In its first ever global report on antibiotic resistance, the World Health Organisation (WHO) last week sounded an alert against rising anti-microbial drug resistance worldwide that will specifically put poor and developing countries at risk.
The key findings of the report stated that while resistance is occurring across a wide spectrum of infectious agents like virus, pathogens and bacteria, antibiotic resistance in seven different kinds of bacteria— causing serious diseases like diarrhoea, pneumonia, urinary tract infections, gonorrhoea, and blood stream infections (sepsis)— has caused high concerns across the globe.
Dr Keiji Fukuda, WHO’s Assistant Director General for Health Security, said at a press conference held in Geneva (WHO’s headquarters), “Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”
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In India, E. coli— which causes urinary tract and blood stream infections – has shown drug resistance between a whopping 16 to 86 per cent while K. pneumoniae – which causes inflammation – has exhibited drug resistance between five to 100 per cent.
India faces the challenge of dense population with several clusters becoming a host to diseases like tuberculosis, malaria, pneumonia and recently dengue. According to provisional figures from National Vector-borne Disease Control Programme (NVBDCP), the country witnessed a jump from 50,222 dengue cases recorded in 2012 to 75,454 dengue cases in 2013. The number of malaria cases in 2013 stood at 8.3 lakhs, of which 379 people died.
TB presents a grim picture for the country- of the 8.6 million cases reported worldwide in 2012, 2.3 million (25 per cent) were recorded in India, says data from Revised National Tuberculosis Control Programme (RNTCP).
As per the WHO report, 20 per cent of MDR cases were of patients who had come for re-treatment. In the city, of the 40,000 TB cases recorded in 2013, over 10 per cent TB cases (4,467) were for re-treatment.
A worrying trend for doctors is now the increasing instances of multi-drug resistant (MDR) and extensively-drug resistant (XDR) TB cases. From 181 new patients diagnosed with MDR TB and 288 already receiving treatment for it in 2011, the figure rose to 2,195 new patients diagnosed with MDR TB and 1,935 on treatment in 2012. In 2013, a whopping 2,903 patients were diagnosed with MDR TB and 2,604 were on-treatment for it.
In 2013, the count of XDR TB rose from 32 in 2012 to 90 cases. This year till March-end 24 patients were labeled as XDR by BMC.
Dr Lalitkumar Anande, chest surgeon in Sewri’s TB hospital, said, “The speed at which TB is spreading has increased. Patients who initially responded to drugs now need surgery as they are no more getting cured by drugs.”
Dr Om Srivastava, head of infectious disease department at Jaslok hospital, said, “We are already seeing patients who could earlier be treated on OPD basis but now need hospitalization. One of reasons why resistance to drugs is increasing is that patients don’t finish their treatment because they feel better before completing the entire dose. Several use antibiotics even when it is not required. For example, patient should take supportive treatment for diarrhoea caused by viral infection. Instead they take antibiotics.”
When asked what challenges India faces, Fukuda accepted that the country— which suffers from a large number of tropical infections— is struggling with a pool of issues ranging from lack of health infrastructure to lack of awareness amongst people about antibiotics. “In a country like India, there is a need of strong regulation. The key action required here is development of national plans and all stakeholders must come together to get a holistic approach,” Fukuda said.
India is exposed to greater threat from anti-microbial resistance perhaps due to lack of health infrastructure and policies to monitor doctors and chemists. Srivastava said, “Countries like Cambodia, Mexico and Vietnam are doing very well in health because they spend over seven per cent of the total GDP (gross domestic product) on health. In India, where public health burden is high, less than five per cent of total GDP is spent on health.”