Antibiotic abuse and growing resistance
Since the discovery of Penicillin in early 19th
century several classes of antibiotics came in market, however in last decades
disease treatment using antibiotics is confronted with steep rise in
resistance. Under the pressure of antibiotics, microbes evolve resistant
mutants creating an arm-race between antibiotics and microbes in which
eventually microbes will win if the antibiotic abuse is not checked
Antibiotic abuse (defined as overuse or misuse of
antibiotics) is one of the major driver for developing resistance against
antibiotics. India, as one of the main antibiotic abuser, has a sharp upsurge
in antibiotic resistance with several thousand of dying with resistant form of
diseases.1,2 One of the classical example is NDM-based (New Delhi
metallo beta-lactamase) resistance, which is prominently present in Klebsiella pneumoniae and Escherichia coli isolates and are
extremely resistant to carbapenems, cephalosporin, etc.
Several
factors contributes to antibiotic abuse and resistance development:
a) Self-medication: Self-medication in the case
of antibiotics can be really dangerous as it leads to un-appropriate antibiotics
usage with less control on quality, specificity and dosage. This gives an ease
to pathogenic microbes in overcoming the pressure of antibiotics by developing
resistant mutants, making them difficult to treat.
b) Easy access to all antibiotics: Self-medication
is extremely aided by having easy access to antibiotics in India. Most often it
is from drug stores but also some people keep the antibiotics from their disease
treatment, and do not hesitate to give them to their family members or friends without
going through doctors and prescriptions.
c) Non-regularized sale of antibiotics: One of
the huge problem is less-control and non-regularized sale of antibiotics at
drug stores. A lot of drug stores sell antibiotics without doctor’s prescriptions
or consult. Sometime these drug store people are even not educated enough to know
which antibiotics are more effective against which type of disease.
d) Pharmacy-Doctor benefit relationship: Often,
big pharma companies and pharmacies have some sort of beneficial relationship
with doctors in which doctors prescribe antibiotics or dosage which are more
beneficial in terms of profits.
e) Lack
of awareness: All of the above points are directly or indirectly related to
lack of awareness about dangers of un-appropriate usage of antibiotics. People
are not aware about in what ways increasing resistance against antibiotics can
be problematic for the society.
Apart of these, one of the major factor is increase
use of antibiotics in livestocks (farm animals) where more education and
awareness is required.3
To tackle this situation, several efforts
have already been taken at different levels. Government has placed a revised
over-the-counter sales implementation of antibiotics (H1 from Central Drugs
Standard Control Organization) which includes 24 antibiotics that should be strictly
sold under prescription by doctor and drugs stores are required to maintain a
proper inventory for the sales of these antibiotics.3 In 2012,
several medical societies of India have formulated a declaration to tackle the
growing problem of antibiotic resistance at 2nd annual
conference of the Clinical Infectious Disease Society (CIDSCON 2012) known as
‘Chennai Declaration’.4 Under this declaration efforts for strict
regularization of drug sales at pharmacies and hospitals were under taken. In
spite of these efforts, a strong awareness about antibiotic resistance and
dangers of antibiotic abuse is required at the base level. Government can also
implement some education about antibiotic misuse and its disadvantages at the
school level which will help us in bringing awareness for coming generations. A
strong control on prescription of antibiotics in both government and private
hospitals can be implemented. Hospitals can also implement simple awareness programs
using which patients can be educated about growing problem of antibiotic
resistance and how to prevent antibiotic abuse.
Along with government’s efforts we should avoid using antibiotics
without doctor’s prescription at all and also advise people around us to do so.
Social media and government-mediated advertisements can also play a big role considering
the reach of social media even in small towns and villages.
……………………….
Dr. Sandeep Ameta, PhD
Senior Research
Scientist,
ESPCI ParisTech,
75005-Paris, France
References:
1. Situation Analysis: Antibiotic Use and Resistance in India
(Center for Disease Dynamics, Economics & Policy
http://www.cddep.org/publications/situation_analysis_antibiotic_use_and_resistance_india#sthash.2OXKZx7D.dpbs
2. Kumar et al. 2013, J Nat Sci Biol Med. Antimicrobial resistance in India: A
review.
3. Laxminarayan
and Chaudhury, 2016, PLoS Med, Antibiotic Resistance in India: Drivers and Opportunities
for Action.
4. Chennai Declaration (http://chennaideclaration.org/)
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