Antimicrobial resistance (AMR) is emerging as a global public health concern with Antibiotics becoming inefficient against a wide range of pathogenic bacteria.
This calls for a multi-disciplinary approach and a co-ordinated response from the global nations.
What are the causes?
Usage - There is an increasing use of antibiotics for human and veterinary purposes in the recent period.
In India, there is high consumption of a broad spectrum of antibiotics, antibiotic fixed-dose combinations and antibiotic consumption in animal food.
This is leading to a condition of development of antibiotic-resistant bacteria (ARB) in the guts of humans and animals.
And these are subsequently released into the environment.
Regulation - Notably, India and China are the largest producers of antibiotics and contributes for 80% of total antibiotics production globally.
In India, effluents generated from these industries are treated as per the pharmaceutical wastewater discharge guidelines as prescribed by the Central Pollution Control Board.
But the current standards do not include antibiotic residues, and they are not monitored in the pharmaceutical industry effluents.
There is also no consensus guideline on the antibiotic residue discharge limits in industrial waste globally.
The existing good manufacturing practices (GMP) under the WHO (2016) framework is restricted to drug safety alone and does not recognise the environmental risk with pharmaceuticals products.
Waste Discharge - The uncontrolled discharge of untreated urban waste is another major source for AMR in many low and middle income countries.
Wastewater from hospitals, communities and urban runoff is discharged untreated or partially treated.
And they finally ends up in rivers, lakes and seas.
What is the concern?
Without exception, all classes of antibiotics have been reported for resistance in at least some of the pathogens they have been intended to treat.
Thus, AMR poses significant challenges to treating even common infectious diseases, resulting in prolonged infection, disability and death.
AMR makes checking and treating infections ineffective without antimicrobials to treat.
Hence, medical procedures such as organ transplantation, chemotherapy, diabetes management and major surgeries become high-risk affairs.
Importantly, being a public health issue, AMR certainly undermine the achievement of the UN’s Sustainable Development Goals.
What is the way forward?
In 2015, a global action plan (GAP) on AMR was developed by the WHO, the Food and Agricultural Organization and the World Organization for Animal Health.
As highlighted in the National Health Policy 2017, AMR is one of the top 10 priorities for the health ministry.
In India, a national action plan in this regard focuses on six priority areas:
awareness and understanding through education, communication and training.
strengthening knowledge and evidence through surveillance.
infection prevention and control.
optimised antimicrobial use in health, animals and food.
AMR-related research and innovation.
strengthened leadership and commitment at international and national level.
Given the complex nature of the AMR problem, no individual nation has the capacity to address this problem independently.
There is thus a need for an integrated approach in multiple sectors such as human health, animal husbandry, agriculture and environment globally.
