Why is it in News?
A global study published in The Lancet Public Health reveals that India's antibiotic consumption is severely skewed toward broad-spectrum 'watch' antibiotics. The findings highlight that while powerful antibiotics are overused unnecessarily, patients with multidrug-resistant infections often lack access to last-resort 'reserve' drugs.
About Antimicrobial Resistance (AMR) & WHO AWaRe Framework
- Antimicrobial Resistance (AMR): Occurs when microorganisms including bacteria, viruses, fungi, and parasites evolve mechanisms that render antimicrobial medicines (antibiotics, antivirals, antifungals, and antiparasitics) ineffective. As a result, standard medical treatments fail, infections persist in the body, and the risk of severe illness, transmission, and death escalates.
- Key Drivers: Healthcare Overuse/Misuse (over-prescribing, self-medication), Agriculture & Livestock (mass prophylactic use), Sanitation Deficits, and Environmental Contamination (pharmaceutical waste discharge).
The WHO AWaRe Framework
The WHO AWaRe framework classifies antibiotics into three operational categories to guide rational prescribing and monitor drug consumption:
- Access Group: First- and second-choice therapies for common clinical infections. They exhibit a lower risk of driving resistance. (Examples: Amoxicillin, Ampicillin, Gentamicin). Target: WHO recommends that at least 60-70% of total national antibiotic consumption come from this group.
- Watch Group: Broad-spectrum antibiotics with higher resistance potential, recommended only for specific clinical indications. (Examples: Ciprofloxacin, Azithromycin, Ceftriaxone, Meropenem). Action: Targeted for strict stewardship and monitoring to limit unnecessary usage.
- Reserve Group: Last-resort antibiotics reserved exclusively for severe or multi-drug resistant (MDR) infections when all other options fail. (Examples: Colistin, Linezolid, Polymyxin B). Action: Strictly managed under specialist oversight and integrated into national surveillance systems.
Static Linkage
- Article 47: Directs the State to raise the level of nutrition, standard of living, and improvement of public health.
- Data/Reports: According to WHO and ICMR estimates, drug-resistant infections cause over 1.2 million deaths globally and over 3 lakh deaths annually in India. The NCDC survey shows that nearly 72-75% of hospitalized patients in tertiary care are prescribed antibiotics, with 57% receiving 'watch' category drugs.
Policy Frameworks & Initiatives
- National Action Plan on AMR (NAP-AMR 2017): Focuses on a One Health approach across human, animal, and environmental sectors.
- Red Line Campaign: Launched to mark prescription-only antibiotics with a red vertical line to curb self-medication.
The Landscape of AMR in India
| Issues / Challenges | Significance / Benefits | Government Initiatives | Way Forward |
|---|---|---|---|
| Irrational Prescribing Patterns: Doctor blindly prescribes; >55% for prophylaxis. Only 6% backed by microbiological testing. | Targeted Prescription: Confirmed treatment based on microbiological testing. | AMR Surveillance Network (AMRSN): Expanded diagnostic infrastructure to track pathogens. | Mandate Microbiological Testing: Ensure accessible testing in hospitals. |
| Overuse of Watch & Fixed-Dose Combinations: High consumption of broad-spectrum drugs; unapproved FDCs. | Stewardship Interventions: Limit unnecessary broad-spectrum exposure. | Schedule H1 Implementation: Regulate over-the-counter sales. | Enforce AWaRe Guidelines: Ensure 'Access' Group antibiotics >= 60%. |
| Underutilization of Reserve Drugs: Underused despite the nation's resistance burden. | National One Health Mission: Integrated framework targeting AMR drivers. | Standardized Data Streams: Clinical guidelines to control prophylaxis duration. | |
| Duplicate Coverage: 26.4% duplicate gram-negative and 8.7% duplicate anaerobic coverage, increasing toxicity and costs. |
Related Previous Year Questions
- Mains Exam [2014]: Can overuse and free availability of antibiotics without Doctor's prescription be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. [15 Marks, 250 Words]
- Prelims Exam [2019]: Which of the following are the reasons for the occurrence of multi-drug resistance in microbial pathogens in India?
- Genetic predisposition of some people.
- Taking incorrect doses of antibiotics to cure diseases.
- Using antibiotics in livestock farming.
- Multiple chronic diseases in some people. Select the correct answer using the code given below: (Correct Answer: 2 and 3 only)