Antibiotic Resistance : Definition, Causes, Types, Symptoms, Prevention & Facts

What is Antibiotic Resistance?

The term “Antibiotic Resistance” is not just a medical terminology. This is a very important health concern worldwide. Before knowing about antibiotic resistance, it is imperative to know about Antibiotics or Antimicrobials.

Antibiotics or Antimicrobials – They are the substances produced synthetically which has the property to inhibit or kill disease causing organisms.

Antibiotics are the greatest contribution of the 20^th century to medicine. As a group of drugs they are the most commonly used as well as most frequently Misused.

Since the definition of Antibiotics excludes the natural substances which have the potential of killing microbes. There are certain other substances too like lactic acid, hydrogen peroxide or ethyl alcohols. These are produced by higher forms of micro organisms and potentially kill other microbes.

• The literary meaning of the word ‘Resistance’ is to oppose, or unwillingness to accept or simply refusal to accept.

In case of Antibiotics, the meaning of resistance can be explained as the ability no to be affected by something especially when it is an adverse effect.

According to Merriam Webster Dictionary, resistance in medical terminology means “the inherent ability of an organism to resist harmful influences”

Antibiotics have been used frequently since the 20^th century, but history behind development of antibiotic is vast.

The term Antimicrobial Agent has become more meaningful as it includes both synthetically synthesized and naturally procured substances. Earlier the term Chemotherapeutic Agents, was employed but it was applicable only for synthetically manufactured agents.

Historical Background of Antimicrobial Agents – For descriptive purposes, the historical events have been divided into three phases

Phase I – Empirical ( Using something based on experience without applying complete logic)

• Chinese used Mouldy Curd for treating boils of skin.
• For treating Leprosy, Hindus used Chaulmoogra Oil.
• Intestinal Worms were treated by Aztecs using Chenopodium Oil.
• Paracelsus treated Syphilis using Mercury in the 16^th century.
• Cinchona Bark has been used for treating fevers since the 17^th century.

Phase II – Paul Ehrlich’s Phase (Late 19^th Century)

Who is Paul Ehrlich??

Paul R. Ehrlich, a known name in the fields of hematology, immunology and antimicrobial chemotherapy. By the end of the 19^th century it was clear that many diseases were caused by microbes.

So Ehrlich who is also had demonstrated the staining of Tubercular Bacteria, came up with the idea that is certain dyes can stain the bacteria they can also be toxic for those.

With this fact in mind, he developed a group of dyes called the Arsenicals. A dye named Atoxyl for treating sleeping sickness. Later he developed Arsphenamine (Salvarasan)and Neoarsphenamine in the years 1906 and 1909 for treating syphilis.

He coined the term ‘Chemotherapy’ for the form of treatment he had been giving to these patients. His idea of selective treatment was termed the “Magic Bullet”.

Phase III – Modern Era (Major Era of Drug discovery and their therapeutic effects)

• This era began in the year 1935 when Dogmagk, showed the therapeutic effect of a potent, Sulphonamide dye (Prontosil) for treating pus producing infections (Pyogenic Infections).
• In the year 1929, Alexander Fleming, found a substance produced the mould Penicillium, this had the potential to destroy the bacteria Staphylococcous. He named the substance
• In a span of past 60 years, various antibiotic producing organisms have been identified.

These major developments in the field of antimicrobial agents, have led to carefree use of this group of medications, which has led towards Antibiotic Resistance.

Definition of Antibiotic Resistance:

Infections of the body can be caused by a wide range of micro organisms which includes Bacteria, Virus, Fungi or Parasites. To treat these infections, a broad spectrum of medications is available that has been termed as Antimicrobials.

Therefore, it becomes essential to have two different terms for resistance i.e, Antibiotic Resistance and Antimicrobial Resistance.

• What is Antibiotic Resistance?

According to the World Health Organization, Antibiotic Resistance is the mechanism adopted by Bacteria which makes it unresponsive towards Antibacterial drugs.

