Here’s What’s Causing India’s ‘Superbug’ Problem

Last August, a Nevada woman in her 70s was hospitalized after returning from an extended trip to India. She was infected with multidrug-resistantKlebsiella pneumoniae what doctors call a nightmare superbug that showed immunity from 26 antibiotics. She died in September from multiple organ failure andsepsis.

Superbugs the term unofficially refers to bacterial and fungal infections resistant to various antibiotics are a growing health problem worldwide. The World Health Organization warned in 2015 of an approaching post-antibioticera. Current estimates are that drug-resistant infections annually kill about700,000 peoplearound the world a figure that could reach10 millionby 2050.

Its just a fact of evolution the more antibiotics that are around, the more bacteria has been exposed to antibiotics, the more opportunity they have to acquire these resistances,Sarah Fortune, a professor of immunology and infectious diseases at Harvard University,said. And, weve been living with antibiotics for 60 years now and bacteria has had plenty of time to develop their defenses.

India is anotorious hotbedfor antibiotic resistance. According to a study on antimicrobial resistance published last year,60,000 newborn livesare claimed each year in the country by antibiotic-resistant infections.

Another 2016 studyexamining the evolution of resistant microbes in India found that the over-prescribing and unregulated use of antibiotics, antibiotic use in agriculture and for livestock, and a lack of regulation of the discharge of antimicrobial waste into the environment all contribute to the superbug problem.

These factors exist in other countries, Barun Mathema, an assistant professor in epidemiology at New Yorks Columbia University and an expert in infectious diseases, told HuffPost. Superbugs exist across the globe; its a problem rearing its ugly head inChina, South Africa,Australiaand even inU.S. hospitals.

Even so, India is considered the global breeding ground for the problem. What makes Indias situation unlike other developing nations, says Mathema, is the extent and degree of the factors that fuel superbugs.

According to the 2016 study, antibiotic use is a major driver of the development of diseases that become resistant to the drugs. Indeed, in 2010 India consumedmore antibiotics for human healthper person than any other country. Whats more, the nations intake spiked by 62 percent from 2001 to 2010.

Such consumption is spurred by overprescription and overuse. Previousresearchfound that antibiotics are prescribed and sold in certain parts of India for conditions such as diarrheaand upper respiratory infections caused by viruses that dont require them. Theres also conflict of interest: one studyfound doctors are compensated by pharmaceutical companies and pharmacists for prescribing antibiotics.

Recently, the Indian Council of Medical Research (ICMR) issued guidelinesfor antibiotic stewardship, which include advising hospitals on how to administer treatment that best suits the patients needs. Kamini Walia, a senior scientist at ICMR, told HuffPost theres growing interest in the voluntary guidelines.

Informing the public is also important.

The culture in India, in some parts of the U.S. and many countries around the globe is to lean on antibiotics for most illnesses, even if there is a low chance they are due to bacteria at all,Kavita Trivedi, adjunct clinical assistant professor of medicine at Californias Stanford University, told HuffPost. We must educate the public about when it is appropriate to demand antibiotics because if we dont, the burden is solely on the prescribers.

The problem lies beyond the culture of antibiotic prescriptions

Prescriptions contribute to overuse, but so does the over-the-counter availability of many antibiotics until recently. For example, India has had one of the highest over-the-counter sales of carbapenems, an antibiotic used to treat multidrug-resistant bacteria.

In 2014, the government re-categorized many antibiotics, including carbapenems, to make them prescription-only. But implementation of the regulation remains murky. According to Walia, antibiotics are still obtainable over the counter to serve those who do not have access to doctors. Previousresearchfound poor access to affordable and effective antibiotics kills more children in India than drug-resistant infectons.

The per capita consumption of antibiotics is high but uneven, Ramanan Laxminarayan, the New Delhi-based director of the Center for Disease Dynamics, Economics & Policy and lead author of the 2016 studyof Indias superbug problem, told HuffPost. There are many that are dying in rural areas because of lack of access to antibiotics while others in urban settings are using them indiscriminately. There is a serious inequity issue here.

Other factors come into play. A2013 studyfound waste water treatment plants serving antibiotic manufacturing facilities to be responsible for transferring resistance genes. Laxminarayan, who calls India an epicenter of superbugs, said that with India being is one of the worlds largest manufacturers, the levels of reported antibiotic pollution are appalling.

Walia said there is also a huge amount of antibiotic use in animals in India. Laxminarayan said mixing antibiotics with animal feed is a practice that should be stopped immediately.

Jean Patel, the science team lead for the Antimicrobial Resistance Coordination & Strategy Unit at the U.S. Centers for Disease Control, said stopping even some of the inappropriate and unnecessary use of antibiotics in people and animals would help greatly in slowing down the spread of resistant bacteria.

Patel added that concern is growing about travelers who might be become infected with resistant bacteria as a result of receiving health care abroad or in areas of the United States where resistant bacteria might be more prevalent.

With antibiotic resistance popping up in many nations, India is in a unique position: according to Laxminarayan, its battle with superbugs provides the opportunity for the nation to be on the forefront of addressing [antimicrobial resistance] and setting up an example for other countries.

And given that Indias problem doesnt stay within its borders as illustrated by the Nevada womans death the nations superbug issue is a global public health challenge.

In this day and age, any countrys problem is another countrys problem too, Mathema said.


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