Antibiotic-resistant superbugs cast a dreaded spell

In 2010, an international study that traced a drug resistant “super bug” strain of bacteria to New Delhi, after which it was named, had the Government in a flap. There was denial from the Government that the Indian subcontinent was the source of this superbug. And there was rage - conspiratorial motives were alleged including a plot to destabilize India as a destination for medical tourism.

While the truth may be somewhere in between, there certainly was a silver lining to this NDM-1 super bug controversy. It put the spotlight on antibiotic resistance, a live and ticking bomb. Resistance happens when bacteria adapts and antibiotics are no longer effective in treating infections caused by them. Simply put, a wound with a bad bug could kill, because even the strongest antibiotic fails to work on the body.

This week, antimicrobial (including antibiotic) resistance received top priority at the 68th World Health Assembly (WHA) in Geneva, with member states agreeing to put a clock on their plans. In two years, countries are expected to have a framework to tackle antimicrobial resistance, aligned to a global action plan.

In its chilling report last year, the WHO had cautioned that the threat of antibiotic resistance was no longer a prediction for the future, but was happening right now, in every region of the world and with the potential to affect anyone, in any country.

This war on antimicrobial resistance assumes significance in India, as health minister JP Nadda is the WHA’s new head. But will India seize this opportunity and crackdown on a problem that the World Health Organisation calls “the most urgent drug resistance trend?”

Step it up Doctors are optimistic that Government will bring in new norms and tighten existing ones that curb irrational use of antibiotics in humans and animals. The worry, however, is on the pace of these actions.

Resistance stems from irrational use of antibiotics or erratic consumption, where people self-medicate or stop taking the drug without completing a seven-day course, for instance.

But the regulatory Drug Controller General of India has recently told State counterparts to rein in irrational sale and ensure that prescription-driven drugs including antibiotics are not sold without a doctor’s recommendation. India seemed to lose some momentum from the initial rush during the super-bug controversy, after it developed a policy (2011) attempting to restrict the sale of all antibiotics.

Remedial measures But the Government did make some progress by restricting the sale of 20-plus antibiotics over the counter, by putting them in a super-restricted H1 category, explains Abdul Gafur, an infectious disease expert with the Chennai Declaration initiative that looks at antibiotic resistance. The use of antibiotics in milch animals, egg-bearing birds, poultry etc has also been notified years ago. And this, along with increased enforcement and pharmaco-vigilance to monitor adverse reactions or record drug resistance, will pack a punch, says the regulatory official, underlining the need for drug regulators, doctors, animal husbandry department etc to work together.

Gafur observes that India’s action plan also needs to assess what goes on in hospitals. “Everyday I treat severe infection and only one or two antibiotics are active,” he says, concerned that cases show resistance to high-end antibiotic carbapenem and colistin.

Hospitals need better infection control and a rational use of antibiotics and general practitioners need to be educated on the dangers of prescribing antibiotics when not required, suggests Gafur.

George Varghese, CMC Vellore’s professor of infectious diseases, insists that all antibiotics (not just 20 odd) should be in a highly restricted category. Short term therapies have no rationale, he adds.

Unhappy with the pace of regulatory action, he explains, bacteria has been on earth for 3.8 billion years and antibiotics, only 70. “Bacteria has evolved over millions of years to adapt to adverse situations”, he says, referring to the herculean pan-country effort required to put a lid on these superbugs.

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