Why in news:

• Rivers worldwide are polluted with antibiotics that exceed environmental safety thresholds by up to 300 times, according to research unveiled at a conference on meeting of environmental toxicologists in Helsinki.

Details:

• In many locations, concentrations of the drugs used to fight off bacterial infection in people and livestock exceeded safety levels. Ciprofloxacin, a frontline treatment for intestinal and urinary tract infections, has surpassed the industry threshold
• In Bangladesh, concentrations of another widely used antibiotic, metronidazole, were 300 times above the limit, the widespread presence of antibiotics not only impacts wildlife, but likely contributes to the problem of antimicrobial resistance.
• The World Health Organisation (WHO) has warned that the world is running out of antibiotics that still work, and has called on industry and governments to urgently develop a new generation of drugs. In 1920s, antibiotics have saved tens of millions of lives from pneumonia, tuberculosis, meningitis and a host of deadly bacteria.
• Overuse and misuse of the drugs are thought to be the main causes of antimicrobial resistance. Safety limits were most frequently exceeded in Asia and Africa, but samples from Europe and the Americas showed that the problem is global in scope.
• The countries with the highest levels of antibiotic river pollution were Bangladesh, Kenya, Ghana, Pakistan and Nigeria.
• Within Europe, one site in Austria had the biggest concentrations anywhere on the continent.

Background: / Antibiotic resistance

• Antibiotic resistance arises when bacteria evolve mechanisms to withstand the drugs which are used to fight infection.
• It is one of the most important public health issues currently. Antimicrobial resistance happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics).
• Microorganisms that develop antimicrobial resistance are sometimes referred to as “superbugs”. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.

Reasons for Antibiotic Resistance:

• Caused by indiscriminate use, wrong dosage, not completing the treatment, poor hygiene, poor regulation, wrong incentives for doctors to prescribe them
• Unchecked use of antibiotics in humans, agriculture and livestock.
• Health system factors are also at fault. Doctors routinely receive compensation from pharmaceutical companies and pharmacists in exchange for antibiotic prescriptions. Infection control in hospitals is poorly monitored and could be improved
• The problem of resistance is exacerbated by a wide range of fixed-dose combinations in the market, often without scientific or medical merit or evaluation.
• Loose antimicrobials come without packaging and do not mention the name of the drug, its manufacturer, the date of manufacture, or the date of expiry. There is poor clinician awareness of the rationality and dosing of fixed-dose combinations
• Environmental antibiotic pollution encourages the transfer of resistance genes to. In particular, waste water treatment plants serving antibiotic manufacturing facilities have been implicated in the transfer of resistance genes into humans and pose a serious threat to antibiotic effectiveness given the size of India’s pharmaceutical sector

Steps taken to deal with the menace:

• Over-the-counter access to antibiotics is a problem, but regulations to restrict access have to be balanced against the need to maintain access for the significant proportion of the population that lacks access to doctors. Indeed, lack of access to effective and affordable antibiotics still kills more children in India than does drug resistance.
• However, to prevent over-the-counter (OTC) sales of important antibiotics, the Central Drugs Standard Control Organization (CDSCO) implemented Schedule H1 that takes an important first step in that direction by introducing a stringent rule that prohibits medical stores from selling 24 key antibiotics without a doctor’s prescription
• Further the ICMR has set up National Anti-Microbial Surveillance Network for understanding of underlying mechanisms of resistance
• National Cell for Monitoring Anti-Microbial resistance has decided to start a Rs 30 Crore Surveillance Plan in tertiary care centres across the country
• National Policy for Containment of Antimicrobial Resistance (2011), to address the problem of multi-drug resistance due to widespread and indiscriminate use of antimicrobial / antibiotic drugs in the country.
• The salient features of the policy are as follows:

  • To review the current situation regarding manufacture, use and misuse

  • To initiate studies documenting prescriptions patterns & establish a monitoring system for the same.

  • To recommend the design for creation of a National Surveillance System for Antibiotic Resistance

  • To enforce and enhance regulatory provisions for use of antibiotics in human & veterinary and industrial use.

  • To recommend specific intervention measures such as rational use of antibiotics and antibiotic policies in hospitals

  • Diagnostic Methods pertaining to antimicrobial Resistance Monitoring