What is Antimicrobial Resistance?

Context

Antimicrobial resistance (AMR) is a global health challenge and a looming public health crisis. The WHO has declared it as one of the top 10 health threats facing humanity.

Probable Question

The growing scourge of antimicrobial resistance needs urgent attention. Explain. (150 words, 10 marks) 

What is Antimicrobial Resistance? 

• Antimicrobials are chemicals or molecules that are used to treat a wide variety of infections in humans and animals.
• Antimicrobials are the backbone of modern medicine. 
• A few Microorganisms (bugs) are helpful like the yogurt-making lactobacillus and some are harmful like the typhoid-causing salmonella.
• Antimicrobial Resistance (AMR), often also called antibiotic resistance,  occurs when bacteria, viruses, fungi and parasites no longer respond to medicines they were used to treat the infections they caused, thus, making infections harder to treat and increasing the risk of disease spread, severe illness and death.
• 1.27 million people died in 2019 as a direct result of AMR, which is now a leading cause of death worldwide, higher than HIV/AIDS or malaria, as per the Lancet Report, that covered 204 countries and territories.

Image source: WHO 

How the Resistance Occurs?

• Irrational use of antimicrobials: Improperly used antimicrobials create selective pressure on bugs, thus increasing their resistance.
• Genetic mutations in germs: These mutations have helped the germs in developing capacity to resist the action of affordable antibiotics.
• Resilient bugs replicate and become superbugs: The bugs most vulnerable to the drugs die quickly, while the most resilient ones survive, replicate and become superbugs. AMR occurs when superbugs develop and antimicrobials stop working.
• Untreated disposal of sewage leading to contamination of water bodies with antibiotic resistant microorganisms. 
• Social factors which include self-medication, access to medication without prescription, and lack of knowledge with regard to the use of antibiotics. 

Also Read: 4 New Corals were recorded in Indian Waters 

Impact of Resistance

• There is a threat to prevention and treatment of infections which poses a risk to medical procedures such as chemotherapy, organ transplantation, etc.
• Increase in cost of healthcare with longer hospital stays, additional tests, and costlier drugs.
• AMR represents an existential threat to modern medicine.
• Increase in neonatal and maternal mortality rate.

Prescriptions for Reducing and Potentially Reversing AMR

• Prevention: Disease prevention and wellness are key to public health and thus preventing infections whenever and wherever possible is equivalent to averting resistance. Measures to be undertaken in this regard includes:

1.   Spearheading sanitation drives.

2.   Ensuring a clean water supply.

3.   Supporting hospital-driven infection-control programmes. 

4.   Prescribing antimicrobials judiciously and only when they are absolutely needed.

5.   Need for more cohesion within management strategies.

6. Coordination across the animal industry and environmental sectors to prevent the unnecessary use of antibiotics in farms. 

7.  Use of Vaccines to curb the spread of AMR infections. 

• Development of robust surveillance systems: Such systems will allow us to detect resistant pathogens of all kinds in the environment and hospitals that would eventually allow containment. 
• Investment in Research and Development: Through both government and private funding as there is an urgent need for a strong pipeline of new antibiotics. Developing new antibiotics takes more than a decade and requires upward of $1 billion. 
• New financial incentives to measure return on investment and measure profitability: As the profits on these drugs are negligible, there is a need to formulate new types of financial incentives to measure return on investment and measure profitability by the social value of the antibiotic, breaking the conventional link between sales and profits.
• Bringing in a collective moral vision to AMR: Antibiotic/antimicrobial drugs should be thought of as limited resources that should be available to all.

Measures Undertaken by the Government to tackle AMR

• The Central Drug Standard Control Organization (CDSO) prohibits medical stores from selling key antibiotics without a doctor's prescription.
• India’s Red Line campaign: Under this campaign, prescription-only antibiotics are marked with a red line, to discourage the over-the-counter sale of antibiotics.
• National Health Policy, 2017: It prioritizes the development of guidelines regarding antibiotic use.
• The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017:  It focuses on ‘One Health’ approach which utilizes the existing expertise and infrastructure in various sectors to tackle the public health problems, particularly endemic zoonoses (diseases transmitted between animals and humans) and pandemics, as also to address issues related to AMR.
• Antibiotic Stewardship Program: It has been launched by ICMR to control misuse and overuse of antibiotics in hospital wards and ICUs.
• The “National Programme on the containment of Antimicrobial Resistance”: It aims to promote the rational use of antibiotics in both healthcare providers and the community.

Way Forward

• Antimicrobial resistance is an impending health catastrophe and requires a multi-disciplinary approach and investment in R&D.
• Antimicrobial prescriptions should be based on definitive diagnosis and not on presumptive diagnosis.
• AMR’s contribution to the economy is significant and  it is critical to develop policies and implement them through a holistic “One Health” approach.
• India’s National Action Plan on AMR is an excellent example of the One Health approach and can be used as a roadmap to respond to other similar public health challenges.

News Source: Indian Express

https://indianexpress.com/article/opinion/columns/the-superbugs-are-here-and-they-are-resistant-to-antibiotics-8368851/

Frequently Asked Questions

Q. What is Meant by Antimicrobial Resistance?

Answer: Antimicrobial Resistance (AMR), often also called antibiotic resistance,  occurs when bacteria, viruses, fungi and parasites no longer respond to medicines they were used to treat the infections they caused, consequently, infections become more challenging to cure, increasing the chance of disease spread, serious illness, and death.

Q. What is an Example of Antimicrobial Resistance?

Answer: One example of antimicrobial resistance is MRSA (Methicillin-Resistant Staphylococcus aureus). As per the ICMR Report, MRSA rates are increasing each year from 2016 to 2021 (28.4% to 42.6%).

Q. What are the 4 Types of Antibiotic Resistance?

Answer: Antimicrobial resistance mechanisms fall into four main categories: 

1. Limiting uptake of a drug
2. Modifying a drug target
3. Inactivating a drug
4. Active drug efflux.

Q. What is Antimicrobial Resistance Caused by?

Answer: The resistance occurs because of the following factors:

• Irrational use of antimicrobials.
• Genetic mutations in germs.
• Resilient bugs replicate and become superbugs.
• Untreated disposal of sewage leading to contamination of water bodies with antibiotic resistant microorganisms. 
• Self-medication, access to medication without prescription, and lack of knowledge with regard to the use of antibiotics. 

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