Antimicrobial resistance and the post antibiotic era: better late than never effort

ABSTRACT

Introduction: Antimicrobial resistance (AMR) is a multi-layered problem with a calamitous impact on humans, livestock, the environment, and the biosphere. Initiatives and action plan to preclude AMR remain poorly implemented in India.

Area covered: This review highlights essential factors contributing to AMR, epidemiology of the resistant bacteria, current treatment options, economic impact, and regulatory efforts initiated by the Indian government to tackle AMR.

Expert opinion: Health-care professionals, hospitals, and the general public must understand and cooperatively implement the ‘One Health approach,’ which entails judicious use of antibiotics in humans, animals, and the environment. Neglecting the AMR problem predicts the expansion of the ‘Post-antibiotic era’ characterized by drying antibiotic discovery pipelines, overuse of ‘Watch’ and ‘Reserve’ groups, coupled with underuse of ‘Access’ antibiotics, increased daily defined doses, increased healthcare cost, rise in morbidity, mortality, and environmental degradation. The Indian case study elucidates a looming international crisis that demands global attention and commitment for envisaging and implementing locally relevant solutions.

KEYWORDS:

• Antimicrobial resistance
• nosocomial infections
• extended-spectrum β-lactamase
• cost
• antimicrobial stewardship program

Article highlights

• India is emerging as an anti-microbial resistance (AMR) hotspot for many reasons such as: large population, high infectious disease burden, increased consumption from excessive antibiotic prescriptions, rising income, access to over-the-counter antibiotics, environmental pollution from industrial effluents and rampant use of antibiotics in veterinary and agriculture.

• There is a surge in the prevalence of multi-drug resistant (MDR) Gram-positive bacteria and Gram-negative bacteria.

• Suboptimal initiatives by the Indian regulatory authorities on surveillance data on antibiotic prescription, consumption and resistance.

• Failure to implement ‘WHO Access, Watch and Reserve (AWaRe) strategy’; excessive use of ‘Watch’ and ‘Reserve’ antibiotics

• Suboptimal infection control practices and anti-microbial stewardship programs at hospital and community levels with poor outcomes.

• India faces the ‘Post-antibiotic era’ (PAE) crisis from failure to implement the ‘One health approach.’

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.