Antibiotic Resistance and India

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    30 year old Rajesh was admitted in the hospital after a week of cough, excessive night sweats, hyposomnia, loss of appetite and sudden weight loss. The emergency room physician checked his vitals and reported that the patient was also undergoing tachycardia along with his other symptoms and immediately sent him for further testing. After an abnormal chest X-Ray and a positive Mantoux tuberculin test the doctors concluded that he had Tuberculosis. He was started on a four drug regimen – isoniazid, rifampin, pyrazinamide and streptomycin and was asked to continue treatment for the next sixth months.

    Rajesh found himself in the hospital after 3 months again with the same symptoms but with higher severity. Doctors knowing that he had a history of tuberculosis started him again on isoniazid and rifampin but this time the drugs didn’t work and his condition turned from bad to worse.

    Later, Rajesh was diagnosed with Multi drug resistant –Tuberculosis which he had developed because he had discontinued his six month treatment just after two months.

    More than 50,000 death are caused every year all over Asia due to Antimicrobial Resistance. From Staphylococcus aureus getting resistant to all forms of penicillin, to Mycobacterium tuberculosis getting resistant to at least four of the core anti-tuberculosis drug, we are seeing it all. Antimicrobial resistance is a worldwide problem but by 2050 India might be at the top of the list.

    This I say not without any substantial proof.  ‘The State of World Antibiotics 2015’, shows that in 2010, India was the largest consumer of antibiotics ahead of China and the US. With India consuming 13 billion Standard Unit (SU) of antibiotics per year, the news of soaring number of cases in antimicrobial resistance comes with no surprise. No wonder India is now called the antibiotic capital of the world.

     In 2009, a 59-year-old man from Sweden of Indian origin visited a hospital in Örebro. This diabetic male, needed treatment for bed sores and urinary tract infection. He had recently returned from India. There he had developed an abscess in his buttocks and had been hospitalised after a surgery in New Delhi. But something was unique with his case. No antibiotic seemed to work on him. Not even carbapenems which is the strongest class of antibiotics currently known to man.

    The result of a routine urine test shocked the doctors. The bacteria causing the infection was the usual Klebsiella pneumonia. But the unusual part was the unknown gene it carried .This gene, later named NDM-1 (New Delhi Metallo-beta-lactamase-1), after the city where the patient was thought to have picked up the bug. This gene made the bacteria resistant to almost all antibiotics. Not only did it make treatment difficult but it also had the ability of moving from one bacteria to another, boosting the infections resistance.

    Who should be blamed for this?

    The population of India who yearns for quick relief from infections and hence consumes high dosages of inappropriate and unnecessary drugs for even minor infections. Or the easy access to the strongest of antibiotics available in medical drug stores which provide medication without prescription. Or the qualified doctors and the quacks, both at par when they prescribe drugs with little thought. Or the high end hospitals who believe in subjecting the patients to expensive but unnecessary drugs just to boost their own profits, and in the process creating colonies of super-bugs. Or prescription of antibiotics for viral infections that they can’t cure, such as colds is to be blamed. Or the lawmakers and the government of India who is unable to introduce and execute stricter laws on the manufacture and consumption of antibiotics. Or the lack of awareness among the population of India about the critical threats of Antibiotic Resistance and ways to prevent it.  Or is the excessive usage of antibiotics on livestock and our food is to be blamed. Or the improper sanitation and inadequate safety measures used by pharmaceutical companies while dumping their waste.

     At the end of the day it doesn’t matter who is at fault until and unless we recognise it as a looming crisis which we can avert if we take action soon.

     

     

     

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