Antibiotics that once cured ailments across the spectrum are now turning into a potential source of prolonged illness, disability and death. The world is transitioning to a post-antibiotic era where common infections and minor injuries will begin to kill, thanks to increasing antibiotic resistance (ABR). In 2015, such resistance was identified as the cause for about 23,000 deaths annually in the US and about 25,000 such deaths in Europe. While accurate data on the incidence of antibiotic resistance in India is unavailable, the highest number of deaths caused by resistant pathogens passed on to newly born babies from mothers or the environment—approximately 58,000—was in our region.
Though ABR in certain cases occurs through the natural evolution of resistance in bacterial pathogens, the rising consumption of Antibiotics is a major contributor. Topping this, the New Delhi metallo-beta-lactamase (NDM) enzyme, which makes bacteria resistant to beta-lactam antibiotics, is now present globally. This indicates free movement of ABR across boundaries, with serious consequences. This is nowhere as stark as in India. Our large population is often blamed for the widespread dissemination of a higher number of resistant pathogens, commonly called superbugs. However, it is the interplay of domestic factors such as a weak public health system, cheap antibiotics available in the market, and their unregulated use, that has created ideal conditions for superbugs.
Prescription of antibiotics for a variety of diarrhoeal and respiratory infections despite their limited curative potential has exacerbated the situation. Poor regulation of pharmacies and licensing out several pharmacies to a single pharmacist introduces a large number of unqualified personnel into the supply chain. New virtual marketplaces have made the entire drug distribution process an opportunity for unchecked financial gains by irresponsible actors. The lack of awareness among patients regarding the appropriate use of antibiotics has led to self-medication and non-adherence to the prescribed course of antibiotics, further intensifying the problem.
The dramatic increase in prevalence of superbugs and the dearth of new antibiotics in the market is a warning signal for India. The absence of a good statistical model to show the relationship between antibiotic consumption and associated resistance makes it difficult to frame usage guidelines for these antibiotics. This in large measure explains the absence of any great success even post the Chennai declaration of 2012. To meet the obligations of this declaration, the National Programme on Containment of Antimicrobial Resistance was launched under the 12th Five-year Plan.