 

On the other hand, Antimicrobial Resistance is a broader term which also includes Antibiotic resistance. This term means when any microbe develops the ability to resist the effects of medications which has been previously used to treat the infection.

Types of Antibiotic Resistance –

 Mechanisms of Antibiotic Resistance –

There are multiple methods by which a bacteria can develop resistance to antibiotics. Development of antibiotic resistance s also depends on the mechanism of action of the Antibiotic.

In broad terms mechanism of action can be-

1. Bacteriostatic- Means this group inhibits the growth of bacteria.
2. Bactericidal – Group of antibiotics which kills the bacteria.

Also the different antibiotics have different sites of action on a bacterial cell.

Class of Antibiotic	Site of Action
Penicillins	Cell wall
Glycopeptides	Cell Wall
Tetracyclins	Ribosomes
Macrolides	Ribosomes
Sulphonamides	Folate Metabolism
Quinolones	DNA synthesis

Can Human Body Develop Antibiotic Resistance?

Answer to this question is No.

Antibiotic resistance is always developed by the bacterial cells using following Natural(Intrinsic) Mechanisms–

1. Modification of Bacterial Cell Enzymes –

Bacteria produces enzymes that either modify or destroy the antibiotic before it reaches the target. The enzyme produced by the bacteria is Beta Lactamase.  This enzyme works by breaking the amide bond of Beta Lactic acid of the drug thereby making it ineffective.

2. Restriction for the Penetration of Antibiotic in Bacterial Cell –

This kind of property is seen in Gram Negative bacteria (On the basis of staining property by Gram stain bacteria have been divided in two forms i.e., gram negative and gram positive).

So in this type of mechanism, the cell membrane of the bacterium alters which does not allow the drug to enter the cell and show effect at the target.

3. Change in the Drug Target Site –

The site where the drug is supposed to act, gets altered , therefore, drug is unable to bind to required site and hence the bacterium become resistant to the drug.

The most common example of this type of drug resistance is of Enterococci (common bacteria causing urine infections) which has become resistant to the drug Vancomycin. The resistant bacteria has been termed as Vancomycin Resistant Enterococci (VRE).

How Do Bacteria Develop Acquired Antibiotic Resistance?

All the above mentioned mechanisms are controlled at the genetic levels and are very sensitive. Genes in a cell are the basic physical unit which control heredity.  At the genetic level, the mechanisms which controls antibiotic resistance, are the Molecular Mechanisms of Antibiotic Resistance.

Types of Molecular Mechanisms –

1. Point Mutation in the target genes. For example, this type is seen in Bacteria producing Beta Lactamase enzyme. (Point mutation is a type in which a single nucleotide is added, deleted or changed)

2. Second type of molecular mechanism involved is rearrangement of genes through the attainment of antibiotic resistance bearing Plasmids. With this the questions arises:

What are Plasmids and their role in Antibiotic Resistance?

Few bacteria have an additional set of DNA which is arranged in circular form termed as Plasmid. These do not contain any set of DNA required for regular metabolic  activities of the cell.

Moreover, Plasmids are present in the lower group of organisms, precisely the unicellular organisms.

 

 Role of Plasmid in Antibiotic Resistance/ Acquired Antibiotic Resistance

The role of plasmid in Antibiotic Resistance was first time studied in Japan, during a an outbreak of Dysentery (Infection of the stomach and infection which results in diarrhea with blood) epidemic.

Later it was found that this epidemic was because of Multidrug Resistant(Bacterial Strain resistant to multiple drugs) bacterium. It was also found that Plasmid not only contains Antibiotic Resistance genes but also genes for controlling the Infection causing capacity (Virulence), in a bacteria.

A Plasmid conveys Antibiotic Resistance by the mode of:

• Conjugation:

In this mode, two bacterial cells are present in close proximity to each other and a structure called Pilus is formed between the two to transfer the plasmid from bacterial cell to another.

Transformation:

A gram positive bacteria after completion of its life cycle undergoes cell lysis. During this cell a fragment of DNA is taken up by Gram Negative bacteria. This taking up of the DNA fragment “Transforms” one type of cell to another.

