Rise In Antibiotic Resistance Among Indians Is The New Evolving Threat Amidst COVID-19 Pandemic: LANCET Study

As the second wave of the COVID-19 pandemic sweeps over India, affecting many and increasing mortality rates, doctors across the country are prescribing countless medications to patients who don't need them, despite the risk of developing antibiotic-resistant infections. [1]

Despite the low rate of bacterial coinfections when the first wave of COVID-19 hit the UK, too many antibiotics were prescribed, says a study published in the journal The Lancet Microbe. [2]

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The question is, is the consumption of such large amounts of antibiotics signaling an evolving epidemic in the COVID-19 pandemic? Take a look at what a new study has to say.

What Is Antibiotic Resistance?

Low- and middle-income nations are disproportionately affected by the large consumption of antibiotics, leading them to antibiotic resistance. To put it simply, antimicrobial resistance occurs when bacteria and fungi evolve defences that allow them to survive even when exposed to antimicrobial medications. That suggests the bacteria aren't being stopped and are instead multiplying. [3]

The rise in antimicrobial resistance poses a major risk to the success of treatments for infectious diseases, cancer, organ transplants, and critical care. About 700,000 fatalities worldwide are attributed to drug-resistant diseases caused by antimicrobial resistance; without effective intervention, this is expected to rise to 10 million deaths.

Antibiotic resistance is a major problem in India, which has one of the highest age-standardized infectious illness mortality rates in all of south Asia. Nearly half of all cases of hospital-acquired infections are deadly because the Klebsiella spp. isolates are resistant to carbapenems (an antibiotic for severe bacterial infection). Klebsiella is a genus of bacteria responsible for causing hospital-related infections that include pneumonia, wounds, meningitis and surgical infections. [4]

The bacteria is also highly resistant to other antibiotics like polymyxins.

India Has Highest Antibiotic Consumption Worldwide

A 2018 research-based study says that among many low-and-middle income countries, India is the highest consumer of antibiotics. The study reveals data research conducted between 2000-2015. [5]

According to the new study, at a rate of 107 units per person, India has the highest antibiotic use worldwide, a key factor in the spread of antibiotic-resistant microbes. [6]

The antimicrobial resistance crisis in India is exacerbated by a number of factors such as:

• the widespread purchase and use of antibiotics without a prescription,
• a lack of knowledge about the risks associated with their use,
• an inability to properly diagnose infections,
• the transmission of disease between patients,
• doctors' financial ties to the pharmaceutical industry, and
• a lack of adequate healthcare facilities.

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Reasons For The Rise In Antimicrobial Resistance

The Antimicrobial Resistance Surveillance Research Network was set up by the Indian Council of Medical Research to assess the level of resistance among seven priority infections and kick off stewardship initiatives.

• Despite efforts to improve surveillance, no clear guidelines exist for the therapeutic management of drug-resistant illnesses. This contributes to a vicious circle of incorrect medication and rising drug resistance. [7]
• Efforts like the Antibacterial Resistance Leadership Group have been launched to address clinical research into drug-resistant illnesses in a coordinated approach.
• Although these groups have greatly aided the study of drug-resistant infections by standardising data collection and reporting, the Indian population is largely overlooked.
• In addition, the majority of Indian research on drug-resistant diseases is underpowered, retrospective, conducted at a single institution, and plagued by substantial biases, reporting only a small amount of surveillance data on molecular patterns of resistance.

To remedy the dearth of clinical research on drug-resistant diseases in India, cooperation between government, academic, and commercial sector partners is essential.

What To Do

• Ethical and regulatory permission must be standardised when bringing together institutions and hospitals from different industries for large-scale studies.
• Clinical settings should prioritise evidence-based methods for the diagnosis and treatment of drug-resistant infections.
• Data created at different centres must be standardised, shared, FAIR (findable, accessible, interoperable, and reusable), and centred on essential clinical outcomes.

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To Conclude

Researchers and healthcare providers should pool their resources and conduct high-quality studies on the identification, evaluation, and prevention of drug-resistant infections. This may help in determining the best way to treat life-threatening infections caused by bacteria that are resistant to antibiotics.