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Antibiotic resistance reaching critical levels, warning for India: WHO

A report on ‘superbugs’ in Delhi’s water supply and warnings from the World Health Organisation about the growing incidence of drug resistant bacteria mark World Health Day

Indiscriminate use of antibiotics is giving rise to antibiotic resistant ‘superbugs’ and could render antibiotics useless, warned the World Health Organisation on April 7, 2011, which is designated World Health Day.

The theme this year was microbacterial resistance. The WHO urged a global movement to safeguard antibiotics for future generations. “We are at a critical point in time where antibiotic resistance is reaching unprecedented levels,” said Zsuzsanna Jakab, the WHO’s regional director for Europe.

On the same day, a study published in The Lancet Infectious Diseases journal showed that the ‘superbug’, NDM 1, or New Delhi metallo-beta-lactamase 1, which makes bacteria resistant to almost all antibiotics, including the most powerful class called carbapenems, was present in Delhi’s water supply.

Indian health authorities have been quick to slam the report. Dr R K Srivastava, director general of health services, said: “The environmental presence of NDM 1 gene carrying bacteria is not a significant finding since there is no clinical or epidemiological linkage of this finding in the study area.” Srivastava, who is part of the Ministry of Health and Family Welfare, added that the study was non-scientific and that the journal repeatedly targets the Indian capital when it is known that ‘superbugs’ are found globally. A separate study carried out by the government over the last two years, based on the stool samples of 1,944 pregnant women at Ganga Ram Hospital in Delhi, found that all microbes in the samples were sensitive to carbapenems.

What is worrying is that the NDM 1 gene appears to have spread to germs that cause cholera and dysentery, two very common and dangerous ailments in India.

What creates drug resistant bacteria is the over-use and unnecessary use of antibiotics either self administered by the patient, or over prescribed by the doctor.

“What people must realise is that every fever is not because of an infection, and does not require an antibiotic. General practitioners must also be aware of the fact. It is harmful to rely on antibiotics to cover up any lapses in infection control or treatment,” said Thara Francis, senior consultant microbiologist, Frontier Lifeline Hospital.

For instance, most upper respiratory infections do not warrant antibiotics as they are mostly viral infections. Antibiotics have no effect on viral infections.

Already, 25,000 people die each year from ‘superbugs’ in Europe and there are a number of bacteria which are now resistant to all drugs. Though figures for India are not available, a study by doctors at the Hinduja Hospital in Mumbai confirmed high and indiscriminate use of antibiotics in Mumbai hospitals.

The Union health ministry has formalised a National Policy for Containment of Antibiotic Resistance which is awaiting the approval of the health minister. Under the policy, junior doctors in hospitals will not be able to recommend third and fourth generation antibiotics without the approval of the head of the department.

Since over-the-counter sale of drugs is said to play a major role in creating drug resistance, the Drug Controller General of India is putting in place a mechanism that will monitor the sale of antibiotics in pharmacies and make it mandatory for certain drugs to be sold only against a prescription; several others will be available only for hospital use and not in pharmacies.

Studies suggest that between 4% and 20% of newly diagnosed HIV patients have transmitted a drug resistant infection. A 2007 study of HIV patients in the United States found one of every six newly diagnosed infections was drug resistant.

Worldwide, there were an estimated 225 million malaria infections and 780,000 deaths in 2009. Plasmodium falciparum, the most dangerous of the malaria parasites, has developed resistance in nearly all areas of the world where it is transmitted.

Multiple drug resistant (MDR), tuberculosis and extensively drug resistant (XDR) TB is on the rise. Almost 50% of MDR TB cases worldwide are estimated to occur in China and India. In 2008, MDR TB caused an estimated 150,000 deaths, a 2010 WHO report said.

As in the case of TB, using more sophisticated antibiotics because of resistance to old ones increases the health costs which is a setback to developing countries with low health budgets. As for ‘superbugs’, no drugs will be available to fight them for the next five to six years, say health experts.    

Source:, April 8, April 7, 2011
             The Hindu, April 7, 2011
             Reuters, April 7, 2011