• Bacteriophage – Mediated Transduction Mode of Antibiotic Resistance

In this mode, a Bacteriophage is a virus infected by bacteria and transmits genetic material from bacteria to another. This method of transferring genetic material from bacterium to another with help of Bacteriophage is called as Transduction.

Causes of Antibiotic Resistance –

1. Indiscriminate use of Antibiotics in routine practice.
2. Insufficient research and development in the field of Antibiotic Resistance
3. Unnecessary consumption of Antibiotics

Indiscriminate use of Antibiotics in Routine Practice – 

This inappropriate consumption can either be done by the individual himself or may be because of health care professionals. A few situations where such use of antibiotics can be seen are –

• Unnecessary consumption of Antibiotics during the course of Viral infections.
• Persistent prescription of Broad-Spectrum antibiotics rather than a bacterium specific drug.

Insufficient Research and Development in the field of   Antibiotic Resistance  

Antibiotic Resistance is an aspect which is least explored because the bacteria keeps on changing according to the misused antibiotic. Therefore, there is a need for such antibacterial agents which can at against such highly evolved bacteria.

 

Unnecessary Consumption of Antibiotics

• Even though in some era the Antibiotics were considered to be “Magic Bullets” but it is aptly said every magic has its after effects. Similar is the situation with Antibiotics.
• Antibiotics do kill or inhibit microorganisms but they affect host immunity as well. It has become a common practice to take antibiotics even for slightest of Infection.
• All the bacterial infections have a tendency to go through phases and human body acts accordingly to cure the infection on its own called host immune response.
• Antibiotics work after lowering the host immunity. Unnecessary antibiotic consumption not only bring resistance in bacteria to the drug. But it also reduces the host immune response on second encounter with same infection.

Evolution of Antibiotic Resistance –

In a span of past 50-60 years, with evolution of medicine, communicable diseases were thought to be one of the most threatening medical emergency. But with the invent of Antibiotics or to be precisely stated Antimicrobial agents, infectious diseases came under control.

Past two decades have seen a resurrection of similar infectious diseases, but with an aggressive mode. For example, Tuberculosis(TB), which was completely curable disease has taken up lethal forms like MDR-TB(Multi-drug resistant TB) and XDR-TB(Extensive Drug resistant TB).

• How does this Antibiotic Resistance spread?

Once the antibiotic resistance seeps in it can spread easily through countries. The important modes of such transmission can be –

• Ease in travelling from one continent to another, due to affordable travel expenses.
• Increase in globalization has lead to a higher number of population migrating to other countries.
• A rising trend in inappropriate consumption of antibiotics.
• Easy access to various internet search engines, where an individual gets to know about symptoms of a disease and the so called required treatment. In such a scenario, many times the patient prefers to buy antibiotics on their own without a prescription.
• Consumption of antibiotics in minor infections which the human can take care on its own. For example, consumption of antibiotics in cases of common cold, which is a viral infection and an antibiotic will not work on it anyways.
• Every time an individual takes an antibiotic pill it puts pressure on the bacteria to evolve in resistance. The next time the similar bacteria will not be affected from the drug.
• Multiple drug manufacturing companies, are in a sack race to develop antibiotics effective for resistant strains of bacteria. But this is going to add to the list of resistant strains of bacteria.

How Does the Bacteria Evolve During the Course of Antibiotic Resistance?

To become resistant to a particular drug, a bacteria goes through these steps –

• A bacteria undergoes mutation via Natural Selection ( it is a process where an organism naturally adapts to its surrounding environment).
• After this, process of mutation, the mutated gene must get transferred to the next generation. This happens by transferring of the Plasmid during bacterial cell division.

