Antimicrobial Resistance

Antimicrobial Resistance (AMR) - Key facts and overview

Key Factors Contributing to AMR

Inappropriate Use of Antimicrobials: Overprescription, self-medication, and misuse of antibiotics in humans and animals accelerate resistance.
Weak Regulations and Enforcement: Lack of strict policies to regulate antibiotic sales and usage.
Inadequate Infection Prevention and Control: Poor hygiene practices in healthcare facilities and farms contribute to the spread of resistant organisms.
Limited Access to Quality Healthcare: Insufficient diagnostic tools lead to inappropriate treatment.
Environmental Contamination: Improper disposal of antibiotics and untreated waste from pharmaceutical industries and healthcare facilities.
Global Travel and Trade: Facilitates the rapid spread of resistant pathogens across borders.
Lack of Awareness: Insufficient public knowledge about the consequences of antimicrobial misuse.

Introduction

Antimicrobial Resistance (AMR) is one of the most pressing public health challenges of the 21st century. It occurs when microorganisms develop the ability to defeat the drugs designed to kill them, rendering standard treatments ineffective. AMR threatens the foundations of modern medicine and jeopardizes global health, food security, and economic stability. This document explores the key aspects of AMR, its global and local impact, and the urgent need for collective action to address this growing crisis.

What is AMR? Antimicrobial resistance (AMR) is the ability of microorganisms—like bacteria, viruses, and some parasites—to stop an antimicrobial agent (such as antibiotics, antivirals, and antimalarials) from working against it. This leads to:

Ineffective standard treatments
Persistent infections
Increased risk of spread to others

AMR is a natural evolutionary process, often accelerated by mutations. Some resistance mechanisms include:

Decreased cell permeability
Active efflux pumps
Enzymatic inactivation
Modification of drug receptor sites
Synthesis of resistant metabolic pathways

Human actions, such as the inappropriate use of antibiotics and poor infection prevention, further exacerbate AMR. Alarmingly, antibiotic resistance is rising worldwide, posing a critical public health threat.

AMR in India India's healthcare system comprises public and private sectors, along with practitioners of both allopathic and traditional AYUSH systems (Ayurveda, Unani, Siddha, and Homeopathy). Antibiotics are often prescribed by all types of practitioners, and even informal healthcare providers without formal qualifications or registration dispense antibiotics.

Key Drivers in India:

Over-the-counter availability of antibiotics, driven by consumer demand
Weak enforcement of existing regulations

Why Awareness is Essential: Educating students and the general public on responsible antibiotic use and infection prevention is vital to combating AMR.

Global Perspective on AMR The World Health Organization (WHO) has emphasized the alarming levels of resistance in common bacteria, reducing treatment options for common infections. If no action is taken, AMR could lead to:

Nearly 10 million deaths annually by 2050
Increased difficulty in treating infections
Hindered ability to perform life-saving procedures such as cancer chemotherapy, organ transplants, and surgeries

Economic and Societal Impacts:

Increased healthcare costs due to expensive and intensive care
Reduced productivity due to prolonged hospital stays
Negative impact on food security and agricultural productivity

Contributing Factors Globally:

Lack of access to clean water, sanitation, and hygiene (WASH)
Poor infection prevention and control in homes, healthcare facilities, and farms
Inadequate access to quality vaccines, diagnostics, and medicines
Limited awareness and knowledge about AMR
Weak enforcement of relevant legislation

Present Situation: Drug Resistance in Bacteria The 2022 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report highlighted alarming resistance rates among bacterial pathogens:

42% resistance in E. coli to third-generation cephalosporins
35% resistance in Staphylococcus aureus to methicillin

For urinary tract infections caused by E. coli, 1 in 5 cases showed reduced susceptibility to standard antibiotics like ampicillin and fluoroquinolones. Resistance is also rising in Klebsiella pneumoniae, leading to increased use of last-resort drugs like carbapenems, for which resistance is also emerging.

AMR in India: Human and Animal Impact

Human Health:
- India has high rates of bacterial infections. AMR heavily contributes to child mortality, with 410,000 children under five dying annually from pneumonia.
- Resistance has risen to both older and newer antibiotics, including carbapenems.
Animal Sector:
- Unregulated antibiotic use in dairy, poultry, and aquaculture drives resistance.
- Studies reveal multidrug-resistant bacteria in over two-thirds of fish samples.