David Thompson, 49, from Bengaluru, had a sudden change in his life when he was diagnosed with oral cancer. After a successful surgery at a private hospital in the city, he was hopeful of a full recovery. But two weeks after his discharge from the hospital, he returned feverish and weak due to an infection at the wound site.

The infection was resistant to all antibiotics, one of the growing cases of antimicrobial resistance (AMR). Since he was admitted to the ICU of a private hospital for observation, the medical team feared that if the infection spread to his bloodstream, it could become life-threatening. Fortunately, his condition later stabilized and he is now out of the hospital and his condition is improving.

His treating doctor, Vishal Rao US, a surgical oncologist who specializes in head and neck cancer, attributed the patient’s antibiotic resistance to indiscriminate/prolonged use of antibiotics and tobacco use. “He may have been using antibiotics for quite a long time during his early youth before being treated for cancer. They also have a history of tobacco use, which is strongly associated with antimicrobial resistance (AMR). Tobacco users are more likely to receive antibiotics than non-tobacco users. This may lead to an increase in AMR in the community. Smoking can impair the immune system and defense against infection, Dr. Rao said, thereby promoting the spread of AMR in the lungs.

What is AMR?

AMR, declared by the United Nations as one of the top 10 global public health threats facing humanity, occurs when pathogens mutate over time and stop responding to drugs/antimicrobial agents, leading to infections It becomes difficult to treat. This increases the risk of disease spread, serious illness, and death. Exposure to antimicrobial drugs due to misuse, abuse, and/or overuse allows pathogens to acquire resistance to the drug.

But David Thompson’s case is no longer an exception. More and more doctors have had to deal with similar cases. So much so that some hospitals have their own antimicrobial policy advising doctors to use judicious use of antibiotics considering cancer-related aspects, while Karnataka is formulating an action plan to reduce antimicrobial resistance (AMAR), Which is expected to be launched early next year.

Karnataka is working on strict regulations and responsible distribution of medicines. This will ensure that antibiotics are only given with valid prescriptions, thereby discouraging over-the-counter medications. , Photo Credit: Getty Images/iStockphoto

one case after another

In another case, M. Govindappa, 59, a Hoskote resident with a history of diabetes, hypertension and chronic kidney disease, was admitted to a local health facility due to non-healing ulcers. A wound swab revealed the presence of a multidrug-resistant organism. The patient reported that he had previously used several antibiotics for treatment at his local facility.

During treatment with high levels of antibiotics for his ulcers, his kidney function declined, necessitating the initiation of hemodialysis. He is admitted to the state-run Institute of Nephro Urology (INU) for the last two weeks.

Kishan A, professor of nephrology at this government institute, said multidrug resistance limits treatment options to just a few high-end antibiotics, and these strong drugs can come with significant systemic side effects, especially affecting the brain and kidneys. Do it.

“Indiscriminate use of antibiotics is a primary factor contributing to the rise of multidrug-resistant organisms. We are seeing increasing incidence of multidrug resistance in both community-acquired and hospital-acquired infections,” the doctor said.

Ravindra M. Mehta, head of integrated pulmonology and critical care consultant at a private hospital, is currently treating Lalit Kumar Sahu, a 40-year-old male who had recent brain surgery, who has since developed complications. “Puff from the lungs revealed the presence of drug-resistant bugs – enterobacter cloacaeThe fluid around the lungs was also tested and revealed another virulent organism – Klebsiella pneumoniae, which was resistant to most available antibiotics. It was later found that the bug had also spread into his bloodstream and had become life-threatening with the risk of organ failure.

“The patient had to face a double blow due to the infection In fact And antimicrobial resistance makes treatment extremely difficult,” Dr. Mehta explained. The patient had to fight a long six-week battle before being discharged.

“The increased risk to life combined with infection, multidrug resistance, and the side effects of powerful antibiotics is the ‘terrible triad’ of modern antimicrobial resistance. “COVID-19 has brought us together like never before and AMR is a more powerful threat that requires global cooperation beyond borders,” the doctor said.

The World Health Organization’s Global Action Plan on AMR provides a comprehensive framework to tackle AMR to ensure the continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used responsibly And are accessible to all who need them. , Photo Credit: Getty Images/iStockphoto

action plan

The World Health Organization (WHO) Global Action Plan on AMR provides a comprehensive framework to tackle AMR to ensure continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, responsibly administered are used and accessible to all. They are needed.

