Antibiotic stewardship involves a series of coordinated efforts to ensure antibiotics are used correctly, which helps improve patient outcomes, reduce side effects, and extend the effectiveness of current antibiotics. This approach could prevent at least 750,000 deaths from drug-resistant bacteria each year in low and middle-income countries (LMICs). According to a study published in The Lancet in May, the global death toll from infections caused by antimicrobial resistance (AMR) – now the second leading cause of death worldwide after heart disease – will continue to rise unless we take urgent action to address this serious public health threat.
While LMICs face a disproportionate burden of AMR owing to limited resources and access to antibiotics, the situation in India, which accounts for the highest antibiotic consumption in the world, is particularly worrisome. While 30 per cent of the infant deaths in the country are caused by bacteria that do not respond to antibiotics, more than 1 lakh people die of multi-drug-resistant tuberculosis every year, the highest after China. Realising that this alarming state of affairs necessitates immediate action, India adopted its National Action Plan on AMR in 2017, but its implementation is sorely lacking. Subsequently, the Indian Council of Medical Research launched the antibiotic stewardship programme as a pilot project, but even this initiative has not been backed by any decisive action so far to extend its scope to government and private hospitals in all districts across the country.
Taking a cue from the antibiotic stewardship programme adopted by the US, India should adopt multiple tracking systems and use electronic health data to assess the burden of AMR and accordingly devise strategies to deal with it. As a result of collaborative antibiotic stewardship efforts, the number of deaths caused by antimicrobial-resistant infections in the US has declined by 18 per cent and by about 30 per cent in hospitals. Though India’s antibiotic stewardship program guided by the WHO is tailored to the unique challenges of the Indian healthcare system, the UK’s comprehensive approach, covering prevention, control and mitigation strategies, is also worth emulating in the Indian context, coupled with the data-driven approach adopted by the US.
Unlike the US and UK, the typical challenges India faces in the effective implementation of its antibiotic stewardship program are lack of knowledge and resources, resistance to change, inadequate training and insufficient electronic medical records. Likewise, Indian hospitals either do not have standard treatment guidelines or do not strictly adhere to them. The monitoring and audit of antibiotic usage also leaves a lot to be desired. Learning from the examples of the US and UK, we should join all these missing links and ensure better coordination between microbiologists and physicians to identify the right course of action.
Adopting the best practices followed by advanced countries to counter the growing threat of drug-resistant bacteria, India should generate hospital antibiogram data on a more regular basis and in a more accurate manner by relying on technological advances in artificial intelligence and machine learning. It should then use the findings of this data on resistance patterns to formulate guidelines on antibiotic use and infection control practices for uniform implementation across all hospitals in the country.
We should also follow in the footsteps of these countries to make a provision for early microscopy tests, rapid molecular tests and other more accurate point-of-care diagnostic facilities based on the latest advancements to ensure that the right medicine is administered at the right time, at the right dosage and for the right duration, considering that any wrong course of treatment will not only prolong patients’ suffering but also lead to the proliferation of antibiotic-resistant pathogens. These definitive steps should be complemented by measures to discourage the over-the-counter sales of antibiotics to prevent their misuse through both punitive action and awareness drives.
Once these strategies are adequately implemented, we should focus on more research to assess their effectiveness and tailor them to the specific needs of different regions in the country. Besides collaborating with countries where antibiotic stewardship activities have yielded the desired results, we should also facilitate collaboration between the public and private sectors and work in association with multiple stakeholders like scientists, hospitals, policymakers, pharma companies and the general public to develop national policies as well as community outreach programmes on AMR.
The writer is President, Global Critical Care, Venus Remedies Ltd and CEO, Venus Medicine Research Centre
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