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Antimicrobial Resistance: A silent Pandemic

Anti-microbial resistance (AMR) is a global health and environmental threat with WHO declaring it as one of the top 10 Global public health threat humanity is facing

Post by on Friday, December 3, 2021

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Antimicrobial resistance is the silent pandemic approaching us. Antibiotics, the wonder drugs of 20th century play a critical role in treating the bacterial infections and were modern medicines greatest success. The story starts back in 1920’s by the discovery of the penicillin by Alexander Flemming. The period from 1950-1970 was considered as the golden era of discovery of novel antibiotic classes. Penicillin after its discovery was not distributed to general public until 1940 and only after one year of its sale to general public the people started to develop penicillin resistance. Since then the story of antibiotic resistance in getting worse day by day. Today we are not only facing the resistance to the major available antibiotics but to antivirals, antifungals and antiprotozoal and for that reason instead of the term antibiotic resistance antimicrobial resistance is used. 
Antimicrobials and antimicrobial resistance
Includes antibiotics, antivirals, antifungals and antiparasitic that are used to prevent and treat the diseases in animals, humans and plants. When the antimicrobials such as virus, fungus and bacteria no longer respond to the antimicrobials and make it difficult or impossible to treat the disease. Bactria are present on earth from over 3.5 billion years and it only takes 30 minutes for them to multiply due to simple random natural mutations. Among the various bacteria present some show resistance to antibiotics due to efflux pumps, by preventing drug uptake, inactivation of antibiotics, target site modification and plasmids. These resistant bacteria room to thrive and multiply and can transfer part of their DNA to other bacteria and this is how AMR develops. Antimicrobial resistance (AMR) is widely accepted as a worldwide health issue, yet its scope remains unknown in many regions of the world.
Anti-microbial resistance (AMR) is a global health and environmental threat with WHO declaring it as one of the top 10 Global public health threat humanity is facing. Antibiotics are the only drugs which every time each one of us uses it becomes less and less effective not only in us but in those who are not even exposed to the drug.  Annually AMR kills about 700000 people around the world and of we continue with the current trajectory by 2050 we will be losing 10 million people to this AMR. It means that loss of a life every 3 seconds due to AMR. The AMR effects GDP with 2-3.5 % decrease per year and decrease in 3-8% of the livestock per year. In year 2013 CDC published the first antibiotic resistance report that sounded the alarm to the danger of antibiotic resistance. The report stated each year in U.S at least 2 million people get a antibiotic resistance infection and atleast 23000 people die among them. There has been high rate of resistance against frequently used antibiotics. Various resistant species has been developed against Carbapenems and to colistin also. Colistin is the last resort antibiotic and is also exhausting. In 2019 a new AMR indicator was included in SDG for monitoring blood frequency of Methicillin-resistant Staphylococcus aureus (MRSA) and 3rdGeneration carbapenes. 
AMR is a major public health concern in India where AMR is not limited to old and more frequently used drugs but there has been rapid increase in resistance to newer and more expensive drugs like carbapenems that is worrisome. Carbapenems are the last resort antibiotics used when i and ii line of treatment fails. There has also been drastic increase in Rifampicin resistant TB and Multiple drug resistant TB. The drug resistance to the antivirals like resistance to anti-retroviral therapy for HIV, antimalarial like Drug resistance to Artemisin based combinations and drug resistance to antifungals like Fluconazole, amphotericin B and areconazole. 
Alexander Fleming the person who invented penicillin predicted this situation we are now over 70 years ago because he understood a very nature of bacteria. We are now living in an after math of overuse where a simple cut or a simple surgery will be life taking and organ transplant will became a distant goal. The main three check points we need to follow is 
(i) Stop use of antimicrobials in food animals as far as possible: 
AMR in food animals 
In animals the antibiotics are mainly used for three purposes i.e., treatment, metaphylaxis and growth promoters. Rising income levels have resulted in an unprecedented increase in demand for animal protein. The demand of the animal proteins is increasing and to meet this surging demand the antimicrobials as growth promoters are used in widespread manner that ultimately lead to the antimicrobial resistance.The difficulties associated with the nutritional shift to animal protein-based diets and the growth of antibiotic resistance is thus inextricably linked.Antimicrobials are often used in modern animal production procedures, potentially boosting selection pressure on microorganisms to become resistant. Despite the serious implications for antimicrobial resistance, there has been no quantitative assessment of cattle antibiotic usage worldwide. 
