Topper’s Copy

Major factors

The primary drivers of AMR in India include:

1) Misuse and Overuse of Antibiotics: This includes self-medication, non-completion of prescribed course, and over-prescription by healthcare providers, often for viral infections where antibiotics are ineffective.

2) Unregulated Sales: Easy over-the-counter access to antibiotics without a doctor's prescription is a major contributor.

3) Inadequate Infection Control: Poor hygiene and infection prevention and control (IPC) measures in healthcare settings and public spaces facilitate the rapid spread of resistant bacteria.

4) Use in Agriculture and Livestock: Extensive use of antibiotics as growth promoters in poultry and aquaculture allows resistant bacteria and residues to enter the food chain and environment.

5) Lack of Awareness: Limited public understanding of the judicious use of antibiotics exacerbates the problem.

Role of Government Initiatives

Kerala's AMEHH program (Antimicrobial Resistance Intervention for Total Health):
Kerala was the first state to develop its own action plan, the Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP) in 2018. Operation AMEHH is a key module under KARSAP, focusing specifically on strictly enforcing the ban on over-the-counter (OTC) sales of antibiotics without a prescription.

Impact / Role:

1) Regulatory Enforcement: It mandates pharmacies to display "antibiotics not sold without a prescription" posters and maintain sales records.

2) Public Awareness: It empowers the public to report non-compliant pharmacies via a toll-free number, fostering community participation.

3) Data Driven Policy: Kerala is the first state to publish a facility-level antibiogram, providing data to help doctors select appropriate treatments and track resistance trends.

4) Holistic Approach: It includes initiatives like the Programme on Control of Unused Drugs (CPROUD) for safe disposal of expired medications and has established block-level AMR committees, decentralizing the response.

Way Forward

Effective AMR containment requires strengthening the "One-Health" approach through stored regulatory enforcement across all sectors (human, animal, environment). Key steps include:

1. Strengthening Surveillance: Expanding the national AMR surveillance network (CNARS-Net) to gather robust, real-time data to guide interventions.

2. Infection Control: Mandating and auditing IPC practices in all healthcare facilities.

3. Public Education: Expanding awareness campaigns, like the Red Line Campaign, to educate the masses about the danger of antibiotic misuse.

4. Incentivizing R&D: Encouraging the pharmaceutical industry to develop new antibiotics and diagnostics.

5. Regulating waste: Enforcing stringent regulations on antibiotic residue discharge from pharmaceutical companies and hospital waste treatment plants.