Brihan-Mumbai Municipal Corporation (BMC) takes a big step in antibiotic policy

Contributed by Dr. Akilesh. R & Dr. A. J. Tamhankar

Brihan-Mumbai Municipal Corporation (BMC) has taken a big step towards standardisation of indications for prescribing antibiotics for use by various specialties(1). This is said to be the first time any Civic Agency has taken such a step. The Corporation, one of the richest in the country, has taken this big step in the right direction.

On the same note, it remains to be seen how much of the policy is followed by the doctors. Rational use of antibiotic was a necessity in the period of world war due to acute shortage. In the present day, there is no dearth of antibiotic availability but they are not effective enough to combat tough infections. In 2013, BMC started this ambitious project to curb the abuse of antibiotics(2).  Over a period of 2 years, various expert committees convened to draft an antibiotic policy for use by each of their specific specialties. And this has culminated in the release of the policy in it's current form.

A couple of years ago, a medical intern lost her life to Multi-Drug Resistant Tuberculosis in Mumbai which was shocking but raised the concerns among the trainees and students in medical colleges all over Maharashtra. The issue of antibiotic resistance is pandemic as World Health Organisation (WHO) claims and all countries irrespective of their development status are afflicted by antibiotic resistance challenges. In the present scenario, development of such a policy is the need of the hour. But what these policies fail to address is that if the policy recommends antibiotics for a particular diagnosis, the challenge is that most cases do not fit that particular diagnostic criteria. Moreover doctors still err on the side of defensive prescription of antibiotics rather than following a system of watchful waiting.

The only way to inculcate these principles is when the training curriculum of medical fraternity stresses on these aspects at every level of the training from their undergraduate levels to the post graduate levels and beyond. Also the associations of medical fraternity must all stress the same to their respective specialties and members. Let's hope rational use of antibiotics becomes the norm before the antibiotics themselves become irrational (useless).

Source:
1. Times of India Article - 2015
2. Mumbai Mirrow Article - 2013

Water bodies contaminated with antibiotic laden effluents from pharmaceutical companies in developing countries

Contributed by Dr. Akilesh Ramasamy & Dr. A.J. Tamhankar

Pharmaceutical companies have shifted their manufacturing units from the West to developing countries in Eastern countries in Asia for advantages. This has helped the economy of these countries as well. But a new issues has cropped up in these countries.

A group of researchers have been following the effects of the pharmaceutical company's effluents. They found that most of the effluents were discharged into sewage water without treatment. These effluents were laden with antibiotics with ciprofloxacin topping the charts. This creates a vicious and dangerous cycle of antibiotic resistance spread in the environment as well. The entire food web concentrates these antibiotics spreading it to the humans at the top of the food chain. As most sewage ends up in the seas, it can contaminate the sea foods as well. The effects are more devastating than we realise / know.

To complicate matters, chlorine, a commonly used chemical for treating sewage has been found to promote antibiotic resistance. Chlorine when used on antibiotic laden sewage, is unable to remove the antibiotics but may also combine with them to form new antibiotic compounds which can then creep into the environment complicating the issue of antibiotic resistance. This can potentially create antibiotic resistance to even not-yet-discovered antibiotics. We are very well running fast into the pre-antibiotic era, it appears.

This brings antibiotic resistance to the very doors of the people. Antibiotics were found in very high quantities in the effluents discharged. This can cause resistance in the organisms in these waters. Many of the bacterial infections are water-food borne or spread by feco-oral transmission which again may be spread via contaminated water bodies. Natural calamities, floods as well as pipe bursts / faults cause frequent contamination of sewage water with potable water lines in many Asian countries. These pathogens in sewage water would already by resistant to most antibiotics, which in turn can cause antibiotic resistant infections which would be difficult to treat especially in times of disasters like flood and natural calamities, when resources are very low. Mortality would be very high then.

Government and environmental bodies must look into this issue and with involvement of the public as well as the pharmaceutical companies, must be stringent about letting out effluents laden with antibiotics into sewage water untreated.

Source:
1.  Article in Chemosphere
2. Nature - News, 2009