Counter the dangers of antimicrobial resistance
Pharma companies must invest in new drugs to slow the evolution of new resistant strains of microbes
Seventy years after the discovery of penicillin by Alexander Fleming in 1928, the world is staring at a future without antibiotics. Antimicrobial resistance (AMR) has become a global threat and developing countries like India are at the epicentre of this problem. It threatens to undo the gains made by India in the control of infectious diseases like tuberculosis, malaria and HIV. If the problem of AMR is not addressed, it will play havoc with our already stretched healthcare budgets. As the world observes antibiotic awareness week, it is important to understand the factors that have led India to this quandary and look at the plausible solutions.
Antibiotics strictly target bacteria, but it is sometimes difficult to differentiate between viral and bacterial infections. The emergence of drug resistant pathogens happens when bacteria adapt to the presence of low dose antibiotics. In the absence of cheap, accurate and affordable diagnostic tests, it is often more cost effective to prescribe antibiotics. The factors that contribute to the emergence of resistance include not taking antibiotics for the prescribed duration, use of counterfeit drugs, and availability of formulations having active pharmaceutical ingredient (API) lower than the prescribed quantity. While patient behaviour is intertwined with socio-economic factors, the issue of substandard drugs can be dealt with by enforcing tighter regulations.
The past few years have seen an unprecedented rise in hospital-acquired infections. Poor infection control practices along with high antibiotic use breed drug-resistant bugs. Hospital-acquired infections complicate the management of sterile procedures.
Worldwide, countries are designing ways to address AMR by reducing both the supply and demand for antibiotics. The three key approaches are discouraging doctors from over-prescribing antibiotics, persuading pharma companies to release new drugs, and reducing overall demand to slow the evolution of new resistant strains. India needs to move away from a syndrome-based approach to an evidence-based approach treating infectious diseases using quality diagnosis, creating better disease-detection facilities and promoting rational antibiotic use in hospitals.
Following an unprecedented number of antibiotic discoveries in the last 40 years, the number of new ones in the pipeline have slumped to an all-time low. All major pharma industries have moved away from antibiotic discovery to focus on more profitable drugs for non-communicable diseases. Improving stewardship efforts around existing products will also influence pharma giants to look at antibiotics as profitable investment. We are born into this world with a limited number of breaths. When our numbered breaths are up, our soul leaves the body at the time of death. What we do with those breaths is up to us. We can choose to spend them wisely or foolishly.
In this regard, there is a story about a poor man who was given a sandalwood forest by a rich man for whom he did a favour. The poor man did not realise the value of the sandalwood and began chopping it up for