World Antibiotics Awareness Week 2017: Report maps antimicrobial resistance research in India

The report identifies factors driving antibiotic resistance and maps the current research in the country

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New Delhi: A report by the researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) released last week, identifies factors driving antimicrobial resistance (AMR), and maps and identifies current research gaps in India. The study was commissioned by the Department for Biotechnology (DBT), Government of India, in partnership with Research Councils United Kingdom (RCUK).

AMR is a global public health threat and India has some of the highest antibiotic resistance rates among bacteria that commonly cause infections in the community and healthcare facilities. India released the National Action Plan (NAP) to combat Antimicrobial Resistance in April, this year.

The study helps to determine future research priorities, and in designing interventions.

Key findings:

Human use

  • Resistance to broad-spectrum antibiotics such as fluoroquinolones and cephalosporins in cases of bloodstream infections, was found to be more than 70% in Acinetobacter baumanniiEscherichia coli, and Klebsiella pneumoniae   more than 50% in Pseudomonas aeruginosa

  • Per capita, antibiotic consumption in India is lower than several high-income countries. Yet, resistance rates to many antibiotics are the highest among Indians.

  • Several third-generation antibiotics and fixed-dose combinations are widely available and commonly prescribed whereas first-line antibiotics are not. Only one pharmaceutical company in India is manufacturing penicillins currently.

  • Impact of antibiotic policies such as Schedule H1 and Red Line campaign have not yet been studied.

Veterinary use

  • Bacteria resistant to broad spectrum (third generation) antibiotics have been found in poultry, cattle, pigs, and fish.

  • Colistin, a last resort antibiotic in human medicine is used for growth promotion in poultry.

Environment

  • More than 40 human antibiotic bulk-manufacturing companies and more than 250 human antibiotic formulation companies are present in India.

  • Hotspots for antibiotic environmental pollution include manufacturing sites in Hyderabad in Telangana, Ankleshwar and Karkhadi in Gujarat, Aurangabad, Mumbai and Tarapur in Maharashtra, Baddi and Ponta Sahib in the Himachal Pradesh and Derabassi in Punjab.

  • There are no standards for antibiotic residues from pharmaceutical industrial pollution in the country.

  • Last-resort antibiotic resistance genes (NDM-1) have been identified in several major rivers in India. At the time of religious mass bathings in river Ganga, NDM-1 levels have been found to be 20 times higher than normal. This is due to inadequate sewage waste management during mass gatherings.

CDDEP fellow Sumanth Gandra, the lead author of the research, says, “Studies published in India on antimicrobial resistance are limited in scope in all areas including humans, animals and environment. We need urgent investments in interdisciplinary studies to ensure appropriate policies are formed to contain the public health threat.”

CDDEP South-Asia Head and co-author Jyoti Joshi says, “The research highlights the need for new technologies, standards and detection tools for antibiotic residues in the environment.”

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