Antimicrobial resistance is
rising to dangerously high levels at state as well as national level. Among the
key factors responsible for antimicrobial resistance in India are the
widespread use and availability of practically all the antimicrobials across
the counter, increasing and wanton use of antibiotics in livestock production,
inappropriate doses, and irrational use of antibiotics in hospitals. New
resistance mechanisms are emerging and spreading globally, threatening our
ability to treat common infectious diseases. A growing list of infections such
as pneumonia, tuberculosis, blood poisoning and gonorrhoea are becoming harder,
and sometimes impossible, to treat as antimicrobials become less effective. Emergence
and growth of superbugs is endangering human lives by making existing
antibiotics worthless. In the year 2008 a bacterial strain “New Delhi
Metallo-beta-lactamase” (NDM1), named after an enzyme that renders bacteria
resistant to a broad spectrum of antibiotics, crossed the shores and spread
resistance in the U.K. as well. It was in 2011 that the Union government came
up with a National Policy for Containment of Antimicrobial
Resistance in India, seeking to reverse what seemed to be a spiralling
healthcare concern. However no such policy has been framed or implemented in
the state of Jammu and Kashmir as on date.
In almost every nook and corner
of our state antimicrobials can be bought for human or animal use without a
prescription in spite of the fact that a new schedule H1 under Drugs and
Cosmetics Rules of 1945 has been created to restrict the OTC sale of antimicrobials
vide gazette notification of the Government of India that came into force from
Mar 1, 2014. This makes the emergence and spread of resistance only worse.
Similarly, in absence of standard treatment guidelines, antimicrobials are
often over-prescribed by health workers and veterinarians as well as over-used
by the patients. Self-medication of antibiotics by patients is also highly
prevalent in our state where patients resort to antibiotic use either on the
basis of earlier use by self or by others. This needs to be reduced through
proper education and awareness campaigns.
In times of sickness, people in
our part of the world prefer to consult an unqualified pharmacist, a compounder
or a Medical Assistant rather than a qualified physician and in turn get
dispensed with heavy doses of antibiotics, sans any prescriptions, most often
consisting of irrational combinations of newest generation antimicrobials. This
only adds to the catastrophe of antimicrobial resistance. Even most of the qualified
physicians of the state, in a bid to bring instant symptomatic relief to their
patients, rampantly prescribe antimicrobials not only to adults but to paediatric
patients too without conducting any culture sensitivity tests. Very few culture
sensitivity tests are conducted upon hospitalized patients at primary,
secondary as well as tertiary care hospitals before prescribing antibiotics.
Situation in private sector is as bad or may be even worse than the government
sector. Rational antimicrobial prescribing in accordance with established norms
and international guidelines is not precisely followed in either sector.
Current scenario of
antimicrobial prescribing and use is likely to bring us sooner than any other
part of the world at the doorstep of antibiotic apocalypse unless we take
adequate measures to avert the impending crisis. Without urgent action, we are
heading towards a post-antibiotic era, in which common infections and minor
injuries will be sufficient enough to kill. Therefore there is need to frame “Hospital
Antibiotic Policy” for each and every tertiary care hospital of our state; to prepare
standard treatment guidelines, SOPs and algorithms for treating various
microbial infections and to constitute infection control committees in all
hospitals who would function in accordance with discrete infection control
procedures that include both prevention and control measures.
Even if new medicines are developed in near future,
without behavioural changes, antimicrobial resistance will continue to remain a
major threat. Therefore behavioural changes must include actions to reduce the
spread of infections through vaccination, hand washing, practising safer sex,
and good food hygiene. Antimicrobial resistance is accelerated by the misuse and
overuse of antimicrobials, as well as poor infection prevention and control. Therefore
steps need to be taken at all levels of society to reduce the impact and limit
the spread of resistance.
People in Kashmir seem to be
conventionally inclined towards usage of high cost antibiotics belonging to
latest generation due to the perception that they treat infections faster and
better. In order to prevent and control the spread of antibiotic resistance,
individual patients need to use antibiotics only when prescribed by a certified
health professional; never demand antibiotics if health worker doesn’t feel the
need to prescribe them; always follow health worker’s advice when using
antibiotics, never share or use leftover antibiotics; prevent infections by
regularly washing hands; preparing food hygienically; avoiding close contact
with sick people; practising safer sex and keeping vaccinations up to date.
Stronger hygiene and infection prevention measures, including vaccination, can
limit the spread of resistant microorganisms and reduce antimicrobial misuse
and overuse.
Policy
makers need to frame a robust action plan to tackle antibiotic resistance; improve
surveillance of antibiotic-resistant infections; strengthen policies,
programmes, and implementation of infection prevention and control measures; regulate
and promote the appropriate use and disposal of quality medicines and make necessary
information available on the impact of antibiotic resistance. Regulators need
to ensure sale of antimicrobials strictly in accordance with prescriptions.
Sale and purchase records need to be checked on regular basis by them to ensure
that they are not sold over-the-counter without prescriptions.
Antibiotics are frequently used
to stimulate growth or prevent infections in poultry farms, cowsheds and
slaughterhouses. Sustainable animal husbandry practices can reduce the risk of
resistant bacteria spreading through the food chain to humans. In addition to
better prescribing practices, the concerned authorities must restrict patients’
and the agricultural industry’s inappropriate and unregulated use of
antimicrobial agents. The use of sub-therapeutic doses of antibiotics
in animal feed and/or water to promote growth and
improve feed efficiency particularly in poultry farms has not perhaps been
officially banned as yet in J&K which is leading to the continuation of
this malpractice and eventually these drugged chicken are promoting antimicrobial
resistance.
Health
professionals like qualified pharmacists and nurses can help a great deal to prevent
and control the spread of antibiotic resistance by ensuring that their hands,
instruments, and environments are clean; by prescribing and dispensing
antibiotics only when they are needed, that too in accordance with current
guidelines; by reporting antibiotic-resistant infections to surveillance teams;
by counselling their patients about how to take antibiotics correctly, and about
antibiotic resistance and the dangers of misuse; by educating their patients
about preventing infections (for example, vaccination, hand washing, safer sex,
and covering nose and mouth when sneezing).
Infection prevention measures
such as sanitation, hand washing, food and water safety, and vaccination can
decrease the spread of microorganisms resistant to antimicrobial medicines. By
preventing infectious diseases whose treatment would require antimicrobial
medicines and viral infections which are frequently mistreated with
antimicrobial medicines, we can better steward these essential medicines. Raising
awareness of antimicrobial resistance and promoting behavioural change through
public communication programmes that target different audiences in human
health, animal health and agricultural practice as well as consumers is
critical to tackling this issue. Including the use of antimicrobial agents and
resistance in school curricula will also promote a better understanding and
awareness from an early age.
Making antimicrobial resistance
a core component of professional education, training, certification, continuing
education and development in the health and veterinary sectors and agricultural
practice will help to ensure proper understanding and awareness among
professionals. With J&K already being labelled as one of the highest
consumers of medicines countrywide, irrational prescribing, illegal dispensing
and unscientific use of antimicrobials is destined to make us notorious world
leaders in antimicrobial resistance too just the way we are leading in
corruption on the Transparency International’s Corruption Perception Index. Therefore
adequate measures need to be taken well in time by the government through its
health ministry, the prescribers, the pharmacists, the drug regulators,
hospital administrators, civil society members as well as by individuals to
avert this apocalypse, for it is better to be late than never.
