Context: The Delhi Declaration during India’s G20 presidency saw a commitment to strengthen the global health architecture by building more resilient, equitable, sustainable and inclusive health systems to implement the One Health approach, enhance pandemic preparedness and strengthen existing infectious diseases surveillance systems. Another important part of this agreement was to prioritise tackling Antimicrobial Resistance (AMR) through research and development (R&D), infection prevention and control, as well as antimicrobial stewardship efforts within respective National Action Plans (NAPs).
The Ministry of Health & Family Welfare (MoHFW) identified AMR as one of the top 10 priorities for the ministry’s collaborative work with WHO. This reflects that antibiotic resistance is a new epidemic threat of the 21st century.
What is Antimicrobial Resistance?
- Antimicrobial resistance is the resistance acquired by any microorganism (bacteria, viruses, fungi, parasite, etc.) against antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials) that are used to treat infections.
- As a result, standard treatments become ineffective, infections persist and may spread to others. Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”.
How Antimicrobial Resistance occurs?
- Some bacteria due to the presence of resistance genes are intrinsically resistant and therefore survive on being exposed to antibiotics.
- Bacteria can also acquire resistance. This can happen in two ways:
- by sharing and transferring resistance genes present in the rest of the population or
- by genetic mutations that help the bacteria survive antibiotic exposure.
Once the resistance has been acquired, it can spread in the rest of the population of bacteria through reproduction or gene transfer.
Various causes of Antibiotic Resistance:
Microbes can become resistant to drugs for both biological and social reasons.
- Microbial behaviour: As soon as scientists introduce a new antimicrobial drug, there is a good chance that it will become ineffective at some point in time. This is due primarily to changes occurring within the microbes.
- People’s behaviour: Not following recommendations for the use of some drugs can increase the risk of antimicrobial resistance. The way in which people use antimicrobial drugs is a significant contributing factor. Some individualistic reasons are:
- Wrong prescription: Doctors sometimes prescribe antimicrobials “just in case,” or they prescribe broad-spectrum antimicrobials when a specific drug would be more suitable. This increases the risk of AMR.
- Inappropriate use: If a person does not complete a course of antimicrobial drugs, some microbes may survive and develop resistance to the drug. Also antibiotics recommended by quacks or pharmacists contribute to magnifying the issue.
- Agricultural use: Using antibiotics in farm animals can promote drug resistance. Scientists have found drug-resistant bacteria in meat and food crops that have exposure to fertilisers or contaminated water. In this way, diseases that affect animals can pass to humans.
- Hospital use: People who are critically ill often receive high doses of antimicrobials. This encourages the spread of AMR microbes, particularly in an environment where various diseases are present.
Impacts of Antimicrobial Resistance:
- A threat to prevention and treatment of infections – medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very risky.
- Failure to treat infections caused by resistant bacteria also poses a greater risk of death.
- Antimicrobial resistance increases the cost of healthcare with lengthier stays in hospitals, additional tests and use of more expensive drugs.
- Without effective antibiotics for prevention and treatment of infections, the achievements of modern medicine are put at a risk.
- Without urgent action, we are heading to antibiotic apocalypse – a future without antibiotics, with bacteria becoming completely resistant to treatment and when common infections and minor injuries could once again kill.
Antimicrobial Resistance is putting the gains of the Millennium Development Goals at risk and endangers achievement of the Sustainable Development Goals.