.

What accelerates the emergence and spread of antimicrobial resistance?

• AMR occurs naturally over time, usually through genetic changes. Antimicrobial resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air).
• They can spread from person to person or between people and animals, including from food of animal origin. The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.

AMR in India:

• India, with its combination of large population, rising incomes that facilitate purchase of antibiotics, high burden of infectious diseases and easy over-the-counter access to antibiotics, is an important locus for the generation of resistance genes (such genes help bacteria in surviving on being exposed to antibiotics).
• The multi-drug resistance determinant, New Delhi Metallo-beta-lactamase-1 (NDM-1), emerged from this region to spread globally.
• Africa, Europe and other parts of Asia have also been affected by multi-drug resistant typhoid originating from South Asia.
• In India, over 56,000 newborn deaths each year due to sepsis are caused by organisms that are resistant to first line antibiotics.

Measures Taken to Address AMR:

• National Programme on AMR containment: The Surveillance Network has been strengthened by establishing labs in State Medical College.
• National Action Plan on AMR: It focuses on One Health approach 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.
• 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.
• Integrated One Health Surveillance Network for AMR: To assess the preparedness of Indian Veterinary laboratories to participate in integrated AMR surveillance network.
• Others: India has undertaken many activities like Mission Indradhanush — to address low vaccination coverage — strengthened micro-planning and additional mechanisms to improve monitoring and accountability.
• The Ministry of Health & Family Welfare (MoHFW) identified AMR as one of the top 10 priorities for the ministry’s collaborative work with the World Health Organisation (WHO).

Way Forward

• Detection and prevention of the sale of spurious drugs, particularly in tier 2 and tier 3 cities.
• The occasional measurement of bioavailability at pharmacokinetics and pharmacodynamics, enforcement of antibiotics policies via prescription databases and auditing of pharmacies.
• Pharmacokinetics is defined as the study of the time course of drug absorption, distribution, metabo- lism, and excretion.
• Monitoring sale of drugs with GST (Goods and Services Tax) tracking/matching of e-prescriptions.
• Shift from the syndromic approach to treatment of the diagnosis, use of new technologies such as imaging and bioinformatics and geographic information systems.
• Adherence to the WASH strategy: antibiotic-free animal feed, and antibiotics fed to animals should be different from those consumed by humans (e.g. marked by different colour schemes).