Fighting the antibiotic apocalypse

Antimicrobial resistance (AMR) is not a country specific issue but a global concern. Yet, in a developing country like India, the burden of infectious diseases is high and healthcare spending is low, and AMR has huge adverse implications. Therefore, Healthcare Senate 2017 had a panel discussion on ‘Fighting the antibiotic apocalypse’ which witnessed experts discussing and deliberating on various measures to contain AMR and arrive at a comprehensive action plan to tackle it. The panel comprised Dr Selwyn Colaco, COO, Cytecare Cancer Hospitals; Dr Nandakumar Jairam, Chairman, CEO and GMD, Columbia Asia Hospitals; Dr Subramanian Swaminathan, Infection Control Expert, Global Hospitals and Sumit Marwah, CEO and Director, Dispoline India. The session was moderated by Dr Clive Fernandes, Group Clinical Director, Wockhardt Hospitals & JCI Consultant, Joint Commission International.

Fernandes set the context for the discussion by highlighting the enromity of the issue. Quoting from the CDC report on Antibiotic Resistance Threats in the US, 2013, he revealed that more than two million people get infected every year and around 23,000 people lose their lives to AMR. The additional cost of treating AMR is $20-35 billion. However, he also said that if something can be measured, it can be managed and asked each panelist to share their views on the subject.

The panel raised an alarm on the overuse of these antibiotics and highlighted that lack of governance and injudicious prescription leads to antibiotic resistance.

Initiating the panel, Dr Jairam gave a brief history about the antibiotics. He informed that though researchers and innovators had the knowledge that antibiotics could gain resistance, the ability to formulate newer, better and stronger antibiotics existed till 70s.

He apprised that lack of governance till the 60s is one of the factors which caused an uncontrolled rise of AMR. Many horrific surgical infections are a result of indiscriminate use of antibiotics and moving towards using single dose peri-operative antibiotics will work in favour of containing it.

The panelists also gave the call to link current practices to proven, evidence-based practices. Dr Swaminathan asserted that the paradigm of switching antibiotics does not hold true as resistance to one drug will often induce multi-drug resistance to all classes. He also threw light on the measures that can help compliance such as managing administrative support and manpower. He also recommended PPPs to streamline process with help tackle AMR. He further mentioned that improving clinical experience and reducing costs will strengthen the processes.

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Key Takeaways

• Poor AMR in India is rising due to poor practices in animal husbandry, lack of effective infection control systems, lack of standardisation of labs and patient unawareness
• A multi-pronged approach including basic training of practitioners and increasing awareness of the common public, is a must to tackle the problem
• India needs to contain AMR on a priority basis with evidence-based, proven practices to improve its health index

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As an administrator, Colaco suggested measures like creating a collaborative venture, confidence building among management and doctors, as well as streamlining antimicrobial stewardship programme in hospitals followed by an audit process would help tackle the issue. he also stated that a holistic approach needs to be adopted to tackle this menace.

The panelists also pointed out that AMR is shooting up due to causes like poor practices in animal husbandry, lack of effective infection control systems, lack of standardisation of labs and patient unawareness. Marwah raised a question on the methods to educate the common public about AMR. Replying to this, Dr Jairam responded that awareness programmes in association with the media and well-planned CSR initiatives will surely yield results. Dr Swaminathan added that better standardisation of labs and adherance with guidelines will also be beneficial.

The panelists were unanimous in their view that we need a multi-disciplinary approach to vanquish this growing problem. All of them recommended increasing awareness, meaningful collaborations, learning from global experience etc. as measures to be implemented as part of a comprehensive blueprint to curb AMR.

The audience also posed several pertinent queries to the panelists. A delegate enquired about the learnings from different countries like Australia and New Zealand, which have a record of curtailing AMR. The session also revealed that the Scandinavian countries have the best health indices as 40 per cent of the patients are treated with vaccinations and are provided with sound and timely health advices, instead of resorting to antibiotics. To promote better health index, the nation needs to contain AMR by curtailing the use of antibiotics.

The session was concluded on the note that the war against AMR needs to fought on multiple levels with a multi-pronged approach.