Dr Krishna Reddy Nallamalla
The specter of the Mucormycosis epidemic, commonly known as black fungus, is sweeping through the country. Antimicrobial resistance (AMR) is a globally recognized public health problem. Hospital-acquired infections are adversely impacting outcomes in patients admitted to intensive care units. The irrational use of antibiotics underlies all of the above.
Billions of microbes (bacteria, viruses, fungi etc.,) live within us and outside of us. They multiply at astonishing rates. As they multiply, they develop mutations or errors in their genetic code. Stress factors increase the frequency of mutations. Drugs that inhibit or kill these microbes (antibiotics, antivirals, and antifungals) cause great stress to these microbes. Some mutations confer asurvival advantage for them to escape the lethal effects of drugs and toxins. This is termed as drug resistance. Some mutations confer advantage against multiple drugs, termed as multi-drug resistance (MDR).
In India, lax regulation allowed people to buy antibiotics, antivirals, and antifungals without a prescription. Unqualified informal providers give antibiotics to patients for every suspected infection. Even formally qualified providers resort to empiric antibiotics to avoid the cost of investigating and establishing the infection. Indiscriminate use of high-end antibiotics is increasing across intensive care units. Very few hospitals have and follow an antibiotic usage policy. Only a handful of hospitals have quality accreditation.
Animal husbandry and poultry industry is the biggest user of antimicrobials. Due to poor oversight, many pharma companies release their antimicrobial effluents into the environment. These drug resistant microbes can enter humans from the environment. These two reasons account for the growing threat of AMR, in addition to the indiscriminate use of antimicrobials in medical care.
Multi drug resistant bacteria account for various hospital-acquired infections, especially in those patients with prolonged stay in intensive care. They not only result in increased number of deaths, but also add to the prolongation of hospital stay and costs. Because of irrational drug use, even community acquired infections are exhibiting multi drug resistance. Multi drug resistant tuberculous bacillus is a serious problem in India. Half of all tuberculosis deaths across the world are reportedfrom India.
Many microbes live harmoniously with and within us. There is a growing body of knowledge about human microbiome and its importance in human health. When we take antimicrobials, we are disturbing our microbiome in unknown ways. Its impact on our digestion and nutrient absorption, on our immune system, and on our brain functioning has been studied.
Dangers of irrational antimicrobial use need to be addressed at the level of health and other social systems. People should be made aware about the perils of self-medication with antimicrobials. They should be in a position to question their physicians when they prescribe these without proper evidence. They should question their political representatives and hold them accountable for effective regulation of the pharma and veterinary industries. They should demand quality accreditation from hospitals to ensure thatgood and safe healthcare services are being provided to them. They should not be misled by social media posts. They should seek right information.
Only people who have access to right health education and information are empowered. Only empowered masses can bring change in complex systems which evolve in response to their needs.
Dr Krishna Reddy Nallamalla
Country Director, ACCESS Health International