COVER STORY/ANTIBIOTIC
not over-prescribe; people do not misuse. In India, Gurugram-based Public Health Foundation of India showed that prescription rate of antibiotics in India is 412 per 1,000 persons per year. This is less than other countries like Italy (957 prescriptions per 1,000 persons), Germany (561 prescriptions per 1,000 persons) and the UK (555 prescriptions per 1,000 persons).
However, when it comes to third and fourth-line of antibiotics, India beats others. The percentage of prescriptions with cephalosporins and quinolones (38.2 per cent and 16.3 per cent) in India is significantly higher than in the US (14 per cent and 12.7 per cent). The third-line of antibiotics, which should be prescribed only at the hospital level, are prescribed at the primary care level in India. These antibiotics make their way into the environment and trigger resistance. It is clear that environmental triggers to antibiotic resistance have to be urgently controlled. There are many alternatives to antibiotics and they are cost-effective too. There are also methods to treat antibiotic residues in effluents from industry and homes and these should be installed.
An opportunity lies in SDGs. The environmental dimensions that support AMR are part of SDGs. Though antibiotic resistance has not been given adequate attention in SDGs, course correction is underway. In 2019, WHO proposed to track two priority pathogens in bloodstream infections, namely
to serve as sentinels of progress. This indicator connects the Monitoring and Evaluation Framework put together by WHO, FAO and OIE.
This indicator is part of SDG 3(d), which is to strengthen the capacity of countries for early warning, risk reduction and management of national and global health risks. While using AMR as an indicator to track progress on SDGs is an important stepping stone, we must keep in mind the fact that only 10 years are available for efforts to take effect on the ground. However, the very fact that there are multiple areas in the SDGs where action on AMR can take place is an opportunity.