HYDERABAD: Navigating the challenges of Anti-Microbial Resistance (AMR), healthcare professionals warn against the impending threat of superbugs causing major health concerns in the future. Dr Ponnari Gottipati, Associate Director of Research Management at LV Prasad Eye Institute explains the problems caused by AMR and what steps stakeholders should take to combat it.
Most infectious diseases, be it COVID, dengue, chikungunya or malaria, are caused by microorganisms. Anti Microbial drugs are used to kill or stop the growth of these microorganisms so that we can stop the spread of the infection. These microorganisms are present everywhere, in our bodies and in the environment. “Infectious diseases are caused by different kinds of microorganisms like viruses, bacteria, fungi, algae and also parasites. There are antivirals, anti-parasitic drugs, antibiotics, etc to treat diseases caused by them. Antibiotics specifically work against bacteria, but those are the most commonly used drugs in the healthcare industry,” explains Dr Ponnari Gottipati.
“Penicillin, for example, was the first antibiotic that was discovered that started off this revolution in healthcare, until then, people were dying because of infections. These antibiotics changed that scenario because now we are able to contain these infectious diseases by using some drugs. However, there is a concept of survival of the fittest. Every organism tries to come up with coping mechanisms to avoid getting killed. Microorganisms also develop mechanisms to evade the effect of these drugs,” she said.
Explaining that microorganisms showing resistance to drugs is a natural process, Dr Gottipati said that during treatment, when one antibiotic doesn’t work, we go for another that works differently on that particular microorganism. “But over the years, we have been using antibiotics indiscriminately,” she said. “We end up taking an antibiotic even though it is not necessary. The misuse and overuse of these drugs have given more chances for microorganisms to evade them. We’re actually fastening the process of these microorganisms becoming resistant to drugs,” she added.
AMR is recognised as one of the top 10 global health threats specified by the World Health Organisation (WHO). “Now we have something called superbugs which are organisms that are resistant to more than two classes of drugs and we see that whatever arsenal we have in our hand is becoming increasingly ineffective,” warns Dr Gottapati.
In the past few decades, the attention of the medical fraternity shifted to non-communicable diseases like diabetes and cancer but now infectious diseases are coming back into the focus. “Their rise can be attributed to multiple factors. Microorganisms exist in the environment and misuse of drugs also exists in animal husbandry, aquaculture, poultry, agriculture, etc,” she said.
With residuals of the pharma industry getting into the soil and water bodies and then into our food chains, rebel microbes are ubiquitous at the moment. “WHO has warned that AMR can cause approximately 10 million deaths by 2050 if we don’t start acting now,” the researcher said.
This would have major economic and social implications. “It is no longer a problem catering only to humans, it is a world health problem. Healthcare professionals from the human sector, agriculture, aquaculture, industry stakeholders and policymakers need to come together to cater to the issue.
“Assessing the infectious diseases and what works for them takes time. Normally, doctors give empirical treatment, trying to alleviate the symptoms, and they prescribe broad-spectrum antibiotics. A large percentage of prescriptions globally are not correct. It is in the best interest of the patient to wait and diagnose accurately. These anti-microbial drugs need to be prescribed only when absolutely necessary and it is important to figure out what specific drugs work for what disease. The doctor should also stop the medication when not necessary. There is something called the AMR Stewardship program for healthcare providers by WHO, which advises doctors on what type of antibiotics to prescribe for specific diseases and how to regulate the dosage. WHO also has AWARE classifications which divide these anti-microbial-resistant drugs into three categories. Some are put under reserved, some under ‘watch’,” said Dr Gottipati.
She mentioned that at the policy level, the over-the-counter sale of antibiotics needs to be regulated. The use of last-resort antibiotics such as Colistin needs to be checked and regulations on treatment of pharma and sewage waste need to be enforced properly, checking the amount of microbials they release in water bodies. There also needs to be continuous surveillance of the growth of AMR, studying the rate at which they grow, the impact they create and how to combat the growth.