Anti microbial resistance (AMR) & Antibiotic protocols
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A 2022 global report by World Health Organization on infection prevention and control observed that the risk of acquiring Healthcare-associated infections (HAls) is up to 20 times higher in relatively poor countries.
" Patients admitted to hospitals for surgery or treatment are susceptible to health care-associated infections (HAI) such as central line-associated bloodstream in fections, catheter-associated urinary tract infections and ventilator-associated pneumonia.
These are exceedingly critical medical conditions to manage, as the bacteria responsible are resistant to even the strongest antibiotics available, a phenome non referred to as antimicrobial resistance (AMR).
SURVEILLANCE STUDY REPORT:
A surveillance study conducted by the International Nosocomial lInfection Control Consortium in 45 low and middle-income countries from 2012 to 2017 found that pooled rates of catheter-associated urinary tract infections and central line-associated bloodstream infections were three to six times higher than in intensive care units in the United States.
The situation in India is particularly alarming.
According to a report published in medical journal The Lancet in September 2023, a network of 26 tertiary-level hospitals in India established to implement HAl surveillance and prevention activities reported 2,622 healthcare-associated bloodstream infections and 737 healthcare-associated urinary tract infections (UTIs) from 89 ICUs between May 2017 and October 2018.
GOVERNMENT INITIATIVES:
To address this major public health challenge, one of the key initiatives was the launch of National Programme on AMR Containment, coordinated by the National Centre for Disease Control (NCDC) in Delhi.
The objective is to enhance the capacity of medical colleges and other large hospitals to generate quality AMR surveillance data and monitor its patterns in the Country.
India had also launched its National Action Plan on AMR (NAP-AMR) in 2017 with six strategic priorities.
These are, improving awareness and understanding of AMR through effective communication, education and training; strengthening knowledge and evidence through surveillance and reducing the incidence of infection through effective infection prevention and control.
CONCLUSION:
Optimising the use of antimicrobial agents in health, animals and food;
promoting investments for AMR activities, research and innovations and strengthen India's commitment and collaborations on AMR at international, national and sub-national levels are the rest of the priorities.
There is a need for continuing medical education updates for practising doctors to update their knowledge on the latest breakpoints and susceptibility patterns.
The ramifications of AMR should also be included in the medical curriculum and infection-control protocols should be uniformly implemented in healthcare settings.
Doctors and hospitals should join hands to take on this threat through an antibiotic protocol, which should be enforced across all hospitals in the country.
With an appropriate protocol in place, the right antibiotic can be administered at the right time, thus cutting down on the presumptive treatment period.
A more robust system that ensures the uniform implementation of AMR-related programmes and protocols across all healthcare settings in the country and active participation of all stakeholders is required to tackle the threat of AMR.
In a letter sent earlier this month, Union government has also urged pharmacists to stop selling antibiotics over the counter, without a valid prescription from a doctor.
estimated to have been directly responsible for 1.27 million global deaths in 2019, while 4.45 million deaths were associated with drug-resistant infections.
The misuse and overuse of antimicrobials, it added, is one of the main drivers in the development of drug- resistant pathogens.
it is an urgent appeal to all the doctors to make it a mandatory practice to write indication reason justification while prescribing antimicrobials”.
The one addressed to pharmacists seeks to remind them to follow schedule H of the Drugs and Cosmetics Rules, which mandates the sale of antibiotics on valid prescriptions.
Some high-end antibiotics are placed in schedule H1, which mandates chemists to retain a copy of the prescription.
In 2019, the World Health Organization (WHO) listed antimicrobial resistance as one of the top 10 threats to public health.