Antimicrobial use in animal production is expected to increase by two-thirds between 2010 and 2030, with one-third likely to involve antimicrobial usage (AMU) for disease prevention and growth promotion (or sub-therapeutic levels), particularly in pig and poultry production Antimicrobial usage for animals is anticipated to increase by 99 percent in the BRICS nations by 2030, whereas human populations are only expected to increase by 13 percent over the same time period. Antimicrobial usage in food animals is estimated to account for 80% of the nation's yearly antimicrobial use in the United States.
In recent years, India has emerged as a worldwide hotspot for antibiotic resistance (ABR), with increased rates of resistance to most antibiotics in common pathogens and an increasing number of treatment failures. India is one of the top consumers of agricultural antibiotics worldwide, accounting for 3 percent of global consumption.India's increased use of antimicrobials, complimented with widespread "misuse" in health and agriculture sector has resulted in the spread of multidrug-resistant organisms (MROs). 
India's battle with AMR made global headlines, when a novel multidrug-resistant strain was detected in a Swedish visitor afflicted with common bacteria (Klebsiella pneumonia) in 2008. The bacteria were harbouring a drug resistant gene having ability to pass between a range of species and was named as “New Delhi Metallo-beta-lactamase-1” by the international scientific community. Despite repeated warnings from the WHO, it took nearly a decade for the problem of AMR to be openly addressed politically.Such concerns were soon followed by the first inter-ministerial background report on the matter titled, “Antimicrobial Resistance and its Containment in India”. 
According to a MoHFW (Ministry of Health and Family Welfare) research, there are minimal restrictions in India prohibiting the use of antibiotics for non-therapeutic purposes, and even where there are rules, the onset of AMR from antibiotic abuse in the animal industry is likely to be an unmeasured burden. Antibiotics routinely used in food production have the greatest rates of resistance, including tetracyclines, sulphonamides, and penicillins, which are also important for animal therapy. According to the report, the usage of antibiotics in animal feed would grow by 82% in India by 2030.The use of antibiotics in food animals plays a major role in human health, as antibiotic-resistant bacteria can be transmitted between humans and animals through contact, in food products, and from the environment. In India, their usage particularly in poultry is predicted to treble by 2030. 
Poultry meat market in India is growing at 10% per annum.Several studies reported isolation of various resistant bacterial strains from faecal samples of chickens. Chicken meat samples contaminated with Salmonella species resistant to multiple antibiotics have been reported. In cattle detection of antimicrobial residues in milk and dairy products is main approach. A high level of shiga toxin producing E.Coli isolated from calves with diarrhoea in Kashmir valley was found in back in 2007 in a study conducted in Kashmir. It is recommended by the experts that always try to buy the organic labelled food or the label as antibiotic-residue free. But the situation is worse to worst in Kashmir where we don’t have any check on the drug residues in milk and meat. We are lacking any registered slaughter houses the label is a far away thing. 
(ii) Educate yourself:  “education is power”. The best to protect ourselves and our families from AMR is education and knowledge. We should know our risks and ask questions, maintain hygiene, get vaccinated to prevent infection, became aware of change in our health, use antibiotics properly, practice healthy habbits around animals, prepare food security, prevent environmental contamination and by staying current. 
(ii) Use antibiotics sparingly:  There are many causes that lead to the anti-microbial resistance and major among them are the Overuse and mis-use, self-medication, prescription sharing, over the counter sale, non-compliance with the prescribed treatment and poor sanitation and hygiene. It has been found that in just out patient departments alone over 250 million antibiotic doses are dispensed per year and about one third of these are inappropriate. There are other causes like socio-cultural that also lead to the spread of the Anti-microbial resistance. 
Spread Awareness, Stop Resistance
World Antimicrobial Awareness Week (WAAW) was celebrated from 18-24 November this year. The 2021 theme, “Spread Awareness, Stop Resistance” calls on One Health stakeholders, policymakers, health care providers, and the general public to be Antimicrobial Resistance (AMR) Awareness champions.There is an urgent need to combine human, animal, and environmental health specialists in order to get a better knowledge of illnesses caused by interactions between humans, animals, and the environment.Antimicrobial prophylaxis should be discontinued, and there should be guidelines for antimicrobial therapeutic usage. Developing recommendations for antimicrobial use in animals will aid in giving antimicrobial usage guidance.
One of the most important instrument for addressing AMR is the regulatory framework of medicines. Attention should be paid to the legislation applicable to production, authorization, prescription, sale and use of the medicines as even schedule H1 drugs are being sold without prescription. . From a regulatory standpoint the fight against AMR takes place by promoting good practices and controlling bad practices and misuse.   
(The Author is PhD veterinary and Animal Husbandry Extension)


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