The Government of India launched the National Action Plan in 2017 adopting a One-Health framework, which recognized the interconnectedness of human, animal and environmental health with six strategic focus areas.

These include improving awareness and understanding of AMR through effective communication, education and training, strengthening knowledge and evidence through surveillance; reducing the incidence of infection through effective infection prevention and control; Optimizing the use of antimicrobial agents in health, animals and food, promoting investment for AMR activities, research and innovations, and strengthening India’s leadership on AMR.

Karnataka’s future plans

In Karnataka, Health Minister Dinesh Gundu Rao declared AMR a focus area in November 2023. He directed the Health Family Welfare Department to revive efforts to strengthen the state’s capacity to tackle AMR and draft a state action plan which has been pending for six years. ,

Shwetavalli Raghavan, appointed as advisor on AMR in the Karnataka health department, is developing the Action Plan to Reduce Antimicrobial Resistance (AMAR) in Karnataka, which is likely to be launched in the first quarter of 2025.

“Self-medication, not completing prescribed courses, and use of antibiotics for viral infections against which they are ineffective are common practices. In India, AMR is one of the top five causes of death. The primary objective of the State Action Plan in the short term will be to reduce antibiotic misuse by increasing awareness, improving infection control measures and promoting best management practices to prevent the increasing burden of resistant infections.

Simultaneously, the plan will lay down a blueprint for capacity building within the State, including necessary digital and physical infrastructure for monitoring and surveillance, human resources to strengthen preparedness to deal with outbreaks of resistant infections in humans and animals. Involves development of resources and communication networks. Dr. Raghavan said that to take this issue forward, responsible leadership will have to be developed at all levels.

Emphasizing the importance of adopting the One Health framework, which considers human, animal and environmental health as interconnected and interdependent, he said, “Building robust surveillance and monitoring of antimicrobial sales, use, disposal and resistance in all sectors Necessary to inform the aspirant. , evidence-based and risk-based targets and interventions to address gaps in the response to AMR.

responsible distribution

Karnataka is also working on strict regulations and responsible distribution of medicines. This would ensure that antibiotics would only be given with valid prescriptions, thereby discouraging over-the-counter medications.

In August this year, a survey conducted by a research team from St. Joseph’s University headed by Dr. Raghavan revealed that about 80% of the 108 pharmacies where the “test-buy” campaign was conducted were over-the-counter. Used to sell over the counter antibiotics.

“Of the remaining 20% ​​who abstained, one in three did not sell because they did not have stock. Moreover, more than 50% of these 108 pharmacies did not bill us unless we requested. A quarter of these were handwritten,” Dr. Raghavan said.

“Although pharmacists were aware that over-the-counter selling was a punishable offense, the fear of losing business (because customers could easily purchase medications from another pharmacy) and familiarity with the customer (which allowed the pharmacist to maintain trust and relationship) Customer) is one of the reasons they do so. Additionally, lack of easy access to health care, which leads consumers/patients to seek help directly from pharmacists, and low awareness among consumers about the legal and health consequences of purchasing and using antimicrobial drugs without a prescription The shortage also contributes to this threat,” he said. ,

behavior change

To control AMR, behavior change is required at all levels, from doctors to patients. Pointing out that more than 17,000 pharmacists and pharmacology students have been sensitized on the dangers of AMR through an interactive workshop, Dr. Raghavan said that this subgroup of health care professionals, who are often ignored, Can influence public awareness, attitudes and behavior on the use of antimicrobials. Medicines.

Subsequently, the Health Minister made a public appeal to use antibiotics responsibly and directed pharmacies to display mandatory warnings within their premises on the purchase/use of antibiotics. A follow-up survey is planned to be conducted in the next quarter with the aim of understanding the effectiveness of the awareness activities.

Following the “test-buy” campaign, cases have been registered by the State Drug Control Department against several pharmacies for indulging in activities that are contrary to the provisions of the Drugs and Cosmetics Act, 1940, Drugs and Cosmetics Rules 1945. Like other applicable laws, which are directly contributing to the rise in antimicrobial resistance, the minister said.

“People should complete the course of antibiotics prescribed by the doctor and should not use old prescriptions to self-medicate, and this is part of the public appeal display board. We will soon conduct random checks to find out whether the boards are displayed in all the pharmacies,” he said.

“The display boards are to make people as well as pharmacies aware about AMR. This is due to the widespread misuse of antibiotics in human medicine, agriculture and veterinary practices and challenges in the health care infrastructure,” he said.

(Patient names have been changed to protect confidentiality)