Antibiotics are chemicals that have the ability to inhibit the growth of microorganisms, especially bacteria, and are either produced naturally by other microorganisms or synthetically in a laboratory. Although antibiotics are commonly prescribed for 7 to 14 days to treat most illnesses, long-term use may be necessary to treat certain chronic infections. Prolonged use of antibiotics can have several side effects, so it is important for both the doctor and patient to weigh the pros and cons of prolonged antibiotic use.

Antimicrobial Resistance

You might have heard about Super Bugs, which are resistant to all the medicines. Such a condition is the outcome of Anti Microbial Resistance (AMR). The studies conducted by WHO have found that in many developing countries including India, the careless use of Antibiotics is very prevalent 

Reasons for Anti Microbial Resistance:

Microbes, such as bacteria, viruses, fungi, and parasites, are living organisms that evolve over time. They adapt to their environments and change in ways that ensure their survival. If something stops their ability to grow, such as an antimicrobial, genetic changes can occur that enable the microbe to survive. There are several ways this happens such as:

I) Natural Causes

a) Selective Pressure:

In the presence of an antimicrobial, microbes are killed but if they carry resistance genes, they survive. These survivors will replicate, and their progeny will quickly become the dominant type throughout the microbial population.

b) Mutation:

Most microbes reproduce by dividing every few hours, allowing them to evolve rapidly and adapt quickly to new environmental conditions. During replication, mutations arise and some of these mutations may help an individual microbe survive exposure to an antimicrobial.

c) Gene Transfer:

Microbes may also get genes from each other, including genes that make the microbe drug resistant. Bacteria that have drug-resistant DNA may transfer a copy of these genes to other bacteria. Hence, the non-resistant bacteria receives the new DNA and become resistant to drugs.

II) Social/Anthropogenic Causes:

There are additional anthropogenic causes that act to accelerate the increase of AMR. This may include:

a) Inappropriate Use:

Selection of resistant microorganisms is exacerbated by inappropriate use of antimicrobials. Sometimes healthcare providers prescribe antimicrobials inappropriately, wishing to placate an insistent patient who has a viral infection or an undiagnosed condition.

b) Inadequate Diagnostics:

Many times healthcare providers use incomplete or imperfect information to diagnose an infection and thus prescribe an antimicrobial drug (broad-spectrum antimicrobial) when a specific antibiotic might be better. These situations contribute to selective pressure and accelerate antimicrobial resistance. Also in countries like India, there isa widespread problem to "self-diagnose" and "self-medication" which causes problem.

c) Hospital Use:

Critically ill patients are more susceptible to infections and, thus, often require the aid of antimicrobials. However, the heavier use of antimicrobials in these patients can worsen the problem by selecting for antimicrobial-resistant microorganisms. The extensive use of antimicrobials and close contact among sick patients creates a fertile environment for the spread of antimicrobial-resistant germs.

d) Agricultural Use:

It also believed that the practice of adding antibiotics to agricultural feed promotes drug resistance. However, there is still much debate about whether drug-resistant microbes in animals pose a significant public health burden.

Tackling with the AMR:

The actions needed to deal with the problem of AMR can be taken at 3 levels: Individual, National and Global.

a) Individual Level:

i) At individual level, AMR can be tackled by:

ii) Avoiding self-diagnose and self-medication

iii) Completing full treatment

b) National Level

i) Devising a strict Drug Prescription Policy and Implementing it

1) Antibiotic Stewardship, Prevention of Infection and Control (ASPIC) program was initiated in 2012 by ICMR. It is a multidisciplinary Program which aims to restrict the inappropriate use of antibiotics and combat the incidence of AMR.

2) Chennai Declaration: is a major step towards Anti Microbial Stewardship (AMS) policy in India. It contains the following objectives: regulating over the counter sale of anti-biotic; Monitoring the use of in-hospital antibiotic; audit and feedback; measures to step up microbiology lab facilities; national AMR surveillance system  

ii) besides this there is a need to give higher priority to the control of infectious diseases in India and also increase the budget allocation for more research facilities in medical sector.

iv) Through the Swacch Bharat program, the Government has taken active steps to improve hygiene and sanitation and reduce the environmental spread of pathogens.

v) The Vaccination is an equally important public health measure, and through Mission Indradhanush, India has set itself an ambitious goal of increasing routine immunization coverage to 90% within just a few years.

c) Global Level:

i) WHO has put forward a "Global Action Plan on Anti Microbial Resistance". Implementing its suggestions at global level can prove to be an effective way of tackling the issue of AMR. It seeks to achieve 5 main objectives:

1) Improve awareness and understanding of antimicrobial resistance through effective

communication, education and training

2) Strengthen the knowledge and evidence base through surveillance and research

3) Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.

4) Optimize the use of antimicrobial medicines in human and animal health

5) Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

ii) International Campaigns for awareness similar to Red Line Campaign