Antibiotics with Promising Potential: A Lifeline India Awaits : Daily News Analysis

Date : 06/07/2023

Relevance: GS Paper 2 : Social Justice - Health issues

Keywords: Emergency Use Authorisation (EUA), Drug-resistant infections, COVID-19

Context -

The relentless battle against highly drug-resistant infections has brought both challenges and a glimmer of hope for a team of dedicated doctors.
Their extraordinary efforts and life-saving experience highlight the critical need for Emergency Use Authorisation (EUA) for essential antibiotics.

Antibiotic Resistance: A Global Crisis

Since the discovery of antibiotics in 1928, these life-saving drugs have played a crucial role in fighting bacterial infections. However, the misuse and overuse of antibiotics have led to the emergence of antibiotic resistance—a concerning phenomenon that undermines the effectiveness of these drugs.

The Looming Threat:

The world is rapidly approaching a post-antibiotic era where previously treatable infections can become deadly once again. According to a UN report, drug-resistant diseases currently claim at least 700,000 lives annually, with the potential to increase to 10 million deaths by 2050. Recent studies in India reveal that two out of every three healthy individuals tested are resistant to two major types of antibiotics, highlighting the rapid spread of antibiotic resistance within the population.

The Devastating Impact:

Antibiotics are essential for preventing infections during surgeries and safeguarding vulnerable individuals, such as cancer patients undergoing chemotherapy. However, India's status as the world's largest consumer of antibiotics has contributed to the emergence of powerful, previously unseen mutations in bacteria. Overuse of antibiotics in humans, animals, and plants has fueled the development of drug resistance. While new antibiotics initially show effectiveness, bacteria adapt and gradually render these drugs less potent. Antibiotic resistance not only complicates treatment but also facilitates the spread of resistant bacteria, leading to more complex diseases, increased reliance on stronger and costlier drugs, and higher mortality rates from bacterial infections.

Examples:

Antibiotic resistance undermines decades of progress in fighting bacterial infections worldwide. A notable case is drug-resistant tuberculosis (TB). The World Health Organization (WHO) reports that in 2017, around 600,000 cases globally were resistant to the most effective first-line drug, with 82% of these cases being multidrug-resistant TB. As new resistant mechanisms emerge and spread, our ability to treat common infectious diseases is compromised, resulting in prolonged illness, disability, and death.

Understanding Antimicrobial Resistance (AMR):

Antibiotic resistance falls under the broader category of antimicrobial resistance (AMR), which refers to microorganisms' ability to withstand the effects of medications. Antimicrobial-resistant microbes occur naturally in people, animals, food, and the environment, spreading between individuals and animals through various means. Factors contributing to AMR include inappropriate medicine use, inadequate sewage waste treatment, poor infection control, unsanitary conditions, and improper food handling.

Addressing Antibiotic Resistance:

In response to the crisis, the World Health Organization established the global antimicrobial surveillance system (GLASS) in 2015. GLASS collaborates with member countries and existing surveillance networks to implement standards and indicators for monitoring AMR. The United Nations has also recognized the threat of antimicrobial resistance, elevating its importance to the same level as diseases like Ebola and HIV.

Findings from the ICMR Study in India:

A recent study by the Indian Council of Medical Research (ICMR) analyzed stool samples from 207 individuals who had not taken antibiotics in the past month and had no chronic illnesses. The study revealed that 139 individuals were resistant to one or more classes of antibiotics, with the highest resistance observed for cephalosporins (60%) and fluoroquinolones (41.5%). Multidrug resistance was detected in only 2% of the individuals.

Factors Contributing to Antibiotic Resistance:

The development of antibiotic resistance is influenced by various factors, including inappropriate antibiotic use, such as for minor ailments like the common cold, extensive antibiotic use in livestock and poultry, and inadequate disposal of residual antibiotics that enter the food chain. These practices contribute to the transformation of healthy human gut flora into a reservoir of antibiotic-resistant organisms.

Actions Taken in India:

India has implemented a national policy for containing AMR since 2011, focusing on understanding the emergence, spread, and factors influencing resistance. The policy emphasizes the establishment of antimicrobial programs to rationalize their use, strengthen infection prevention and control measures, educating stakeholders on responsible use, improve sanitation and water quality, increase public health expenditure, and regulate the private health sector.

Recommendations by the World Health Organization:

The WHO considers antibiotic resistance one of the top ten global health threats. Countries are urged to prioritize national action plans to combat resistance. This includes improving surveillance of resistant infections, enhancing infection prevention and control policies and programs, regulating the appropriate use of quality medicines, raising awareness of the impact of resistance, and investing in research and development.