Symptoms of Antibiotic Resistance

The common symptoms of Antibiotic Resistance can be any of the following –

1. Paitent does not respond to existing treatment given even when given antibiotic targeting the bacteria.
2. The symptoms arise as per and according to the infection and causative organism, few common examples where Antibiotic Resistance leads to severe symptoms are

• Resistance in Klebsiella Pneumoniae –
• Common bacterial strain causing life threatening infections
• Due to resistance may produce hospital acquired infections such as pneumonia, blood infections and infections of the  new borne as well as patients admitted in the intensive care unit.
• This bacteria has developed resistance to the key antibiotic used for managing the infection i.e. Carbapenam.
• Therefore the symptoms which arise are more severe and untreatable.

 

Resistance in Tuberculosis – 

According to World Health Organization, by the year 2014 there were 480,000 new cases of MDR-TB were reported. Treatment protocol for MDR-TB is long term more extensive and also becomes expensive.

Till year 2014 only half of patients suffering from MDR-TB have been treated successfully.

Another form of resistant Tuberculosis is XDR-TB. This form of TB is resistant towards four antibiotics. XDR-TB is a form of MDR-TB and it has been estimated by WHO, around 9.7% MDR-TB patients develop XDR-TB.

Resistance in Malaria – 

Malaria is caused by four known strains of Plasmodium. These are Plasmodium Falciparum, P.Malairae, P.Ovale and P.Vivax. Out of these, P.Falciparum has shown resistance to anti malarial drugs. This makes the treatment more difficult.

Malaria resistance has been found to be prevalent in the Thailand-Cambodia border. It is estimated that Malaria resistance can arise as worldwide threat. This resistance can also pose major public health problem making it epidemic situation.

Resistance in HIV – 

According to WHO, 7% of HIV positive patient who were receiving Anti-retroviral therapy, had developed antiretroviral drug resistance.  This percentage of patients was found in the year 2010. The percentage was higher in developed countries, which was >15%.

The anti-retroviral resistant patients are treated with higher dosage of drugs with increased time period. This increases the cost of treatment and lowers the chances of remission.

Moreover, resistant patients also suffer from multiple debilitating morbidities. These patients require constant monitoring in order to effectively reduce the further spread of Anti-retroviral Resistance.

To combat the effects of this resistance WHO has come up with “Global Action Plan for HIV DrugResistance”(2017-2021).

Resistance in Influenza (Common Cold) – 

Influenza or common cold is caused by the Influenza A virus and this virus has a capability to mutate very fast. It can change between one season to another or sometimes even during the season. This type of resistance is termed as Antiviral Resistance which means a virus will stop responding to treatment given by antiviral drugs.

Every season the Centre for Disease Control(CDC) performs laboratory tests to check for any specific resistance in the Influenza virus. Based on the findings, antiviral drugs are prescribed of rthe season.

For example for the year 2015-2016 flu season, the antiviral drugs Oseltamivir, Zanamivir and Peramivir were stated in the guidelines of CDC in the United States.

 

Methods to Detect Antibiotic Resistance –

In order to detect, if the antibiotic is susceptible or resistant to a particular organism can be done using a set of Antibiotic Susceptibility Tests. Some of them are –

Antibiotic Susceptibility Tests –

These tests are used to measure the Minimum Inhibitory Concentration (MIC) this is the least or minimum concentration of the antibiotic agent which is required to inhibit the bacteria.

This MIC can be measured in either a solid or liquid phase.

• Liquid Phase MIC Estimation/ Dilution Tests –

The dilution tests can be carried in the done by two very well known methods –

1. Broth Dilution Method
2. Agar Dilution Method

These two methods are based on dilution of different concentrations of antibiotic in the agar or broth medium.

• Solid Phase –

This type of test uses solid media and diffusion technique. The antibiotic is used in a disc form  and the drug diffuses in the surrounding media having inoculums of particular bacteria.

Based on the arrangement of these discs the tests are of two types-

1. Stokes Disc Diffusion Method
2. Kirby-Bauer Disc Diffusion Method

• Beta-Lactamase Production –

This is a rapid test of choice to measure the antibiotic sensitivity as for the patients in need for urgent treatment the other methods are time consuming and this leads to prescription of broad spectrum antibiotics.

