News and Opinions  –  2017

India’s new National Action Plan on Antimicrobial Resistance

2017-03-20

As one of the countries most affected by antimicrobial resistance India is now taking rapid strides to address the growing problem.

Back in February the Indian Public Health Authorities released their National Action Plan on Antimicrobial Resistance for public comments and suggestions before presentation at the upcoming World Health Assembly in Geneva in May. This public consultation will close on April 1st.

The National Action Plan on Antimicrobial Resistance, still in draft form, covers a wide range of themes and factors that drive antimicrobial resistance and clearly outlines all the challenges that need to be tackled to overcome the phenomenon.

Six strategic priorities for Indian health authorities

There are six key areas that the National Action Plan has identified as being strategic priorities for the Indian Public Health Authorities to take action on. These include:

  • improved awareness of antimicrobial resistance through effective communication
  • strengthening knowledge and evidence through surveillance
  • reducing the incidence of infection through effective infection prevention and control
  • optimizing the use of antimicrobial agents in health, animals and food
  • promoting investments for antimicrobial resistance activities, research and innovations and
  • strengthening India’s commitment and collaborations on antimicrobial resistance at international, national and sub-national levels.

Among the key stakeholders identified are government ministries, state-run research institutions, health agencies and civil society groups who need to be mobilized for implementing the action plan.

Some of the Ministries involved are: Ministry of Health and Family Welfare, Ministry of Food Processing Industries, Ministry of Environment, Forest and Climate Change, Ministry of Chemicals and Fertilizers

Some of the research institutions are: Indian Council of Medical Research, Indian Council of Agricultural Research

Civil Society Organizations involved are: Public Health Foundation of India, Center for Science and Environment

Given the current low levels of access to basic healthcare, essential medicines, sanitation and clean water one of the important tasks identified by the draft is strategizing to secure sustainable funds for implementation of the National Action Plan.

Significantly, the Indian National Action Plan pays considerable attention to the issue of antibiotic use in the animal farming, agriculture and aquaculture sectors. It also promotes the One Health perspective of integrating human and animal health sectors and calls for more research and better surveillance systems to tackle antimicrobial resistance.

Focus on waste water in India’s new Action Plan on Antimicrobial Resistance:

  • The Indian National Action Plan on Antimicrobial Resistance promises actions to regulate the release of antibiotic waste and monitoring antibiotic residues in wastewater.
  • Within a period of three years India intends to introduce emission limits for antibiotics from manufacturing industries. It is also suggested that within the same time period, development of a framework for monitoring antibiotic residues should be done including for wastewater from pharmaceutical production facilities.

Until a few years ago, attention and political prioritization of antimicrobial resistance was a limited in India, like in many other developing countries. However, the National Action Plan, developed as part of India’s commitment to the WHO’s Global Action Plan, is now expected to galvanize national efforts to deal with antimicrobial resistance comprehensively.

Rising antibiotic consumption

According to a study published in the Lancet, in 2010, India was the largest consumer of antibiotics in the world with almost 13 billion units followed by China with 10 billion units and the US with almost 7 billion units. Between 2005 and 2009, the units of antibiotics sold in India increased by about 40 per cent. These figures however, do not include antibiotics consumption in the animal and food production sector.

A number of studies of prescribing practices among Indian physicians, over the years, show a very high rate of use of antibiotics. One study from 2008 found that antimicrobial prescription rate was 69.4% for patients with uncomplicated acute respiratory infections, fever and diarrhea at four sites around India.

For a long time, the absence of nationwide surveillance, systematic mapping and long-term studies of resistance patterns exhibited by important pathogens, has made it difficult to get a detailed overview of the antimicrobial resistance situation in India. Studies carried out over the last decade in both hospital and community settings, however, indicate that resistance in important pathogens against certain antibiotics, such as quinolone resistance in Salmonella Typhi, is already at high levels in many parts of India. The situation in vulnarable populations is also worrying – estimates say that more than 55 000 neonates die each year from sepsis attributable to bacteria resistant to first-line antibiotics in India.

References

Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, Laxminarayan R. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis 2014 Jul; 14: 742–750 http://dx.doi.org/10.1016/S1473-3099(14)70780-7

Global Antibiotic Resistance Partnership (GARP) – India Working Group. Rationalizing antibiotic use to limit antibiotic resistance in India+. The Indian Journal of Medical Research. 2011;134(3):281-294.

Indira Kumari KS, Chandy SJ, Jeyaseelan L, Kumar R, Suresh S. Antimicrobial prescription patterns for common acute infections in some rural and urban health facilities of India. Indian J Med Res. 2008 Aug;128(2):165-71.

Gandra S, Mojica N, Klein EY, Ashok A, Nerurkar V, Kumari M, Ramesh U, Dey S, Vadwai V, Das BR, and Laxminarayana R. Trends in antibiotic resistance among major bacterial pathogens isolated from blood cultures tested at a large private laboratory network in India, 2008–2014. Int J Infect Dis. 2016 Sep; 50: 75–82. https://dx.doi.org/10.1016%2Fj.ijid.2016.08.002

Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen JA, Klugman K, Davies S. Access to effective antimicrobials: a worldwide challenge. Lancet. 2016 Jan; 387: 168–175 http://dx.doi.org/10.1016/S0140-6736(15)00474-2

Not an open resource:

Laxminarayan R, Bhutta ZA. Antimicrobial resistance—a threat to neonate survival. Lancet Glob Health. 2016 Oct; 4: 676-677. http://dx.doi.org/10.1016/S2214-109X(16)30221-2

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