Global antibiotic consumption up by 46%: GRAM Study

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    • Global antibiotic consumption rates increased by 46% in the last two decades, according to a study covering 204 countries from 2000 to 2018, and published in The Lancet Planetary Health by the Global Research on Antimicrobial Resistance (GRAM) Project.

    About

    • Comparative analysis: The study provides a comparative analysis of total antibiotic consumption rates in humans globally, expressed in the WHO metric of defined daily doses (DDD) per 1,000 population per day. 

    Key Findings

    • Variation between countries: In total antibiotic consumption rates, ranging from as low as 5 DDD to 45.9 DDD per 1000 population per day.
    • Up by 46%: Between 2000 and 2018, global antibiotic consumption rates increased from 9.8 to 14.3 DDD per 1000 population per day.
    • Low- and middle-income countries: Increase observed between 2000 and 2018 in low- and middle-income countries (from 7.4 to 13.1 DDD per 1000 per day).
      • In high-income countries, consumption rates remained stable.
    • Region-based: Highest Increase in antibiotic consumption rates are in South Asia which is 116% and the second-largest increase was in North Africa and the Middle East region 111%.
    • Most important driver of drug-resistant infections: Excess and inappropriate use of antibiotics is an important driver of drug-resistant infections, says study.

    World Antimicrobial Awareness Week

    • Date: It is celebrated annually from 18 to 24 November.
    • Aim: To increase awareness of global antimicrobial resistance and to encourage best practices among the general public, health workers and policymakers to avoid the further emergence and spread of drug-resistant infections.
    • Endorsed: A global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the Sixty-eighth World Health Assembly in May 2015..

    Problem of Anit-Microbial Resistance

    • Meaning: 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.
    • Emergence and spread: AMR occurs naturally over time, usually through genetic changes.
      • Antimicrobial-resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air).
      • They can spread from person to person or between people and animals, including from food of animal origin.
    • The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials,
      • 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, and
      • lack of enforcement of legislation.

    What is Multiple drug resistance (MDR)?

    • Three or more antimicrobial categories: It is antimicrobial resistance (AMR) shown by a species of microorganism to at least one antimicrobial drug in three or more antimicrobial categories.
    • Extensively drug-resistant (XDR): is the non-susceptibility of one bacteria species to all antimicrobial agents except in two or fewer antimicrobial categories.

     Factors Causing AMR in India

    • Inappropriate consumption of broad-spectrum (last resort) antibiotics is high because of changing prescription practice in the healthcare system due to the non-availability of a narrow spectrum of antibiotics.
    • Inappropriate antibiotic use among the general public like Self-medication to avoid the financial burden.
    • Large proportion of sewage is disposed of untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms.

    Challenges Posed by AMR

    • Major threat: Antibiotic resistance is emerging as the threat to successful treatment of infectious diseases, organ transplantation, cancer chemotherapy and major surgeries.
    • Out of pocket expenditure on health care: The issue of AMR causes out of pocket expenditure on health care, especially on medicines. The use of high order drugs or second-line expensive antibiotics pushes treatment costs high.
    • Prone to a section of society: Neonates and the elderly both are prone to infections and are vulnerable.

    Various Initiatives Adopted

    Global Efforts:

    • Global Action Plan on Antimicrobial Resistance (GAP): Globally, countries committed to the framework set out in the Global Action Plan1 (GAP) 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of multisectoral national action plans.
    • Tripartite Joint Secretariat on Antimicrobial Resistance: Tripartite joint secretariat (FAO, OIE and WHO) has been established and is hosted by WHO to drive multi-stakeholder engagement in AMR.
    • Interagency Coordination Group (IACG) on AMR: It was convened by the Secretary-General of the United Nations after the UN High-Level Meeting on Antimicrobial Resistance in 2016.
      • The IACG brought together partners across the UN, international organizations and individuals with expertise across human, animal and plant health, as well as the food, animal feed, trade to formulate a plan for the fight against antimicrobial resistance.
    • Global Antimicrobial Resistance and Use Surveillance System (GLASS): WHO launched it in 2015 to continue filling knowledge gaps and to inform strategies at all levels
      • GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and the environment.

    India’s initiative:

    • Need of a doctor’s prescription: To prevent the Over counter sales of antibiotics, the central drug standard control organization (CDSO) prohibits medical stores from selling 24 key antibiotics without a doctor’s prescription.
    • India’s Red Line campaign: Which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics– is a step forward.
    • National Health Policy, 2017: terms antimicrobial resistance as one of the key healthcare issues and prioritizes the development of guidelines regarding antibiotic use and check on restricting the growth of antibiotics.
    • The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017: has assigned coordinated tasks to multiple government agencies involving health, education, environment, and livestock to change prescription practices and consumer behaviour and to scale up infection control and antimicrobial surveillance.
    • Various guidelines: FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.

    Way Forward

    • Discovery of new drugs: before the emergence of resistance in germs; and prudent use of available antibiotics.
      • The discovery of a new drug is an expensive and unpredictable process; the estimated cost for developing a new antibiotic exceeds $1 billion.
    • Efficient use: to use the available antibiotics carefully to ensure their efficacy for as long as possible.
    • Awareness and education: Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines.
    • Policy alignment: is also needed much beyond the health system. Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.

    Source: IE