Center for Disease Control & Antibiotic Resistance –

What is Center for Disease Control ? 

• It is a Federal Agency which is involved in conduction and support of health care promotion, prevention of diseases and activities related to work towards preparing for disease outbreak.
• This agency is based in Atlanta and was established in the year 1946.

What is the Role of CDC?

• CDC works at local, state and national level
• It implements disease outbreak control strategies.
• It promotes public awareness in controlling chronic debilitating diseases
• CDC keeps a record of national health statistics.

Role of CDC in Antibiotic Resistance –

CDC published a report in the year 2013, containing around 18 drug resistant threats to the United States. Microorganisms keep on mutating to evolve resistance and it practically impossible to stop this evolution, it can of course be prevented.

CDC has implemented four basic actions to prevent Antibiotic Resistance

1. Preventing Infections –

Prevention is always better than cure. Its always better to prevent infections and therefore the need for antibiotic consumption. To prevent infections the gold standard measurements are –

• Adoption of Hand washing Habits
• Maintenance of personal hygiene
• Timely Immunization
• Preparation of Food taking safety and hygiene measures

2. Tracking of Cases and Recording the Data

CDC records the cases of antibiotic resistant infections and maintains the  statistics of particular infection. This record helps in developing strategies to control such antibiotic infections.

This helps in preventing the spread of resistant bacteria too.

3. Improvement in Antibiotic Prescription/Antibiotic Stewardship –

Antibiotics prescribed unnecessarily to humans as well as animals has spread and increased the rate of antibiotic resistance. One of the ways to control this Antibiotic Resistance is to use antibiotics safely and use only when required.

4. Developing New Drugs and Diagnostic Tests –

Reversal of Antibiotic Resistance is possible but it is a long term and gradual process. In situations of strict need for treating cases of   infection from resistant microorganisms it becomes a priority to treat the infection first with new range of effective antibiotics.

Moreover, in order to treat it is imperative to get an adequate diagnosis. Therefore, it is important to develop sensitive and quick diagnostic tests.

   Can Antibiotic Resistance be Reversed? 

Antibiotic Resistance can be reversed or not is a debatable topic. In this field multiple research projects are being carried on to come to a conclusion.

Different types of approach are being tried to reverse the effects of Antibiotic Resistance. Few of them are:

• Using a multidrug approach in cases where the resistant bacteria has been isolated.
• Treating the patient using antibiotic drug combined with a “helper agent”. Such kind of agents are under investigations and they are thought to enhance the activity of antibiotics.

One such agent is Azelastine which has been tried to combine with eight known groups of antibiotics. Such combination gave positive results.

• Natural substances have also been tried to reverse the antibiotic resistance. One such agent is the plant extract of Piper Longum Fruit (Indian Long Pepper). This extract gave positive results in treatment of multidrug resistant infections caused by bacteria such as Staphylococcus aureus, Escherichia coli and Salmonella typhi etc.
• Along with multidrug approach, a time bound antibiotic intervention is also being tried. Antibiotics have also been prescribed in an ON/OFF manner. This kind of investigation has not yet been tried on humans but still in the initial phases in laboratory.

Staphylococcus aureus and Antibiotic Resistance –

What is Staphylococcus/Staphylococci?

Staphylococci or Staphylococcus are the most common microorganisms which cause pus producing infections. This bacterium was first discovered by Sir Alexander Ogston in the year 1880.

He was a Scottish Surgeon who isolated this bacteria in Abscess(collection of pus) and other infections producing pus.   The term Staphylococcus is made up of two words “Staph” which is a latin word meaning Bunch of Grapes. Another  word is  Coccus  which means round.

So this bacteria is round in shape and arranged in the form of bunch of grapes when observed under a microscope.

 Different strains of Staphylococcus bacteria have been isolated. This isolation is based on the color of colonies formed by the bacteria on culture media. The different strains are –

• Staphylococcus aureus forms golden or yellow colored colonies.
• albus similar color as of aureus
• citrus forms yellow colored colonies.

