BMJ 2017;357:j2049 doi: 10.1136/bmj.
j2049 (Published 2017 April 26)
News
India launches strategy to curb antimicrobial resistance
Sumi S Dutta
New Delhi
Indias health ministry has announced the countrys first plan
to curb antimicrobial resistance, including measures to prevent
misuse of antibiotics by doctors, consumers, and healthcare
institutions.
The National Action Plan on Antimicrobial Resistance (2017-21)
is the first to assign coordinated tasks to multiple government
agencies involving health, education, environment, and livestock
to change prescription practices and consumer behaviour and
to scale up infection control and antimicrobial surveillance.
Health officials said that the plan aims to tackle longstanding
concerns that antibiotic misuse in the human and animal health
sectors in India is contributing to antimicrobial resistance that
threatens public health in India and other countries.
Releasing the plan, Indias health minister, Jagat Prakash Nadda,
said, We are ready with a blueprint that meets global
expectations. The challenge now is in its efficient
implementation through a coordinated approach at all levels of
use of antibiotics.
The plan follows a call by the World Health Organization to
member states to have national plans in place by 2017, aligned
with a global action plan adopted by the World Health Assembly
in May 2015.
The India plan outlines the need to enforce regulations that
prohibit the sale of antibiotics without prescriptions and promote
guidelines for appropriate use of antibiotics. It cites ample
evidence of pressure from patients that forces medical
practitioners to overprescribe antibiotics, especially for viral
illnesses, upper respiratory tract infections, and diarrhoea.
The plan proposes introducing lessons in schools and colleges
on antimicrobial resistance and the correct use of antibiotics,
as well as establishing nationwide surveillance mechanisms to
study antibiotic use. It warns, India is among the nations with
the highest burden of bacterial infections. Indias crude
mortality from infectious disease stands at 417 per 100 000
persons.
The emergence of resistance is not confined to older and more
frequently used classes of drugs, as a rapid increase has been
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seen in resistance to newer and more expensive antibiotics such
as carbapenems, the plan emphasises.
The Indian Network for Surveillance of Antimicrobial
Resistance, which monitors 15 tertiary hospitals, found that
41% of patients had meticillin resistant Staphylococcus aureus
(MRSA) and found high rates of resistance to ciprofloxacin,
gentamicin, co-trimoxazole, erythromycin, and clindamycin.
Indias drug resistance is a threat to other countries, too. Timothy
Walsh, a professor of medical microbiology at Cardiff
University, and his colleagues described a new mechanism for
carbapenem resistance in a strain of Klebsiella in 2009, which
was isolated from a Swedish patient who had travelled to New
Delhi.[1
In January this year, US doctors reported a patient who seemed
to have acquired a bacterial infection resistant to 26 antibiotics
after she had undergone hip surgery in an Indian hospital last
August.[2
Experts have welcomed Indias plan but warned that it will
require a huge commitment from the government.
Ramanan Laxminarayan, director of the Centre for Disease
Dynamics Economics and Policy in Washington, DC, USA,
who is tracking global trends in antimicrobial resistance, told
The BMJ, Many goals in the action plan look gigantic at
present, and achieving even 10% of what is being promised will
require huge commitment.
I wish that the government had also proposed budgetary
allocation for every strategy announced.
1 Yong D, Toleman MA, Giske CG, et al. Characterization of a new metallo-beta-lactamase
gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic
structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents
Chemother 2009;357:5046-54. doi:10.1128/AAC.00774-09. pmid:19770275.
2 McCarthy M. Woman dies after infection with bacteria resistant to all antibiotics available
in US. BMJ 2017;357:j254. doi:10.1136/bmj.j254 pmid:28096073.
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