Roles of Individuals, Policymakers, and Health Professionals:

At the individual level, responsible use of antibiotics is crucial. It involves using antibiotics only when prescribed by certified health professionals, avoiding sharing leftover antibiotics, practicing hygienic food preparation, maintaining personal hygiene, practicing safer sex, and staying up to date with vaccinations. Policymakers need to ensure robust national action plans, strengthen surveillance of resistant infections, improve infection prevention and control measures, and regulate appropriate medicine use. Health professionals play a vital role in preventing resistance by maintaining cleanliness, judiciously prescribing antibiotics, and promptly reporting resistant infections.

Conclusion:

Antibiotic resistance poses a significant threat to public health globally. Misuse and overuse of antibiotics have fueled the emergence and spread of resistant bacteria. Urgent action is required at all levels to address this crisis. Responsible antibiotic use, robust national action plans, improved surveillance, enhanced infection prevention and control measures, increased research and development, and collaboration are key strategies to mitigate the impact of resistance. By working together, we can secure a safer future where antibiotics remain effective in treating infections and saving lives.

An Indian Innovation: Cefepime/Zidebactam:

In a Hyderabad hospital's intensive care room, leukemia patient faced not only his aggressive cancer but also an extensively drug-resistant strain of Pseudomonas aeruginosa. The limited treatment options available were ineffective, and the patient's condition rapidly deteriorated.
However, the doctors turned to a promising antibiotic called cefepime/zidebactam, developed by Indian researchers. Though still in phase 3 trials, this antibiotic showed remarkable potential and was administered to the patient under a compassionate use protocol.
Miraculously, the patient showed signs of improvement, demonstrating the urgent need for EUA for antibiotics in phase 3 trials or licensed from other countries.

The Dire Situation:

Medical professionals dealing with severe infections in critically ill and immunocompromised patients face a grave reality.
The scarcity of potent antibiotics to combat drug-resistant infections directly threatens countless lives. The increasing resistance to available antibiotics has rendered once-effective treatments ineffective.
Each year, millions of lives are lost due to the inadequacy of existing antibiotics, leaving doctors with limited choices and resorting to suboptimal treatments.
The urgency to stay ahead of mutating bacteria adds immense pressure to frontline doctors.

India's Call to Action:

India, having demonstrated urgency and commitment in granting EUA for COVID-19 vaccines, now stands at a critical juncture.
The same level of urgency and commitment must be extended to save lives from infections resistant to current antibiotics.
Powerful antibiotics that have been thoroughly evaluated or proven effective are vital in the battle against superbugs. Cefepime/zidebactam, an Indian innovation, has shown immense potential in saving lives and should be granted EUA, offering hope not only within India but also to countless individuals globally.

Importance of Cefiderocol:

Cefiderocol, a licensed antibiotic developed by a Japanese company, has shown excellent efficacy against drug-resistant infections. However, it remains unavailable in India.
The severity of cases faced by Indian patients calls for access to this life-saving antibiotic without delay. Responsible and appropriate utilization of these medications is crucial, requiring a collective decision by an experienced medical team to minimize the risk of misuse or overuse.

A Plea for EUA:

Authorities are implored to recognize the urgent need for action and acknowledge the potential of these life-saving antibiotics.
Granting EUA for cefepime/zidebactam and cefiderocol would strengthen India's arsenal against drug-resistant infections. This step would empower doctors, instill hope among patients and their families, and allow India to make a substantial impact on the world stage.

Conclusion:

Emergency Use Authorisation for essential antibiotics, such as cefepime/zidebactam and cefiderocol, can be the difference between life and death in the relentless battle against drug-resistant infections. Urgent action is required to expedite the EUA process and provide timely access to effective treatment options for patients in need.

Probable Questions for mains exam -

Discuss the global crisis of antibiotic resistance and its impact on public health, with a focus on India. Analyze the factors contributing to the emergence and spread of antibiotic resistance and evaluate the actions taken by India to address this issue. Suggest additional measures that can be implemented to mitigate the threat of antibiotic resistance and ensure the availability of effective antibiotics. (10 Marks,150 Words)
The emergence of drug-resistant infections poses a significant challenge to healthcare systems worldwide. Examine the importance of Emergency Use Authorisation (EUA) for essential antibiotics in the battle against drug-resistant infections, with reference to the Indian context. Discuss the potential of innovative antibiotics, such as cefepime/zidebactam and cefiderocol, in addressing this crisis. (15 Marks,250 Words)

Source : The Hindu