Antimicrobial resistance (AMR) refers to the ability of microbes to combat therapeutic interventions. AMR microorganisms such as bacteria, viruses, and fungi resist antimicrobial drugs, making standard treatments ineffective. According to a report by CDC, 2.8 million AMR infections occur in the USA annually.
A UK study projected that by 2050, AMR infections may cause 10 million deaths annually. AMR infections have increased child mortality in India as commonly used treatments have become ineffective. Pathogenic bacteria, such as E.coli, Acinetobacter, and Staphylococcus aureus, have acquired antibiotic resistance and are often referred to as “superbugs,” causing infections that are difficult to treat. Superbug infections prolong hospital stays, raise mortality rates, and require costly treatments. AMR has a significant socioeconomic burden in India. Addressing AMR is an imperative global health need and requires collective worldwide effort.
While antibiotic resistance in bacteria is a natural phenomenon, rampant misuse of antimicrobial agents has accelerated this process. Overuse and misuse of antibiotics in healthcare setups provide selective pressure on bacteria to acquire mutation/genes for antimicrobial resistance. Antimicrobials work by disrupting the physiology of microbes. Different classes of antimicrobials target other areas of the microbes to kill. Penicillin, discovered in 1928, revolutionised the fight against common infectious diseases by providing the impetus to develop several novel classes of antibiotics. However, nature and life find ways to survive through evolution. Modifying antibiotic targets, novel enzymatic mechanisms to degrade antibiotics, forming outer protective coating like biofilms, etc, are some of the resistance mechanisms leading to the survival and persistence of microbes.
AMR is recognised as one of the top ten global public health threats by the World Health Organization (WHO). In 2024, WHO compiled a bacterial priority pathogen list, which includes bacteria such as Enterococcus, S aureus, K pneumoniae, A baumannii, P aeruginosa, Enterobacter, and E coli, known to cause AMR nosocomial infections. Significant drivers of AMR in India are misuse of antibiotics, self-medication, inadequate healthcare facilities, improper use of antimicrobials in the agriculture sector, and lack of sanitation facilities. Overuse of antibiotics during the Covid pandemic has exacerbated the problem.
Strategies to mitigate AMR
Infection prevention and control programmes: Infection control programmes directly affect the use of antibiotics. Vaccines help combat the spread of AMR both directly and indirectly. Vaccination decreases unnecessary antibiotic use and hospitalisation, further preventing the spread of AMR.
Strong AMR surveillance programmes: In 2015, the Global Antimicrobial Resistance and Surveillance programme was launched by WHO as a collaborative initiative to standardise AMR surveillance. Data heterogeneity hinders comparative analysis of AMR-associated pathogen phenotypes/genotypes. AMR surveillance can foster new antimicrobial guidelines and reduce inappropriate antibiotic usage. Documentation of patient data and electronic-APP-based inventions can be helpful in AMR surveillance.
Access to proper healthcare and sanitation: In India, several socioeconomic factors, such as the lack of adequate sanitation facilities and clean water, further aid in the spread of AMR. In many rural areas, access to healthcare facilities is also lacking. Government of India initiatives, such as the Swachh Bharat Abhiyan, can help curb the spread of infections.
New antimicrobial development: Developing new antimicrobials is the need of the hour. A renewed push for R&D and sustained funding could aid in discovering and inventing new antimicrobials.
Awareness programmes: One of the major problems in India is the overuse and misuse of antibiotics. Patient awareness programmes are needed to make the general public aware of the risks associated with self-medication and over-the-counter use of antibiotics. Many awareness campaigns are being launched at state and central levels to increase awareness regarding AMR.
The Government of India-National Action Plan works on a similar mandate as WHO to tackle AMR. Recently, many initiatives have been taken. The national programme on AMR containment involves establishing labs in state and medical colleges. The Delhi Declaration on AMR was signed by concerned ministers to pledge support to AMR containment. Recently, the Chennai Declaration was launched, which limits the use of second- and third-line antibiotics. AMR is a significant threat to global health, and collaborative efforts at both the national and international levels are needed to curb its spread.
Dr Richa Priyadarshini
Associate Professor, Department of Life Sciences, School of Natural Sciences, Shiv Nadar University, Delhi-NCR