Not just antibiotic abuse, corruption, low health spend also fuel superbugs

NEW DELHI: Superbugs — disease causing bacteria and micro-organisms resistant to conventional medicines — aren’t caused just by overuse of antibiotics but also by poor sanitation, unsafe water, higher income and education (because these improve access), corruption and low public health expenditure, even hotter weather, as per a new study.

Overuse and misuse of antibiotics have long been believed to fuel antimicrobial resistance (AMR), but new research shows that simply lowering consumption is not enough. Poor sanitation, unsafe water, corruption and low public health expenditure have a bigger role in pushing up drug-resistant infections in low-income countries and middle-income countries, including India, as per the study published in Lancet Planetary Health.

“Lowering of antibiotic consumption is not sufficient to control antimicrobial resistance because the spread of resistant strains and resistance genes are the dominant contributing factor. Providing sanitation, clean water and good governance, increasing public health expenditure and better regulating the private health sector are all necessary to reduce antimicrobial resistance,”

said study co-author Ramanan Laxminarayan from Princeton Environmental Institute, University of Princeton, US. “This is not to say that antibiotic consumption should not be lowered; it is an important factor to

lower antimicrobial resistance when all these other correlations have been fixed. Simply reducing consumption will not be enough when the resistant gene is out there, we must stop transmission by fixing all the above,” said Laxminarayan. Quantifying the effects of improving the indices with the most potential for reducing antimicrobial resistance, the study found E coli resistance levels fall by 18.6% for every one standard deviation improvement in the infrastructure index. Additionally, there was a 5.5% decrease in E coli resistance levels if the governance index was improved by one standard deviation.

“In India, antibiotics are used most often to treat diarrhoea and upper respiratory tract infections, both of which can be reduced by improving sanitation, providing clean water, adopting personal hygiene and getting vaccinated,” said Dr Kamini Walia, scientist and programme officer (antimicrobial resistance) Indian Council of Medical Research. Even temperature has a role to play. The warmer the country, the higher its antimicrobial resistance levels, found the study. Studies in the past, including one published in Nature Climate Change in May, have linked higher local temperatures and population densities with more antibiotic resistance in common bacterial strains. “Warm temperatures offer more potential for bacteria to multiply, transfer antimicrobial resistance, as do higher insect populations, which also spread resistant bacteria,” said Laxminarayan.

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