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Mahesh

11/09/24 10:34 AM IST

The grave threat from AMR

In News
  • Antimicrobial resistance, which is caused when microbes evolve into drug-resistant ‘superbugs’ in response to the misuse or overuse of antibiotics, is a growing problem in India.
About AMR
  • AMR is a condition in which a pathogen acquires the ability to survive and cause infection even in the presence of an antimicrobial drug.
  • AMR is the result of evolution of microbes in a situation where there is a misuse or overuse of antibiotics.
  • Excessive use of antimicrobial drugs can lead to the creation of resistant or extremely resistant superbugs, which can circulate in hospitals, through drinking water, or sewers.
  • Infections caused by these pathogens will not respond to commonly prescribed antibiotics.
  • Growing antibiotic resistance would mean that simple infections would become difficult to treat — for example, doctors have reported patients requiring admission to hospital for the treatment of even urinary tract infections.
  • Within hospitals, this is likely to lead to more complications and longer stays, making the treatment increasingly more expensive.
Increasing use of AMR
  • Many Indians have a tendency to pop an antibiotic for a fever, without even checking if the fever is caused by a bacterium.
  • An antibiotic is of no use for viral infections such as influenza, but consuming it can drive up resistance in the population.
  • Many find it difficult or expensive to go to a doctor for a simple sickness, and instead prefer to take a pill that perhaps their local chemist has recommended.
  • Instead, we have to prevent infections so that people do not feel the need to take antibiotics.
  • This can be achieved through improving hygiene and measures like frequently washing hands.
  • It can also be achieved through vaccinations. For example, the pneumococcal vaccine or influenza vaccine for the elderly can reduce incidents of pneumonia.“However, not many people take this vaccine.
DOCTORS
  • Doctors must be educated to not use broad-spectrum antibiotics.
  • These are antibiotics that work against a wide range of infections, but these are also the ones that are more likely to lead to resistance.
  • Our report provides a list of antibiotics that should be used in the community for a particular infection and ones that should be reserved for patients admitted to hospitals.
  • A survey on prescribing trends for antibiotics released by the National Centre for Disease Control (NCDC) last year found that 71.9% of patients coming to hospitals were prescribed antibiotics on average, with only a 10-percentage point difference in antibiotic use between intensive care units that have the sickest patients and the other wards.
  • Surprisingly, 55% of the antibiotics were prescribed not for the treatment of an infection, but to prevent one.
  • Overuse of antibiotics has rendered some of them useless or of limited use.
  • Dr Walia cited the example of the common diarrhoea medicine Norfloxacin, which has become ineffective.
  • Also, resistance to carbapenem, a class of strong, third-line antibiotics used to treat severe bacterial infections, is on the rise for the treatment of conditions such as typhoid, which is not required.
Common Pathogens in India
  • The three most common pathogens isolated in patient samples from tertiary care centres in the ICMR surveillance network are e. coli, which can cause gut infections; Klebsiella pneumoniae, which can cause pneumonia and urinary tract infections; and Acinetobacter baumannii, which is mainly associated with hospital acquired infections.
  • E. coli isolates demonstrated a decrease in susceptibility to most antibiotics, with susceptibility to carbapenem reducing from 81.4% in 2017 to 62.7% in 2023.
  • Klebsiella pneumoniae also showed reduced susceptibility, with the susceptibility to two different medicines from the carbapenem class reducing from 58.5% to 35.6% and 48% to 37.6% between 2017 and 2023.
  • While no significant change was found in susceptibility for Acinetobacter baumannii, its resistance to carbapenems stood at 88% in 2023. Pathogens such as this are highly resistant to even strong antibiotics.
  • PREVENTION of infections by putting in place hygienic practices, improving sanitation, and urging people to get vaccinated.
  • EDUCATION of doctors to ensure appropriate use of antibiotics, saving the stronger ones for hospital based patients, and getting the patients tested to see which infection they have.
Source- Indian Express

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