The antibiotics of choice for treatment of Staphylococcus infection are the Penicillin group of drugs like oxacillin or flucloxacillin. Sometimes during severe infection course, these penicillins are combined with Aminoglycoside group of drugs.

But with the due course of time, and evolution of antibiotic resistance, this bacteria has developed Penicillin resistance. Penicillin resistance develops with development of the enzyme Penicillinase which destroys the antibiotic.

To conquer this resistant strain, different antibiotic drugs have been developed, those are Methacillin, Dicloxacillin & Naficillin etc.

But with the further spread and transfer of mutated genetic material, the bacteria became resistant to Methicillin. This strain of bacterium has been termed as Methicillin Resistant Staphylococcus Aureus.

Methicillin Resistant Staphylococcus Aureus (MRSA)

It is the commonest microorganism which causes hospital acquired infections worldwide. In hospitals the high risk areas are the Intensive Care Units (ICU). So these areas are provided with high surveillance strategies.

Transmission takes place by the hand carriage of bacteria on health care workers and also from direct patient to patient contact.

Major Risk Factors for MRSA infection

1. Old age
2. Prolonged hospital stay
3. More common in males
4. Chronic Illness
5. Prolonged antibiotic therapy
6. Patients inserted with tubes and intra venous sets for long time.
7. Patients with open wounds.

As per a research study conducted on various hospitals India has a high level of MRSA. This study also showed that majority of MRSA was isolated from Blood samples.

Methods to Prevent the Spread of MRSA

1. A thorough hand washes before eating, providing any medical care and after using the bathroom.
2. For hand wash antimicrobial soap can be used.
3. If soap is not available, then use antiseptic which is waterless and alcohol-based.
4. Patients with positive MRSA infection, should be kept in isolated rooms.
5. For home care patients, proper maintenance of cleanliness should be kept under check.

Infections caused by MRSA

MRSA is capable of causing an array of infections. The symptoms depend on the site involved.  Infections include Skin and soft tissue infections, respiratory infections, heart valve infections, bone infections and blood stream infections.

It is one of the most contagious infections and also threatened to arise as a global epidemic.

Skin infections are the commonest MRSA infections and they can either be community associated(CA-MRSA) or can spread by the contact of a health care facility (HA-MRSA).

HA-MRSA is more dangerous as the bacteria tends to infect the surgery wounds and through the tube sets inserted in the patient. Later on this can spread through body causing Blood infection or Sepsis. This sepsis is life threatening.

Symptoms of MRSA Infection –

MRSA infection begins as small pimple or boil on the skin. Sometimes may appear as an abscess of the skin which eventually bursts open, oozing out pus. The raw eroded skin area becomes further prone to colonization of bacteria if not given proper antibiotic coverage.

In case the treatment is not given on time it may take up a severe mode and may produce sepsis. Sometimes skin infections may go deep producing infections in some vital organs(heart valves, lungs or bones) of the body.

Treatment of MRSA Infections

1. Surgical drainage of pus from the abscess or in case of skin infections
2. In case the source of infection is the iv tube or any other medical device it should be immediately removed.
3. A microbiological culture should be performed to detect the causative organism.
4. Appropriate antibiotic therapy should be give to the patient. In case of MRSA, the antibiotic of choice is Vancomycin.
5. But this antibiotic therapy should also be accurately monitored.
6. Sometimes the bacteria may not be susceptible to Vancomycin or the causative bacteria is not being isolated. In such cases the antibiotic treatment of choice is Vancomycin with another group of antibiotics which are the Aminoglycosides.

MRSA and Pregnancy

Pregnant females like other healthy individuals are not really affected by MRSA. Moreover, fortunately there has been no evidence of any pregnancy complications because of MRSA.

A pregnant female will be screened for MRSA in case when she has been scheduled for a C-section surgery. In case a pregnant female is found to be infected with MRSA, she can be easily treated with antibiotics.

In a situation a newborn being admitted to intensive care, should be regularly tested for MRSA infestation. Another scenario to consider MRSA in pregnant females is when the female has a previous history of MRSA infection.

