Antimicrobial Awareness Week 2021: Why water is important in the AMR debate

Access to safe water is one of the prerequisites for maintaining sound health and environment in a community and is also a responsibility of administrative stakeholders

By Ashok J Tamhankar, Vishal Diwan
Published: Wednesday 24 November 2021

Antibiotics are one of the most common medicines for humans and animals. A large amount of antibiotics get released into wastewater due to excretion from humans and animals and the disposal of unused compounds from domestic as well as healthcare systems like hospitals.

Another large source is the pharmaceutical industries, which contribute to the spread of antibiotics in the environment through their effluents.

A large proportion of antibiotics are also used in animals for purposes other than treatment of disease such as as growth promoters, which also end up in aquatic systems through surface flow from animal and fish / prawn / shrimp farms (aquaculture).

Any exposure to antimicrobials by microbes starts the process of development of antimicrobial resistance in microbes, that influences quick recovery from infectious diseases of humans and animals.

Globally, two million tonnes of sewage, industrial and agricultural waste is discharged into the world’s waterways. It is estimated that more than 80 per cent of Asia’s wastewater is discharged untreated, polluting both groundwater and surface water sources, where they pollute the usable water supply.

Antibiotic residues  and resistant bacteria have been detected in various aquatic compartments of environments such as rivers, ponds, lakes in India, as well as globally.

For example, samples from the Ganga at Haridwar and Rishikesh have shown the presence of antibiotics like fluoroquinolones, sulphonamides, erythromycin and tetracycline in amounts of over 100 nanogram per litre (ng/litre).

Groundwater at Patna was found to contain Sulpha up to 360 ng/litre. Samples of bacteria from the Yamuna have shown a high level of resistance against tetracycline and polymyxin B.

Bacteria from samples of drinking water from Lucknow have been found resistant to antibiotics. Water samples from the Kshipra river at Ujjain have exhibited the presence of antibiotics and a high degree of resistance in the bacteria therein.

Hospital wastewater in Ujjain was found to contain antibiotics upto 600 microgram per litre (mg / litre). Effluents from drug manufactures near Pantacheru near Hyderabad have been found to contain antibiotics upto 31 mg / litre.

Other countries are no exception and surface water or ground water from China, the United States, Serbia, Italy, Bangladesh and Malayasia have also been found to contain antibiotics.

Bacterial samples from wastewater irrigated soil have a significantly higher antimicrobial resistance profile when compared to those irrigated with unpolluted groundwater.

Fish and other species, breeding in water that contain antimicrobials and resistant bacteria, are harvested for food purposes, thus facilitating the entry of resistant bacteria and antimicrobials in the food chain.

Antibmicrobials have been detected in wild fish in many countries including in fishes from rivers in China and India, seawater from Poland, etc and they are known to affect the endocrine system.

For example, suplphonamides influence thyroid endocrine disruption and alteration of concentration of T4 and and Plasma E2; Tetracyclines influence the steroidogenesis pathway, Thyroid endocrine disruption, T3 concentrations, T3/T4 ratio, Whole body TSH and alteration of gene expression level in HPT.

Erithromycin influences energy metabolism, gene-related oxidative phosphorylation, lipid metabolism and neuroendocrine disruption. The trophic transfer through the foodchain can very easily result in them influencing human and animal systems. 

India is an important player in global aquaculture production and its aquaculture industry is an important contributor to India’s food security. To ensure sufficient production in the aquaculture set up, large quantities of antibiotics are used in fish / prawn / shrimp cultivation.

This is potentially dangerous for human health and there is a lot of concern about this all over the world, as this  may result in water and sediment contamination and the development of antibiotic resistance genes.

In integrated poultry-fish farming, the use of antibiotics in poultry feed can cause the prevalence of antibiotic-resistant bacteria in pond environments and its consequent spread can be a matter of great concern.

Access to safe water is one of the prerequisites for maintaining sound health and environment in a community and is also a responsibility of administrative stakeholders.

FAO has developed a Code of Conduct for aquaculture and fisheries. The guidelines inform that antibiotics need to be preferably used under veterinary supervision and preventive use of antibiotics in aquaculture must be avoided as far as possible.

It has been stated that states should regulate the use of chemicals in aquaculture that are hazardous to human and animal health and the environment and that marketing and the use of drugs that have not been certified for aquatic use should be strictly regulated.

It is also important to advice consumers on the proper storage and disposal of unwanted antimicrobials. Consumers can then serve as environmental stewards to reduce water pollution.

It will be a good initiative to standardise and implement antimicrobial take-back programmes. It is also essential to formulate rules and regulations regarding waste water treatment for antibiotics removal to avoid entry of antibiotics into the environment.

Relevant governmental administrative units, scientific communities, civil societies, non-profits, etc need to work in tandem to advise all relevant stakeholders such as concerned ministries, pharmaceutical industry, aquaculture industry, municipalities, consumers, etc. on the proper use, storage and disposal of antimicrobials.

The joint initiative can then serve as environmental stewards to reduce pollution of aquatic environment by antimicrobials and consequently also of resistant pathogens and thus help reduction in antimicrobial resistance.

Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth

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