who theme of the year ---antimicrobial resistance

'The arsenal to fight microbes is very weak right now'

Apr 27, 2011, 12.00am IST

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• World Health Organisation

The World Health Organisation (WHO) has made antimicrobial resistance the theme of this year's World Health Day. The WHO representative to India, Nata Menabde , spoke to Rema Nagarajan on why the issue of growing resistance to antibiotics is a threat to the global fight against infectious diseases and what the Indian government needs to do to address this issue:
How serious is the problem of the irrational use of antibiotics?
It's a very serious problem globally because it endangers human lives when antibiotics don't work. In 80 years, 150 antibiotics have been developed. No new antibiotics are expected for at least 10 years. Hence, the arsenal to fight the microbes is very weak now. Antibiotic resistance in any part of the world is a threat to global health security as the resistant microbes travel and spread fast with global travel and trade.
Why is the problem said to be more serious in India?

It is an even bigger problem in this region because infectious diseases account for 40% of all diseases in Asia. Diseases like malaria, tuberculosis and HIV can only be treated with antibiotics. We don't even know how big the problem is in India because there is no surveillance system. In malaria we know that chloroquine is not working. So far more expensive artemisinin derivatives are being used. Similarly, many people are infected with TB bacteria resistant to first-line drugs. So you're forced to move those patients to more expensive second-line drugs. India carries 20% of the world's TB burden. Of all TB cases being reported, 28% are cases of multi-drug resistant TB. In HIV treatment, the second-line therapy is six times costlier. So, fighting these diseases is not only going to become more difficult but also more expensive.
What is the biggest barrier to implementing a rational antibiotics policy in India?
Antibiotics are available over the counter in India and most people don't complete the full course of antibiotic therapy. Plus, spurious drugs often do not contain the full or correct dosage. Incomplete therapy or dosage gives microbes time to develop resistance. Often people pressurise their doctors to prescribe antibiotics and doctors out of fear of losing business prescribe it even when not needed. There is no monitoring of antibiotics prescription by doctors.
Can India fight growing antibiotic resistance?
Advances in IT and mobile technology means that the solutions are available here. The government has to strengthen the regulatory mechanism, monitor the professional quality of doctors and medical associations need to enforce them. Over-the-counter sale of antibiotics should be stopped. The health ministry is considering labelling antibiotics a different colour and selling them only in hospitals so that they cannot be dispensed without prescription. It is not easy to enforce all this immediately. It is a process. But it has to start and hopefully, things will improve.
What is the role of WHO in promoting rational use of antibiotics?
WHO collaborates with governments and gives a supporting shoulder. We help generate enough evidence to back the policy measures that need to be put in place and also help the government develop appropriate curricula for medical personnel. Antibiotic resistance is under-researched in Asia and WHO has started collecting data to help understand the problem better. It also helps governments put in place proper labs and research facilities and with multi-sectoral coordination that is required to tackle this problem.