Model Answer
0 min readIntroduction
Antimicrobial resistance (AMR) is a global health threat, and India is particularly vulnerable. The indiscriminate use of antibiotics, often available over-the-counter without a physician’s prescription, is a major driver of this resistance. This practice fuels the evolution of ‘superbugs’ – bacteria resistant to multiple drugs – rendering common infections increasingly difficult and expensive to treat. The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2022-2027 acknowledges this challenge and aims to combat AMR through a One Health approach, but significant hurdles remain in effectively controlling antibiotic overuse and availability.
Contribution of Overuse and Free Availability to Drug Resistance
The overuse and free availability of antibiotics contribute significantly to the emergence of drug-resistant diseases through several mechanisms:
- Selective Pressure: Antibiotics kill susceptible bacteria, leaving behind resistant strains to proliferate. Frequent exposure to antibiotics creates a strong selective pressure favoring the survival and spread of these resistant strains.
- Horizontal Gene Transfer: Bacteria can share resistance genes through horizontal gene transfer, rapidly disseminating resistance across different species.
- Lack of Diagnostic Certainty: Often, antibiotics are prescribed for viral infections where they are ineffective, contributing to unnecessary antibiotic exposure.
- Self-Medication: Easy access to antibiotics without prescription encourages self-medication, leading to incorrect dosage, incomplete courses, and inappropriate use.
Statistics (as of 2022 knowledge cutoff): A 2016 review in *The Lancet Infectious Diseases* estimated that India had the highest consumption of antibiotics in the world, with a total consumption of 6.2 billion units.
Available Mechanisms for Monitoring and Control
India has several mechanisms in place to monitor and control antibiotic use and resistance, though their effectiveness varies:
- National Programme on Antimicrobial Resistance (NP-AMR): Launched in 2017 under the National Health Mission, it focuses on surveillance of AMR, infection control, and appropriate antibiotic use.
- Indian Council of Medical Research (ICMR) - AMR Surveillance Network: Collects data on antibiotic resistance patterns from hospitals across India.
- Red Line Campaign: Launched in 2019, this campaign aims to raise awareness about the need for prescription-based antibiotic use.
- Schedule H & H1 Drugs: The Drugs and Cosmetics Rules, 1945, categorize certain antibiotics as Schedule H and H1 drugs, requiring a prescription for dispensing. However, enforcement is weak.
- National Action Plan on Antimicrobial Resistance (NAP-AMR) 2022-2027: Aims for a One Health approach, integrating human, animal, and environmental health aspects of AMR.
Critical Issues Involved
Despite these mechanisms, several issues hinder effective control:
- Weak Regulatory Enforcement: The enforcement of prescription requirements for Schedule H and H1 drugs is lax, particularly in rural areas.
- Lack of Awareness: Both healthcare professionals and the public lack sufficient awareness about the appropriate use of antibiotics and the dangers of AMR.
- Inadequate Diagnostic Infrastructure: Limited access to rapid and accurate diagnostic tests leads to empirical antibiotic therapy, increasing the risk of inappropriate use.
- Over-the-Counter Availability: Despite regulations, antibiotics are often readily available over-the-counter in pharmacies, especially in smaller towns and villages.
- Antibiotic Use in Animal Husbandry: The use of antibiotics as growth promoters in livestock contributes to the development and spread of AMR. This sector is largely unregulated.
- Poor Infection Control Practices: Inadequate infection control practices in healthcare settings contribute to the spread of resistant organisms.
Example: The emergence of New Delhi Metallo-beta-lactamase 1 (NDM-1) in India, a gene conferring resistance to carbapenem antibiotics, highlights the severity of the problem and the need for urgent action.
Table: Comparison of Regulatory Frameworks for Antibiotic Use
| Aspect | India | United Kingdom |
|---|---|---|
| Prescription Requirement | Schedule H & H1 drugs require prescription, but enforcement is weak. | Strict prescription-only status for most antibiotics. |
| Surveillance | ICMR-AMR Surveillance Network | UK Antimicrobial Resistance and Healthcare-Associated Infection (AMR HAI) Programme |
| Antibiotic Stewardship | Emerging, primarily hospital-based. | National Institute for Health and Care Excellence (NICE) guidelines and widespread implementation. |
Conclusion
Addressing the challenge of antibiotic resistance in India requires a multi-pronged approach. Strengthening regulatory enforcement, raising public and professional awareness, improving diagnostic infrastructure, and regulating antibiotic use in animal husbandry are crucial steps. A One Health approach, as advocated by NAP-AMR 2022-2027, is essential for long-term success. Failure to address this issue will have severe consequences for public health and economic development, potentially reversing decades of progress in infectious disease control.
Answer Length
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