Curb misuse in humans, monitor for overuse in farm animals
Without concerted action on antibiotic overuse, global health faces a significant threat from antimicrobial—specifically, antibiotic resistance—warns a new report from the Center for Disease Dynamics, Economics and Policy (CDDEP). Earlier, CDDEP researchers had warned that the world’s antibiotic consumption could double from 2015 levels by 2030, sans policy intervention; for perspective, the use of antibiotics had shot up 65% from 2000 levels by 2015, and the WHO had already flagged antimicrobial resistance as a global health emergency by then. While there has been some progress on controlling antibiotic consumption in developed nations, the trend of increase in usage in low- and middle-income countries (LMICs), which shoulder the larger chunk of the burden of infectious diseases, and the Covid-19 pandemic threaten to undo much of these gains. The global consumption of antibiotics that the WHO labels as Watch—these are critical for humans, but have a significant resistance potential—has gone up by 90.9% since 2000, driven largely by a 165% increase in use in LMICs. And, now, evidence is emerging that Covid-19 has thrown a spanner, too; many early pharmaceutical intervention protocols against SARS CoV-2, a virus, involved antibiotics (which are solely aimed at bacteria), apart from a range of existing antivirals, without any evidence of efficacy. In one multi-hospital study, nearly two-thirds of the Covid-19 received antibiotics, while only 3.5% of them had a confirmed concurrent bacterial infection—many others continued to be prescribed by doctors, outside of trials, not just as part of a treatment-line, but also as preventives!
Even if consumption doesn’t increase as drastically as CDDEP envisaged over 2015 levels, there could be tectonic consequences for global health from present levels of consumption. For instance, India—it is one of the highest overall and per capita consumer of antibiotics—saw total use of antibiotics rise from 5,411 million daily defined doses (DDDs) in 2010 to 7,976 million DDDs in 2020, a nearly 50% increase over the period, with a 30% jump in per capita usage. No wonder, the country reports one of the highest rates of resistance for certain pathogenic bacteria—70% of the Staphylococcus aureus isolates in the country are methicillin-resistant and whopping 90% of the Escherichia coli isolates in the country are third-generation cephalosporin resistant. The problem is exacerbated by high levels of antibiotic usage in the farm sector; for instance, both ampicillin and tetracycline report a 16.5% resistant-isolate proportion for Salmonella (which causes typhoid) among animals reared for human consumption—and infected poultry is a common route of transmission.
Every year, nearly 60,000 newborns in the country die of sepsis caused by microbes resistant to first-line antibiotics. Read against the number of antibiotic preventable deaths, India’s growing antibiotic-resistance problem brings out the twin-issue of overuse and lack of access starkly. Fixing this will need plugging many gaps, spanning multiple focus-areas for policy. Not only greater vaccine coverage for preventable infections, but also ensuring sanitation access and proper effluent (household, industrial and farm) management is called for. The government also needs to quickly adopt farm antimicrobial usage monitoring. But, no solution will come about till the time overuse/improper use (underdosing, missed doses, etc) is curbed among humans.