PM Modi flags why antibiotics are failing in pneumonia, UTIs: What you need to do to prevent the silent epidemic of antibiotic resistance

Prime Minister Narendra Modi, in his latest episode of ‘Mann ki Baat’, took note of an important, but often ignored, health concern — antimicrobial resistance. There is a growing threat of antimicrobial resistance in India, leading to difficulty in treating even the most common infections. “… antibiotics are proving ineffective against many diseases like pneumonia and UTI (urinary tract infection). This is a matter of great concern for all of us. A major reason for this is people’s indiscriminate use of antibiotics. Antibiotics are not medicines that should be taken mindlessly. They should be used only on the doctor’s advice,” he said.

Antimicrobial resistance is essentially the ability that pathogens gain to evade drugs meant to kill them and cause persistent infections. This makes infections more severe, difficult to treat, and last longer, with many — especially those with weakened immune systems — requiring hospitalisation for the treatment of even common infections.

Excessive and indiscriminate use of antimicrobials puts pressure on the pathogens to evolve and gain ability to evade the drugs. This process can also lead to the creation of the extremely resistant superbugs.

Dr Kamini Walia, who heads ICMR’s Antimicrobial Resistance Research and Surveillance Network, said, “The data has been documenting increasing levels of resistance and associated deaths — deaths that are not recorded by any system or notified. This is the reason why it is sometimes called a silent pandemic, nobody knows how many lives it is actually claiming in India. The numbers are quite large in the vulnerable groups such as newborns, the elderly population and the immunocompromised population.”

An estimated 2.6 lakh deaths in India due to various infections in 2021 were directly attributable to antimicrobial resistance, meaning the people would not have died had they responded to treatment. That year, a total of 9.8 lakh people died in India with resistant infections — deaths that would not have occurred had the infection been prevented, according to data from Global Burden of Diseases study. The data also shows that most of these deaths occurred in children under the age of five years in 1990 but the highest number of antimicrobial resistance associated deaths in 2021 was in people above the age of 70 years.

A study across 10 hospitals conducted in 2015 found that people with multi-drug resistant bacteria were nearly two times as likely to die as those with infections susceptible to the drugs. This risk went up to three-fold in people with extremely drug resistant infections. The overall mortality due to the resistant infections stood at 13.1%, with rates as high as 29% with Acinetobacter baumannii — a bacteria that can cause pneumonia, blood stream infection, or even urinary tract infection.

Dr Rajiv Bahl, director general of ICMR, warns people against popping antibiotics whenever they have a fever. “Bugs become antibiotic resistant when these are irrationally, overused, or used for small concerns. What this means is the antibiotics afterwards do not work so well. So, it is essential that antibiotics be used only when they are needed. It should be taken only on prescription from a registered medical practitioner, people should not go to a chemist shop and ask for it.” Importantly, when prescribed, the patient should complete their full-course of antibiotic treatment and not stop taking the pills as soon as they start feeling better.

It is also important that a person should not start taking the same pills if they have similar symptoms later on — the same symptoms may be caused by a bacteria or a virus but antibiotics do not work against a virus. People should also not share the prescription with others with similar symptoms.

Importantly, people should not consume antibiotics that are past their expiry date as they may not be effective. “Antibacterial and anti-fungals are effective at a particular dose — any overuse or underuse drives the bugs to become resistant. That’s why it’s very important that the antibiotics we give to the patient are meant for a specific bug, they are given in an appropriate dose, for an appropriate duration.”

A survey of antibiotic prescriptions across 20 tertiary care hospitals in India by the National Centre for Disease Control hinted at antibiotic overuse and misuse. It found that nearly three in four patients were prescribed antibiotics, with more than half the prescriptions not meant for the treatment of an infection but a prophylaxis to prevent one — a practice that is discouraged. The survey also found that 57% of the antibiotics used were from the watch group — a group of antibiotics used in sicker patients that are more likely to lead to antimicrobial resistance.

The use of antibiotic prophylaxis is recommended only when a patient has to undergo a “dirty procedure” — any surgery where the internal organs are opened up or there is pus and faecal matter involved.

Importantly, only 6% of these antibiotics prescribed were definitive treatment — meaning meant to attack a diagnosed infection — with the other 94% being empirical prescriptions given by the doctors based on what they think has caused the infection based on the symptoms and prevalence.

The government came up with the first five-year national plan to combat AMR in 2017. However, several provisions in it could not be implemented, especially owing to Covid-19. The “non-human” health sectors such as animal husbandry took limited ownership and the National Authority for Containment of AMR that was meant to coordinate the inter-sectoral actions was never constituted, according to the new plan.

The National Action Plan 2.0 that will remain in effect between 2025 and 2029 will work on six key objectives, chief among them being creating awareness and understanding on AMR through communication, education and training. It also involves strengthening laboratory capacity for AMR surveillance, reducing the incidence of infection through control measures and optimising the use of antimicrobials in humans, animals, and food.