Antimicrobial Resistance and India’s “Red Line Campaign”

Resistance is developed by bacteria due to overuse and misuse of antibiotics. It eventually develops resistance and adapts and grows in the presence of antibiotics. Since most of the antibiotics belong to the same class of medicines, resistance developed in one organism spreads rapidly and as a result bacteria becomes drug resistant. These drug resistant bacteria circulate among the human beings, animals through food, water and environment. These drug resistant bacteria can also be found in food animals and animal products consumed by humans.

The antimicrobial resistance is rapidly spreading and has been identified as a major global threat by WHO. As a matter of concern, there are exist only a few prospects for the development of new classes of antibiotics in a short period of time. As per the report of Global Review on Antimicrobial Resistance commissioned by UK Prime Minister David Cameron in 2014 commissioned by UK Prime Minister David Cameron in 2014 and chaired by economist Jim O’Neill:

• The report highlights even though the law bans the sale of antibiotics and other antimicrobials over the counter, it is not strictly enforced in many countries.
• It has found that around 20-30% of antibiotics are consumed without prescription in south and east Europe and up to 100% in some parts of African continent.
• It has lauded India’s Medicines with the Red Line campaign on antibiotics and advocated that the campaign should be considered as a starting point to curb the menace of anti- microbial resistance.
• It has estimated that deaths due to antimicrobial resistance could rise to 10 million each year by 2050 if corrective measures are not taken. The cost to the global is likely to be incurred to the tune of $100 trillion.

As per a paper titled ‘Antibiotic Resistance in India: Drivers and Opportunities for Action’ released by PLOS Medicine in March 2016, antimicrobial resistance is a global threat but the situation in India is largely alarming.

Questions & Answers

• What are the steps taken by India to counter anti-microbial resistance? What are the challenges in it?
• What is India’s Red Line campaign?
• What are the major reasons for spread of antimicrobial resistance in India?
• What are the Global action plans adopted by the WHO?
• What is the way forward for limiting antimicrobial resistance in India?

What are the steps taken by India to counter anti-microbial resistance? What are the challenges in it?

India awoke to risks of antibiotic overuse late and is struggling to control the menace of antibiotic resistance since then. It took the issue seriously after a resistant bug was named as The New Delhi Metallo-beta-lactamase-1 (NDM 1). In 2011, a National Policy for Containment of Antimicrobial Resistance in India was released.

What is India’s Red Line campaign?

India’s Medicines with the Red Line campaign was launched in February 2016 by the Union Ministry of Health and Family Welfare to tackle the problem of growing misuse of antibiotics across the country. Its aim is to curb irrational use of antibiotics and create awareness on the side effects of taking antibiotics without prescription. Under it, all prescription only antibiotics will be marked with a vertical red line on the packets. The red line antibiotics packets should be consumed on doctor’s advice and the patients need to complete the full course prescribed by the doctor.

Praise for the campaign

The Global Review on Antimicrobial Resistance in its final report has appreciated India’s Medicines with the Red Line campaign on antibiotics. The global review was commissioned by the UK Prime Minister David Cameron in 2014 and was chaired by economist Jim O’Neil.

What are the major reasons for spread of antimicrobial resistance in India?

As per a report in the August 2014 edition of The Lancet infectious Diseases journal, India consumed a whopping 13 billion units of antibiotics in 2010.

• High disease burden
• Rising income
• Cheap and unregulated sales of antibiotics
• Poor public health infrastructure
• Patients demand for quick relief
• Lack of awareness
• Inadequate guidelines and regulation
• Doctors prescription habits influenced by the incentives from drug companies for promoting certain products.

It is ironical that India faces a twin challenge of overconsumption of antibiotics breeding drug-resistant bacteria on the one hand and lack of access or delayed access to effective antibiotics on the other.

While drug resistant bacteria had resulted in the highest neo-natal deaths in India in 2012, around 1.7 lakh Pneumonia deaths in children could have been averted if these children had access to effective antibiotics, as per the study published by The Lancet journal in November 2015.

What are the Global action plans adopted by the WHO?

Recently, WHO has launched a campaign called ‘Antibiotics: Handle with care’ as a global initiative to change the way the antibiotics are used across the world. As a part of this initiative it will work with the governments and health authorities to contain antibiotic resistance.

Global action plan

WHO has unveiled a global action plan to combat antimicrobial resistance. It has defined five strategic objectives to be followed in the next 5 to 10 years. They are:

• Objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, education and training
• Objective 2: Strengthen the knowledge and evidence base through surveillance and research
• Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures
• Objective 4: Optimize the use of antimicrobial medicines in human and animal health
• Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions

What is the way forward for limiting antimicrobial resistance in India?

India should try to ensure sustainable access to antibiotics while maintaining sustainable effectiveness of all antibiotics. All the stakeholders like government, doctors, patients, pharmacists and pharmaceutical companies must realize their roles and play their roles in a responsible manner.

Proper awareness has to be generated among the people. They should be made aware that suboptimal dosages and consuming antibiotics for cold and viral infections would make the bug resistant to antibiotics. For example, the multi drug resistant tuberculosis requires longer duration of treatment involving intake of toxic drugs.

Government should immediately close down pharmaceutical companies manufacturing irrational fixed-dose combination drugs. It should also regulate drug companies discharging antimicrobial waste into the environment. The use of antibiotics in animal feed also needs to be regulated. Ensuring better sanitation in health care settings would also go a long way in containing the spread of drug resistant strains of bacteria.

Over-the-counter (OTC) sale of drugs should be regulated. Sometimes, collusion between drug companies and the chemists result in the sale of antibiotics even for ailments where it is not necessary. Although, introduction of Schedule H1 category to prevent the sale certain third- and fourth- generation antibiotics without prescription is laudable, it needs to be extended to other similar drugs. But while restricting the OTC sales of antibiotics, care has to be taken that access to antibiotics especially in rural areas are not cut off.