Antimicrobial Resistance (AMR) is the phenomenon whereby bacteria, viruses, fungi and parasites evolve mechanisms to survive exposure to antimicrobial medicines that were previously effective.
According to the World Health Organization (WHO), AMR is one of the top ten global public health threats, and a “silent pandemic.”
Example: Multi-Drug-Resistant Tuberculosis (MDR-TB), where resistance develops to isoniazid and rifampicin, the two most potent TB drugs.
AMR is a Cause of Serious Concern:
1. Public Health Impact:
- 1.27 million deaths were directly attributable to bacterial AMR in 2019; it contributed to nearly 5 million deaths globally.
- Rising resistance is reported in over 40% of bacteria–drug combinations from 2018 to 2023.
2. Threat to Modern Medicine: Makes surgeries, organ transplants, chemotherapy and neonatal care significantly riskier undermining decades of medical advancement.
3. Economic Burden: Could lead to global GDP losses of up to USD 3 trillion annually by 2030 due to productivity losses and higher healthcare costs.
4. Agriculture losses: Indiscriminate antibiotic use in livestock accelerates resistance and reduces farm productivity.
5. Regional Vulnerability: Around 41% of bloodstream infection reports originate from India, China and Pakistan combined, highlighting India’s vulnerability.
Global Measures to Combat AMR:
- Global Action Plan on AMR (2015): Adopted by WHO members; mandates national strategies based on surveillance, stewardship and awareness.
- Quadripartite Joint Secretariat on AMR: WHO, FAO, UNEP and WOAH implementing the One Health approach.
- GLASS, 2015: Global surveillance system for AMR and antimicrobial use; country participation has increased four-fold since 2016.
- WHO AWaRe Classification: Promotes rational antibiotic use by prioritising Access antibiotics over Watch and Reserve.
- UN General Assembly Political Declaration on AMR, 2024: Aims to reduce AMR-related deaths by 10% and ensure 70% of human antibiotic use comes from Access group.
- Global Antibiotic R&D Partnership (GARDP): Accelerates development of new treatments for drug-resistant infections.
Measures taken by India:
- National Action Plan on AMR, 2017: Aligned with WHO GAP; adopts a One Health framework covering human health, animal husbandry, agriculture and environment.
- National Programme on AMR Containment: Coordinated by the National Centre for Disease Control (NCDC).
- Schedule H1 (Drugs & Cosmetics Rules, 1945): Restricts over-the-counter sale of critical antibiotics.
- Red Line Campaign: Raises public awareness against self-medication.
- Ban on Colistin (2019): Prohibited in food-producing animals to curb last-resort antibiotic misuse.
Way Forward:
1. Strengthening Antimicrobial Stewardship: Rational prescription, audit of antibiotic use, and clinician training.
2. Expanding Surveillance Systems: Wider coverage of AMR surveillance across human, animal and environmental sectors.
3. Promoting Rapid Diagnostics: Investment in point-of-care diagnostics to reduce empirical antibiotic use.
4. One Health Approach: Integrated action across human health, veterinary, agriculture and environment sectors.
7. R&D boost: Support for new antibiotics, vaccines, and treatment procedures like phage therapy.
Conclusion:
There is a need for coordinated global action, strong regulatory frameworks, scientific innovation and a robust One Health approach. Preserving the effectiveness of antimicrobials is essential not only for present healthcare needs but also for safeguarding future generations.
+1 Value Addition:
- Kerala launched Operation AMRITH to detect illegal antibiotic sales.
- Antibiotic residues like ciprofloxacin residues are far above safe limits in rivers near pharmaceutical hubs.
- Pathogens like E. coli and Klebsiella are particularly dangerous due to multiple resistance mechanisms and limited treatment options.
- Multi-Drug-Resistant Tuberculosis (MDR-TB) resistance to isoniazid and rifampicin illustrates how AMR complicates disease control.
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