Drug resistance seems to have emerged as an endemic problem in India and the Union Health Ministry has written to the Planning Commission asking for a national programme to tackle anti-microbial resistance and cover the whole gamut of pathogens. If the Planning Commission decides to include it in the 12th Five Year Plan,this would be the first time that a national programme for health will not be directed towards a particular disease or deficiency but against a phenomenon that,in many ways,is linked to improved access in healthcare. We have of late had many reports of drug resistance ranging from XDR TB in Mumbai,artemisinin resistant malaria in the Thai border,strains of Schigella that do not respond to common anti-diarrhoeal drugs and some initial indications of the emergence of miltefosine resistant kala-azar. We realised that while there are many vertical programmes against communicable diseases,one problem all of them were dealing with is drug resistance and it has reached a stage where nothing less than a national programme will contain a potential disaster in our hands, explained a senior official in the Ministry of Health and Family Welfare. The World Health Organisation had,as early as 2001,called for national strategies to counter anti-microbial resistance centred around mainly two pillars - prevention of resistance arising in a microbe and pre-empting the spread of such an organism. The pivotal philosophy of the programme is prevention of irrational use of antibiotics though ministry sources say misuse extends not just to anti-bacterials but also anti-virals and all other drugs targeted towards living pathogens. Hence the programme is being defined by the word anti-microbial rather than antibiotic. Awareness of doctors and patients is the key. In Mumbai,some hospitals have put up stickers on protocol for common anti-microbials prominently in hospitals. There needs to be a concerted campaign like there is now for DOTS to tell people that drug dosages need to be completed. On the medical side,these protocols have to be made official and standardised like the ones we have for malaria and TB, the official said. He concedes that despite existing protocols,violations are rampant and even a simple recommendation banning artemisinin monotherapy was not being followed.
