Antimicrobial Resistance (AMR)

India has introduced Nafithromycin, its first new antibiotic in nearly 30 years, to combat the rising challenge of antimicrobial resistance (AMR). AMR is causing increasing deaths due to drug-resistant infections globally and in India. This development highlights the critical need for enhanced research, healthcare practices, and regulation to address this public health threat.

Antimicrobial Resistance (AMR)

• Antimicrobial Resistance (AMR) occurs when microorganisms (bacteria, viruses, fungi, and parasites) evolve resistance to antimicrobial drugs previously effective against them.
• Global Impact:
  • In 2019, AMR caused 1.27 million deaths globally (IHME, University of Washington).
  • Projected deaths due to AMR by 2050: 1.91 million (direct), 8.22 million (associated) – The Lancet study.

Major Drivers of AMR

• Misuse of Antibiotics: Self-medication and over-the-counter antibiotic sales in India.
• Non-Human Use: Over 70% of antibiotics are used in livestock, aquaculture, and agriculture.
• Inadequate Diagnostics: Delayed antibiogram results and incorrect treatments.
• Healthcare System Gaps:
  • Poor infection control in hospitals.
  • Lack of communication and accountability.
  • Substandard medical equipment and overburdened healthcare workers.

Governmental and Institutional Efforts:

• Policy Framework:
• National Action Plan on AMR (2017).
  • AMR surveillance networks.
  • Public awareness initiatives.
• Regulatory Actions:
  • Ban on colistin as a growth promoter in poultry.
  • Emphasis on prescription-only antibiotic sales (yet poorly enforced).

Challenges in Antibiotic Development:

• Economic Disincentives: Low ROI compared to chronic disease drugs.
• Regulatory Bottlenecks: Cumbersome clinical trial approval processes.
• Accessibility Issues: Pricing disparities across regions. Example: 80% price difference between India and the US.
• Misuse of New Molecules: Early resistance reported to advanced formulations like Ceftazidime-avibactam.

Way Forward

• Strengthening Regulatory Frameworks:
  • Enforce prescription-only sales of antibiotics.
  • Monitor and penalize illegal over-the-counter antibiotic dispensing.
• Improving Diagnostic Infrastructure:
  • Invest in rapid diagnostic labs and antibiogram testing tools.
  • Ensure equipment quality and trained diagnostic personnel in all tiers of healthcare.
• Boosting Public Awareness:
  • Integrate AMR education in school curriculums and public campaigns.
  • Dispel myths about antibiotics being cure-alls for viral infections.
• Incentivizing R&D:
  • Support small pharma through funding, tax incentives, and fast-track approvals.
  • Promote public-private partnerships in drug discovery.
• Global Collaboration and Surveillance:
  • Share data across borders to trace and contain resistant strains.
  • Contribute to global AMR strategies under WHO's One Health framework.
• Institutionalizing Antibiotic Stewardship:
  • Mandate hospital-based AMR control programs.
  • Train healthcare workers in responsible prescribing practices.