Why antibiotic resistance is getting worse in India

Powerful, newer generation drugs are being sold far more frequently for no apparent reason

Seventy years ago, before we had antibiotics, a simple cut or wound could kill because of a bacterial infection. Antibiotics changed that. These remarkable drugs are capable of killing off biological organisms in our body without harming us. Under the illusion that taking antibiotics is essential for every sneeze and cold (which by the way, are unaffected by antibiotics), we have collectively overused antibiotics. 

There is a reason why these are meant to be sold only under a doctor’s prescription. Firstly, because using antibiotics unnecessarily can expose us to unnecessary side effects. Secondly, because each time we use antibiotics, we allow the few superbugs—bacteria that are able to survive the antibiotic—to thrive.  Over time, the entire population of bacteria is made up only of these superbugs and our antibiotics no longer work.   

Many reports and studies have been sounding the alarm that we have placed ourselves at risk for a world without antibiotics.  The most recent one was released by the World Health Organization (WHO) last week that reported data from 114 countries across all WHO regions. In every country and region, resistance is a problem but is much worse in those where restrictions on use of antibiotics are fewer.

Read more on WHO report on antibiotic resistance
    
Antibiotic resistance now a global pandemic

Even if resistance emerges in one country, it can spread easily to other countries and put others at risk even if they have never taken a course of antibiotics.  What was also troubling about the WHO report was that so little resistance data were available from important countries like India.

India does not have standardised national data on resistance rates and everything we know about resistance comes from a few reports from hospitals and communities. From all studies in India with 30 isolates or more, resistance rates of E coli to third-generation cephalosporins (new powerful drugs) were 82 per cent and to fluoroquinolones was 86.4 per cent.  In other words, the next time we need an antibiotic for a urinary tract infection, the antibiotics we take are not going to work most of the time.

Wrong focus

India’s response to the threat of antibiotic resistance has been unfolding ever since the NDM-1 strain was discovered in a patient who had been hospitalized in New Delhi.  Although much of the media attention was focused on controversy over this strain being named New Delhi metallo-beta lactamase (NDM 1), which is frankly irrelevant (the most common strain of community associated methicillin-resistant Staphylococcus aureus is called USA 300, for example), little attention was paid to the fact that patients in India were suffering from infections that are now essentially untreatable (see 'Fatal resistance').

Why is resistance getting worse in India?  The use of antibiotics is increasing nationwide. Between 2005 and 2009, 40 per cent more units of antibiotics were sold.  Powerful drugs like newer generation cephalosporins are sold far more frequently for no apparent reason—between 2005 and 2009, sales of cephalosporins increased 60 per cent.

What about drug use in livestock?

Antibiotics are also used in animals and a significant proportion of antibiotic resistance is due to its use in animals. India is a large exporter animal food products and 160,000 livestock animals were reported to have been affected by bacterial infections in 2009.   Antibiotics are used in animals to treat infections, for growth promotion using sub-theraputic levels, and for prophylactic purposes to prevent disease. There is high levels of antibiotic resistance in veterinary sectors. Resistant bacteria in animals can spread to humans in several ways with the consumption of animal products, exposure to raw meat products, and direct contact between animals and humans as the main modes of transfer.  Current Indian laws regulate antibiotic use in animals but both new laws and stronger enforcement of existing laws could slow the spread of antibiotic resistance in animals and, therefore, humans

Read more what the WHO report has missed out

WHO report on antimicrobial resistance skips some obvious truths

We have a serious problem that we will each face when we or a loved one gets an infection that will simply not go away. It has been a long time since people died of untreatable bacterial infections and the prospect of returning to that world is worrying. 

References

* World Health Organization. (2014). Antimicrobial resistance: global report on surveillance 2014 (p. 257).
*Ganguly N.K., N.K. Arora, S. J. Chandy, M.N. Fairoze, J.P.S. Gill, U. Gupta, S. Hossain, S. Joglekar, P.C. Joshi, M. Kakkar, A. Kotwani, A. Rattan, H. Sudarshan, K. Thomas, C. Wattal, A. Easton, R. Laxminarayan, “Rationalizing antibiotic use to limit antibiotic resistance in India” Indian Journal of Medical Research, 134, September, 142-55, 2011.
*Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057–98. doi:10.1016/S1473-3099(13)70318-9.

Ramanan Laxminarayan is vice-president, research and policy at the Public Health Foundation of India (PHFI)

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