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Drug War: On use of antibiotics and antimicrobial resistance

Background:

The adage “prevention is better than cure” holds valuable wisdom in medicine. However, blindly wielding this principle, particularly in the form of prophylactic antibiotic use, risks undermining the very purpose of treating patients – their recovery. This concern becomes even more dire when considering the rise of antimicrobial resistance (AMR), a phenomenon where pathogens evolve to evade the very drugs designed to combat them.

Relevance

  • GS3 – Science and technology- developments and their applications and effects in everyday life.
  • GS2 – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Main Exam Question:

Critically analyze the challenges posed by rising antimicrobial resistance (AMR) in India, citing evidence from the recent “First Multicentric Point Prevalence Survey of Antibiotic Use.” Suggest concrete solutions to combat AMR and ensure responsible antibiotic use for the future of healthcare.

In Reports

The recent “First Multicentric Point Prevalence Survey of Antibiotic Use at 20 NAC-NET Sites India 2021-22”conducted by the National Centre for Disease Control paints a worrying picture.

  • The survey reveals that in over 70% of cases across hospitals in 15 states and 2 union territories, patients received antibiotics. But the truly alarming statistic is that 55% of these prescriptions were purely prophylactic, not to treat existing infections.
  • Only 45% of antibiotic use targeted active infections, and an even smaller 6% were based on specific bacterial identification.

AMR Explained:

  • Pathogens are microorganisms like bacteria, viruses, and fungi that can cause disease.
  • Over time, through mutations and genetic exchange, these pathogens can develop resistance to the drugs designed to kill them. This is antimicrobial resistance (AMR).
  • Resistant pathogens become difficult or impossible to treat, leading to longer illnesses, increased healthcare costs, and even death.

Prophylactic Antibiotic Use: A Double-Edged Sword

  • Prevents infections in high-risk situations: Used before surgery, dental procedures, or in immunocompromised individuals to prevent post-operative or opportunistic infections.
  • Reduces infection rates in specific scenarios: Can be effective in certain situations like preventing recurrent urinary tract infections or traveler’s diarrhea.
  • Contributes to AMR: Unnecessary use accelerates the development of resistant bacteria, threatening effective treatment of future infections.
  • Increases potential for side effects: Antibiotics can disrupt gut flora, cause allergic reactions, and contribute to antibiotic-associated diarrhea.
  • Misuse is widespread: The recent survey highlights the issue of over-prescription and lack of bacterial identification for prophylactic use
The Dangers of Misuse and Overuse:
  • The survey’s findings highlight the rampant misuse and overuse of antibiotics, contributing to the rapid rise of AMR. This accelerates the evolution of resistant pathogens, putting a question mark on the efficacy of these vital drugs.
  • The World Health Organization (WHO) estimates that AMR was responsible for 1.27 million deaths globally in 2019 and contributed to 4.95 million deaths.
  • AMR jeopardizes not only infection treatment but also other medical procedures like surgery, cesarean sections, and cancer chemotherapy, which rely on effective antibiotics to prevent complications.
The Role of Players:
  • Doctors: Responsible for prescribing antibiotics judiciously, based on specific bacterial identification and only when necessary.
  • Government: Needs to enforce regulations on antibiotic use, invest in research, and ensure access to effective drugs.
  • Patients: Must understand the dangers of unnecessary antibiotic use and practice patience when seeking treatment.

Way forward

Infectious disease specialists and critical care experts have long sounded the alarm on AMR, advocating for rational antibiotic prescription practices. Curbing the non-therapeutic use of antibiotics in both humans and animals is crucial. Addressing the research and development pipeline crisis for new antibiotics is essential to stay ahead of evolving pathogens. Equitable access to new and existing antibiotics globally is another critical aspect.


February 2024
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