The Looming Threat of Antimicrobial Resistance: A Call to Action

We very often read articles or hear news about “Doomsday Theory”. We usually pretend that doomsday would be happening due to World War, Pandemic or any other crisis which would be like a last straw event, but we usually tend to ignore small events or act by counting them as trivial things or procrastinating it as farfetched scientific theory which would never happen and even if it happens, it would be dealt by government or intergovernmental bodies. One such theory that demands our attention is Antimicrobial Resistance (AMR). So, what exactly is AMR?

About Antimicrobial Resistance

According to World Health Organization, Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.

AMR is part of the evolutionary process, whenever we take medication for any issue, we are effectively providing reinforcement to our body cells to fight the bacteria, virus or pathogen. When we provide the same reinforcement frequently or even when it’s not required we end up accelerating the evolutionary process of the bacteria, virus or pathogen, due to which they become resistant to the those medication.

Knowing the facts, should we not take medication for fever or any other medical issue?

The clear answer is NO. Firstly, we should not self-medicate or overuse the dosage prescription given by medical professional. 

Due to adoption of hygiene hypothesis and also the COVID pandemic, we have tend to become over cautious, even for common fever including pain, constipation etc. we are self-medicating and rushing to over-the-counter medicines without addressing the under lying issues. For example, antibiotics are ineffective for viral illness but still we take antibiotics like azithromycin even when it won’t help.

Secondly, AMR is also accelerated when we don’t complete the prescribed dosage. Most of the medical professionals prescribes Fixed Drug Combinations (FDC) when they administer the drug dosage. These FDCs are meant for treatment of either single ailment or multiple comorbid conditions. Doctors always recommends to complete the dosage but we being ignorant don’t follow these guidelines, effect of which is that the remaining bacteria, viruses, or pathogens may not get fully eradicated. Incomplete treatment courses creates a survival advantage for the microbes, allowing them to adapt and develop resistance to the prescribed medications. 

Are only patients and common man responsible for AMR?

The clear answer is NO. The Government too is responsible. The waste water many times is released directly into water bodies, it’s the duty of government to put rules, regulation and infrastructure in place so that the waste water is properly treated.

According to a report titled Bracing for Superbugs by United Nations Environment Programme, it states that, ‘Antimicrobial agents are widely used in human medicine, aquaculture, livestock and crop production, and are also put into the feed and water of food animals. They are excreted in significant quantities into the environment as active molecules, or partially degraded, from various sources. The concentration of antimicrobials excreted unmetabolized in the faeces and urine of humans and animals is highly variable and is dependent upon the antimicrobial drug class, formulation, the route of administration, animal species and health status. Where provision of wastewater treatment is not adequate, close contact with polluted waters can result in a consumption-excretion cycle (WEF 2021). The consumption-excretion cycle occurs when containment, controls or barriers for these pollutants are lacking, such as pit latrines without confining barriers, or when inadequately treated or untreated wastewater is used to irrigate farmland, or animal manure or human waste is used to fertilize crops. This results in functional antimicrobials entering the environment unless waste management measures to address AMR development and spread are applied. Such releases transmit antimicrobial resistant microorganisms and ARGs, which can conditionally promote AMR, into the environment.’ So it’s the duty of government to have Sewage treatment Plant with proper capacity.

Secondly, having rules and regulation for over-the-counter medication also falls under responsibility of Government.

Thirdly, Climate change is also one of the driving factor behind AMR, according to National Institute of Health, Candida Auris is the first drug resistant fungal infection which is considered as consequence of Climate Change. Though talking climate change is not just government’s responsibility but lack of policy framework is.

Is there ray of hope?

Solutions exist at both national and international levels:

Solutions at national level:

1. Awareness programmes- Citizens should be made aware of this crisis which we would be facing.
2.  Policy formulation and data collection by government to understand the magnitude of the issue.
3. Scientific studies funded by government and private bodies.
4. One health approach, rather than compartmental approach or silo approach various department and ministries such Agriculture, Health, Fisheries, Scientific institution etc. should come together to address issues like AMR.

Solutions at international level:

1. Institutions like WHO are currently working on this, they published a report Global antimicrobial resistance and use surveillance system (‎GLASS)‎, they have studied more than 127 countries and created a database to study this crisis.
2. International awareness: Medical journal like lancet have series of report on AMR and allied issues, these are helping not just citizens but medical professionals also, by providing them latest information and case studies.
3. Funding the Low Income Countries, climate change is something which knows no boundary. Events like Conference of Parties under UNFCCC serves as a platform to not just discussion but to also mobilize fund for the cause.

In conclusion, raising awareness and implementing proactive measures at both national and international levels are imperative to combat the looming threat of Antimicrobial Resistance. It's a shared responsibility that demands collective action for a healthier and sustainable future.