All the alarms sounded on rising antimicrobial resistance (AMR)—chiefly, antibiotic resistance—should have meant a course correction for India. The country reports the largest total and per capita direct consumption of units of antibiotics globally. Overuse aside, abuse is common—a WHO study shows over half of the Indians on antibiotics were taking these without prescription while an AIIMS study found traces of antibiotics in sewage. Against such a backdrop, the findings of a study conducted by American researchers on drug-fed poultry in Punjab should highlight how badly policy has failed at sensitising people to the threat of AMR. Two-thirds of the poultry farms that were part of the study reported using antibiotics, and these were thrice as likely as farms that were not using antibiotics to report multi-drug resistance (MDR). India already accounts for 3% of the global consumption of antibiotics in farms—the fourth highest consumption in the world, behind China (23%), the US (13%) and Brazil (9%). The consumption is all set to double by 2030, if urgent action is not taken.
Antibiotics are commonly used in livestock and poultry as their sub-therapeutic usage (administering low doses) is positively correlated with rapid weight gain; indeed, the Punjab study found that meat-producing poultry farms were more likely than egg-producing ones to be breeding grounds for multi-drug resistance. In India, these are also an insurance against poor sanitation and hygiene conditions in the farms. Good for the poultry business in the short-term, it will cause long-term damage as drug resistance spreads to humans. Poultry birds are one of the common transmitters of bacteria of genus Salmonella. In a 2016 paper, Ramanan Laxminarayan—one of the authors of the Punjab study—and Ranjit Roy Choudhury, reported that resistance to fluoroquinolones (a class of antibiotics) among invasive Salmonella typhi isolates in India increased from 8% in 2008 to 28% in 2014. Blood culture isolates from hospital in Delhi showed resistance to nalidixic acid in 96.7%, to ciprofloxacin in 37.9% and to azithromycin in 7.3%. MDR was reported in 3.4% isolates.
Given how resistance is tied to abuse and overuse, there has to be concerted government action on controlling antibiotic sales, both for human and farm use. Developed jurisdictions like the EU and the US have banned the use of certain classes of antibiotics as animal growth promoters. In 2011, the Union government proposed a National Policy for Containment of Antimicrobial Resistance, that called for a complete ban on non-therapeutic use and over-the-counter sales, and had recommended rules for use for livestock; there had been no regulatory provisions on antibiotic use in farms till then. The policy was, however, shelved after it incited protests across the country. The present government, in April, announced a National Action Plan on Antimicrobial Resitance, which seeks to “optimise use of antimicrobials in animal and food sectors”. Though it hasn’t spoken of specific rules/directives to that end, any “optimisation” would certainly entail better monitoring of antibiotics sold to the farm sector and restrictions such as no sale without prescription or no sale of last-resort human use antibiotics. Apart from weathering the likely protests by the farm sector, this also calls for state governments to considerably beef up their machinery for effective implementation.