The revision of antibiotics classes by the World Health Organisation in its list of essential medicines is a welcome step in the global initiative to push back against antimicrobial resistance, the phenomenon of bacteria becoming resistant even to the most potent drugs. With a graded approach to the use of antibiotics, under which some medicines are reserved for the most resistant microbes, the WHO list can stop their misuse as broad-spectrum treatments. The Indian Council of Medical Research issued a warning two years ago, based on studies conducted in hospitals, that resistance to antibiotics was found in 50% of patients. A large number of infants were dying due to infections that did not respond to treatment. Antibiotics have had great success, extending the frontiers of medicine for over 70 years. But Alexander Fleming, who discovered the first antibiotic, himself foresaw the danger of relying too much on them. The revised WHO classification can mitigate the problem if the many issues associated with use of the drugs can be monitored and regulated. Within the realm of medical practice, the prescription of antibiotics is often guided by such factors as patient demand, competing alternative treatment systems, and even financial incentives. Close scrutiny of these by national stewardship programmes such as those initiated by the ICMR is needed. There are also environmental factors, including the widespread use of antibiotics on farm animals, that require more research to determine their role in building resistance.
One of the key aspects of the WHO’s guidance is the availability of a first-line ‘access’ group of antibiotics at all times. Other drugs are placed under a ‘watch’ category as second choice, or as ‘reserve’ to be deployed as a last resort. Clearly, this system underscores the need for universal access to essential medicines both in the public health system and for patients cared for by private practitioners. The Ministry of Health and Family Welfare, which has promised health assurance for all, must come out with a framework to ensure this. Access to speedy and accurate diagnosis is equally important in order to deploy the correct antibiotic early. While the medical community can be sensitised to its responsibility to prevent antimicrobial resistance, it will take enlightened policies on housing, sanitation and hygiene education to prevent new infections and the spread of disease-causing organisms: hand-washing, for instance, is extremely beneficial. Drug-resistant microbes pose a serious challenge today to treat, among other things, pneumonia, infection of blood and surgical sites, and meningitis. The quest for new classes of drugs goes on. An effective response demands scrupulous adherence to prescription discipline of the kind advocated by the WHO. India has severe asymmetries in the delivery of health care: rural-vs-urban, and poor-vs-affluent patients, to name just two. It will take good public health policies, sufficient funding and determined leadership to overcome antibiotic resistance.
