The government to restrain prescription and sale of antibiotics to fight drug resistance.

The government may soon issue restrictions on prescription and sale of commonly used antibiotics in an attempt to avoid development of drug resistance to infectious diseases like tuberculosis, malaria, urinary tract infection and even HIV.

Doctors and chemists will have to follow certain mandatory protocols and guidelines while prescribing antibiotics. For instance, chemists will have to maintain records of all kinds of antibiotics that they procure and sell along with the doctor’s prescription. The move is part of the new global strategy, adopted by all member countries of the World Health Organization, to fight drug-resistant diseases.

While WHO will assess implementation of the strategy at its ongoing South East Asia Regional Committee meeting in Timor Leste, India is so far ahead of the May 2017 deadline set up at the World Health Assembly meeting of WHO in Geneva in May, officials said. The resolution passed at the Assembly, which is the highest decision making body of the UN agency, asked countries to frame plans by May 2017 and align them with WHO’s global strategy.

Standard Drug Treatment Protocol Ready

“India is ready with the standard treatment protocol,” said Rajesh Bhatia, chief scientific advisor to the regional director, WHO South East Asia Regional Office (SEARO). The health ministry, along with central drug regulator Drugs Controller General of India, has already framed standard treatment guidelines, which will be notified very soon, he said.

AMR

 

The guidelines, part of a national action plan on anti-microbial resistance, will present a blueprint with specific norms for doctors, chemists and patients. While all countries are struggling with the problem of rising drug resistance, India is primarily coping with antibiotics resistance which is posing an increasing threat to treating infectious diseases, as well as undermining many other advances in medicine.

  • Facts on antimicrobial resistance

Currently, over 700,000 deaths each year are attributed to drug resistance. In India, an additional two million lives can be lost by 2050 due to drug resistance. For instance, while India accounts for the highest number of tuberculosis cases, it is also the hub of multi-drug resistant (MDR) tuberculosis. Out of the estimated global annual incidence of 9 million tuberculosis cases, India accounts for 2.3 million.

  • About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths.
  • Extensively drug-resistant tuberculosis (XDR-TB) has been reported in 64 countries to date.
  • Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.
  • Falciparum malaria parasites resistant to artemisinins are emerging in South-East Asia; infections show delayed clearance after the start of treatment (indicating resistance).
  • A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci.
  • Resistance is an emerging concern for treatment of HIV infection, following the rapid expansion in access to antiretroviral medicines in recent years; national surveys are underway to detect and monitor resistance.
  • Ciprofloxacin is the only antibiotic currently recommended by WHO for the management of bloody diarrhoea due to Shigella organisms, now that widespread resistance has developed to other previously effective antibiotics. But rapidly increasing prevalence of resistance to ciprofloxacin is reducing the options for  safe and efficacious treatment of shigellosis, particularly for children.
  • New antibiotics suitable for oral use are badly needed.
  • AMR has become a serious problem for treatment of gonorrhoea (caused by Neisseria gonorrhoeae), involving even “last-line” oral cephalosporins, and is  increasing in prevalence worldwide. Untreatable gonococcal infections would result in increased rates of illness and death, thus reversing the gains made in the control of this sexually transmitted infection.
  • New resistance mechanisms, such as the beta-lactamase NDM-1, have emerged among several gram-negative bacilli. This can render powerful antibiotics, which are often the last defence against multi-resistant strains of bacteria, ineffective.

Apart from the standard protocol, WHO’s global plan sets out five key Objectives:

  • Improve awareness and understanding of anti-microbial resistance
  • Strengthen surveillance and research
  • Reduce incidence of infection
  • Optimize use of anti-microbial medicines
  • Ensure sustainable investment in countering antimicrobial resistance.
  • The plan also covers use of anti-microbial medicines in animal health and agriculture, apart from human health.

What is antimicrobial resistance? 

Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.

Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g. antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.

The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food-handling encourage the further spread of antimicrobial resistance.

What is the difference between antibiotic and antimicrobial resistance? 

Antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections. Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV) and fungi (e.g. Candida).

WHO has already launched COMBAT DRUG RESISTANCE mission.

drug res

Source-Times of India

WHO site

Click here to Download WHO Global Report on Surveillance