In case a newborn baby contracts MRSA infection, it can be treat easily with antibiotics and is not known to take up a severe form.

What are Superbugs? 

As the name sounds very interesting, but what are these and what is so special about them to give such a term. Do they have any medical relevance, posing any healthcare issue.

Superbugs: It is the term given to the bacterium which undergoes resistance after being exposed to a particular drug. That means when the bacteria will be exposed to the similar drug again it will not be killed by the drug.In simple term, the bacteria is shielded or is covered with a bullet proof jacket against the “magic bullet”.

Medical Relevance – The superbug may spread and further evolve producing multidrug resistance.

Antibiotic Resistance Facts

• Every year in the United States, around 2 million people acquire infections from resistant bacteria. About 23,000 people die from such infections.
• Antibiotic resistance is a medical emergency since the year 1945, but has not been taken seriously. Now it is the time it should be taken into some serious consideration.
• Antibiotic resistance is increasing per year and by the year 1997, it was established that about 44% of bacteria were resistant.
• A large portion of antibiotics are being misused in animals too which adds to the antibiotic resistance.
• It is feared that a pandemic situation (a global epidemic situation) can arise due to an antibiotic resistant superbug.
• The Food and Drug Administration has reduced approving newer antibiotic drugs.

Antibiotic Resistance in India –

• In 2010 India was found to be the largest consumer of antibiotics
• Antibiotic resistance is a severe health care problem in India
• These high rates of antibiotic resistance can be attributed to easy availability of over the counter antibiotics.
• Self prescription of antibiotics in phenomena of self healing infection.
• In a six monthly study conducted in a renowned medical institute in India it was found that 143 patients out of 1,230 patients were suffering from 152 infections caused by health-care associated bacteria.
• This shows that the lack of hygiene in government aided healthcare bodies.
• According to a report issued by the Department of Biotechnology(DBT), the last resort antibiotic to treat serious infections which is Carbapenam, a very high number of Carbapenam resistant bacteria were found.
• According to a government commissioned research, it was found that during the months of pilgrimages i.e. May and June, there was higher spread of Superbugs which also included bacteria causing Tuberculosis.
• Another major cause of high antibiotic resistance in India is the inadvertent selling of drugs which are either banned or not approved according to FDC drug formulations.

Government Policies to Deal with Antibiotic Resistance in India:

• National Action Plan on Antimicrobial Resistance (2017-2021): NAP-AMR –This plan has strategies to curb antibiotic resistant by improving awareness and understanding of antibiotic resistance. Optimizing the use of antibiotics in health care, veterinary care services.
• Role of National Center for Disease Control : This government aided body controls the misuse of antibiotics by keeping close surveillance on manufacture and sell of antibiotics. This body also keeps record of the cases of infections due to resistant bacteria. Also a check on strengthening the diagnostic methods for antibiotics sensitivity.
• Drug strips with red line on the back should not be sold without prescription.
  

  The Red strip on the back antibiotic pack is provided in order to prevent the sell of over the counter antibiotics. These antibiotics should not be consumed with out a proper prescription form the medical practitioner

   

  Conclusion

  Antibiotics have been the sole source of treating infections past 5-6 decades. Once considered to be magic bullets the magic of antibiotics has shown its after effects. This has a raised a whole new army of “Superbugs”.

  Further mutation in these has worsen the situation. This has made Antibiotic Resistance a silent medical emergency which requires immediate attention.

  Antibiotic Resistance is now considered to become a major cause of deaths in coming future. It is also worried that in developing countries like India, where there are high rates of Antibiotic resistant bacterial infections, it is imperative to stop the sell and manufacture of under formulation drugs.

  Moreover, antibiotics should be prescribed in a calculated manner and should be avoided in minor infections which the body can take care on its own.

  The human body is blessed with immense power of healing and rectifying the infections on its own. This is managed by the immune system of the body and for this system to work in harmony it is mandatory to not disturb it with outsource of the so called “Magic Bullets”.