HEALTH SPECIAL ................Anti-antibiotic: the resistance move

Anti-antibiotic: the resistance move

India faces a serious health crisis of rising antibiotic resistance thanks to doctors prescribing them unscrupulously.

Pooja Malhotra can’t remember the number of times she has been prescribed antibiotics for a simple cold and cough. The 23-year-old says that many of her friends and family have, like her, blindly popped antibiotics for years without knowing that they are not required to treat coughs and colds. Prescribing antibiotics has become common place among medicine practitioners in India, and is a leading factor contributing to rising antibiotic resistance in the country, say health experts. According to the World Health Organisation (WHO), antibiotic resistance causes people to become sick for longer periods and increases the risk of death. For example, people with MRSA (methicillin-resistant staphylococcus aureus) bacteria are 64 per cent more likely to die than people with a non-resistant form of the infection. Recent data studies have revealed a six-fold increase in the number of antibiotics being popped by Indians. Effective and inexpensive antibiotics like ciprofoxcillin, septran, ampicillin, amoxicillin, roxythromycin and chloramphenicol are now useless in most cases as bacteria have developed resistance to these, says Dr Shrirang Bichu, a nephrologist at Bombay Hospital. “In fact, many higher antibiotics like cefuroxime, ceftriaxone, pipracillin and cefoperazone are also becoming ineffective in most cases. If left uncontrolled, a time will soon come when we will be left with no effective antibiotics.” Passing the bug Dr Camilla Rodrigues, consultant microbiologist and chairperson of the Infection Control Committee at PD Hinduja Hospital, revealed that antibiotic resistance in India is rising because of the absence of good sanitation in community and hospitals. “Every stakeholder needs to act responsibly if we have to control antibiotic resistance. Whether it is a farmer or someone dealing with livestock or a doctor — everyone is using antibiotics without thinking about the consequences,” she says, adding that a person developing antibiotic resistance has widespread implications for society as s/he can spread the resistant bug to others. Treating gram negative infections — which mostly affect hospitalised patients — is becoming difficult because the category of bacteria is evolving and becoming ever more immune to existing antibiotics, adds Dr Bichu. Bacteria classified as gram-negative because of their reaction to the so-called gram stain test can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them resistant to attack with antibiotics than gram-positive organisms like MRSA. “Gram negative infections are a matter of immense concern. This not only leads to prolonged hospital stay but also leads to increased treatment cost,” says Dr Om Shrivastava, infectious disease expert at Jaslok Hospital. According to Dr Khusrav Bajan, an intensivist at Hinduja, “Community acquired pneumonia, urinary tract infections and typhoid are the three diseases whose treatment is most affected because of incidences of antibiotic resistance.” Stronger dose, longer recovery Dr Indraneel Raut, chief intensivist at Jaslok Hospital, gave the example of a 48-year-old male patient who had been admitted to the hospital and was receiving immunosuppressive drugs because of a kidney transplant earlier. “He was admitted for pneumonia infection with a multi-drug resistant bacteria. He was treated with a higher-than-usual dose of antibiotics that finally cleared the infection from his lungs. We've been increasingly seeing more cases of antibiotic resistance,” says Raut. The hospital's microbiology department confirmed that resistance of klebsiella to carbapenem and third generation cephalosporins plus betalactamase inhibitor combination drugs has increased by approximately 20 per cent in 2015 as compared to in 2012. “Resistance to aminoglycosides has increased by 22 per cent. However, resistance of gram positive bacteria, such as staphylococcus aureus, towards the antibiotics has not increased significantly. This data is derived from patients coming from the community, transferred from other hospitals and immunocompromised patients,” says Dr Sonar Narula, consultant microbiologist at Jaslok. The Ministry of Health and Family Welfare has now included high-end antibiotics into Schedule H1 drug category wherein the chemist has to maintain a separate register to keep record of name and address of the prescriber, name of the patient, drug name, quantity, etc. In order to strengthen the surveillance of antimicrobial resistance (AMR) in the country, the Indian Council of Medical Research has set up a National Anti-Microbial Resistance Research and Surveillance Network to enable compilation of national data of AMR. santosh.andhale@dnaindia.net, somita.pal@dnaindia.net, @dna