Antibiotic Use in Agriculture in India - Under-studied Under-regulated Blind spot

Contributed by Siddarth David and Dr. Tamhankar

In May 2015, the World Health Assembly endorsed the Global Action Plan on Antimicrobial Resistance, which calls on all countries to adopt national strategies within two years to curb antibiotic use in humans as well as in animals. The USA, the European Union and other countries have formulated policies and enforced guidelines to tackle antibiotic use in animals, which accounted for more than 63 thousand tonnes worldwide in 2010, much higher than human consumption and is expected to increase by two-thirds by 2030.

However, in India there are no guidelines for antibiotic use in animals especially for domestic use. The guidelines are mainly for animal products being exported. Moreover, it is also highly understudied area of research with few empirical papers on the subject. A 2010 study by the Centre for Science and Environment, Delhi showed the presence of antibiotic residue in honey being sold in India, reiterating the critical threat that unregulated use of antibiotics poses in the country. 

While antibiotic use in humans and its challenges have started receiving attention in academicians and policymakers in India, it is important that attention is drawn to antibiotic in the field of agriculture, which is a major contributor of environmental antibiotic resistance. 

India has one of the highest antibiotic resistance rates among 30 countries: CDDEP

Contributed by Siddarth David and Dr. Tamhankar

According to data by the for Disease Dynamics, Economics & Policy (CDDEP), Washington DC, found that India has among the highest rates of antibiotic resistance for 12 common bacteria including Escherichia coli (E. coli), Salmonella, Klebsiella and methicillin-resistant Staphylococcus aureus (MRSA) in the 30 countries studies.

While, almost all low and middle income countries in the study such as Brazil, Kenya, South Africa and Vietnam have rising rates of antibiotic resistance, the rates in India were particularly alarming. For example in 2014 in India 57% of the infections caused by Klebsiella pneumoniae, were found to be resistant to the last-resort antibiotic class of drugs carbapenems, up from 29% in 2008. This is particularly crucial as “Carbapenem antibiotics are for use in the most dire circumstances—when someone’s life is in danger and no other drug will cure the infection,” according Sumanth Gandra, a CDDEP resident scholar in New Delhi.

Dr. Ramanan Laxminarayan, CDDEP Director and report co-author attributed the rising resistance across the world to the "rampant rise in antibiotic use poses a major threat to public health, especially when there’s no oversight on appropriate prescribing". The data from India represented by data from SRL, a large private laboratory network from 2008 to 2014 which includes 5,700 collection centres across the country.

The data is another reminder for the country to quickly implement its new guidelines on antibiotic  use which are already ready since earlier this month. 

Handwashing should be a tool to fight antibiotic resistance: UK Experts

Contributed by Siddarth David and Dr. Tamhankar

Greater emphasis on hygiene for coughs, colds and other infectious diseases is needed amid growing antibiotic resistance across the world, stated the National Institute Health and Care Excellence (NICE), UK last week. NICE is a statutory body in the UK that lays down standards and guidelines to be followed by all healthcare providers and facilities in the country.

The draft guidelines aimed at changing behaviour among the public on antibiotic use, advocates national and local campaigning on handwashing and other self-care techniques for preventing infectious diseases rather than taking antibiotics. It recommends teaching children and students on proper handwashing techniques as well as convincing people that self limiting conditions do not require antibiotics.

The draft which is out for public consultation will be finalized and implemented as guidelines throughout the UK. This comes in the heels of the guidelines for antibiotic stewardship for physicians that were finalized last month by the NICE. 

Given the critical public health challenge that antibiotic resistance in India poses, we have yet to see policy level recognition of building public awareness on the issue. The Indian guidelines so far have targeted physicians and pharmacists who are crucial stakeholders in tackling the problem. However, unless the public is part of the process, it would be impossible to holistically address the problem of antibiotic resistance in the country.

"Data in India indicate high resistance among bacteria-causing common infections": Epidemiologist Laxminarayan

Contributed by Dr. Tamhankar and Siddarth David

Noted epidemiologist Ramanan Laxminarayan from the Public Health Foundation of India and the Centre for Disease Dynamics, Economics, and Policy in the USA in a recent interview discussed the challenges with antibiotic resistance in India.

He stressed the need for updating the existing laws of sale of over-the-counter drugs in India and more importantly enforcing them. He also explained how the lack of national-level data on resistance apart from limited localized studies is a big gap in the estimating the extent of the problem of antibiotic resistance.