Antimicrobial Resistance

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    In Context

    • Recently, a strand of antimicrobial-resistant gonorrhoea outbreak has hit Kenya.

    More about the news

    • About:
      • The outbreak of Neisseria gonorrhoeae is not just a threat to the citizens of the East African anchor state but the region as a whole, according to experts. 
      • The outbreak is a major concern among health practitioners, especially happening at a time WHO endeavours to end STIs as a public health concern by 2030.
    • More about Gonorrhoea:
      • About:
        • Gonorrhoea is the second-most common disease to be sexually transmitted across the world after chlamydia, according to the World Health Organization (WHO).
        • The medics said the drug-resistant super gonorrhoea was first detected in samples taken from sex workers in the capital city, Nairobi, and other urban areas like Kiambu County.
      • Drug resistance:
        • Some of the drugs that got 100 per cent resistance included ciprofloxacin and ceftriaxone, which are in the current STI treatment algorithm in Kenya.
        • The United Nations health agency blamed the drug resistance of some strands of gonorrhoea on the overuse of antibiotics, genetic mutations of the bacteria and repeated use of poor-quality drugs, in its regular reports.
    • Other diseases with the concern of antimicrobial resistance:
      • Other diseases that medics have expressed concern over due to total antimicrobial resistance include various strains of SARS-CoV-2, ebola virus disease, Crimean-Congo hemorrhagic fever, Lassa fever and marburg virus disease.
      • The same has been reported regarding some strains of Middle East respiratory syndrome coronavirus, Rift Valley fever, severe acute respiratory syndrome, Nipah and henipaviral diseases.

    More about the Antimicrobial resistance

    • About: 
      • Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death
      • Difference between Antibiotic & Antimicrobial resistance:
        • Antibiotic resistance refers specifically to resistance to bacteria. Antimicrobial resistance refers to resistance to bacteria, viruses, fungi and parasites.
    • Issue:
      • A study in 2019 found more than 1 million people a year died from infections linked to microbes that are resistant to antibiotics — more than those who died due to malaria or with HIV/AIDS.
      • Experts describe antibiotic resistance as one of the greatest challenges facing humanity.
        • They predict that if the problem remains unsolved, 10 million people could die as a result by 2050.
    • Causes:
      • Antibiotic resistance occurs when bacteria evolve to evade antibiotics. Overuse and misuse of antibiotics are the biggest drivers of resistance. 
      • That means that the more we use antibiotics, the worse the problem of antibiotic resistance becomes.
      • Other drivers of antimicrobial resistance include the lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals, poor infection and disease prevention and control in healthcare facilities and farms, poor access to quality, affordable medicines, vaccines and diagnostics, lack of awareness and knowledge.
    • How does it work?
      • Antibiotics work by binding to a specific target protein on a bacteria, then entering to kill it from the inside. 
        • Penicillin, for example, weakens the bacterial cell wall, causing the cell to disintegrate.
      • The most common ways bacteria evade antibiotics come from mutations that allow them to stop drugs from binding to bacteria. 
        • It’s like the bacteria changed the locks so the antibiotic key no longer opens the cell door.
      • Bacteria can also achieve resistance by producing proteins that inactivate or modify the antibiotic, so it no longer binds to the bacteria. Or the target protein is mutated so the antibiotic can no longer bind to it.
      • But worst of all is when bacteria evolve many of these mechanisms in backup, so even if you overcome one, other resistances might fill the gap.

    Suggestions

    • Unfortunately, it isn’t as simple as developing a drug that will permanently overcome antibiotic resistance. 
    • Antibiotic resistance will always be with us. It’s the nature of evolution by natural selection that means bacteria will always find ways to evade antibiotics.
    • Modifying existing antibiotics:
      • Scientists have been working on the issue from many different angles. One approach is to modify old antibiotics so they overcome resistance.
    • Developing new antibiotics:
      • Another strategy is to make brand-new drugs, but this approach hasn’t been very successful in recent decades.
      • But there are some signs of progress. For one, scientists are now armed with much more sophisticated drug discovery technologies, not least artificial intelligence (AI).
      • But central to the issue is that antibiotic resistance develops quickly whereas antimicrobials — the basis of antibiotic drugs — are developed slowly.
    • Global efforts:
      • Overcoming antibiotic resistance will require tremendous international effort dedicated to the problem.

    Measures Taken to Rising Anti-Microbial Resistance in India 

    • National programme on AMR containment:
      • It was launched during the 12th FYP in 2012-17
    • National Action Plan on Antimicrobial Resistance (NAP-AMR): 
      • It has a focus on the One Health approach & was launched on 19th April 2017 with the aim of involving various stakeholders ministries/departments.
    • AMR Surveillance Network:  
      • ICMR established the AMR surveillance and research network (AMRSN) in 2013, to generate evidence and capture trends and patterns of drug resistant infections in the country.
    • AMR Research & International Collaboration: 
      • ICMR has taken initiatives to develop new drugs /medicines through international collaborations in order to strengthen medical research in AMR.
    • India’s National Action Plan for containment of AMR:
      • It  focuses on an integrated One Health approach and involves coordination at the state, national and international levels.
    • Key priority of National Health Policy 2017:
      • In its National Health Policy 2017, India has identified managing AMR as a key priority and since then the health ministry has taken several initiatives to nip the epidemic that is growing fast globally.