Threat of Superinfections looms over India

India is facing a threat of Superinfections due to the growth of drug-resistant bacteria among its population following the rampant misuse of antibiotics.

Doctors have warned that if the problem is not tackled it will lead to a serious ‘drug-resistant’ pandemic in the country.

“If the misuse of antibiotics goes unabated we will be left with no alternative for the treatment of different infections,” said Dr. Ajay Kumar, a leading Gastroenterologist.

He said self-medication must end and chemists shouldn’t be allowed to sell antibiotics without prescription, which is otherwise going on rampantly.

Dr. Kumar, who is also the HOD at the Institute for Digestive and Liver Diseases at BLK Hospital, said the drug misuse was going on at every level, be a private clinic or government hospital.

It has also given rise to serious infections related to the digestive system, he said.

“The unnecessary antibiotic use creates a serious impact on our gut as it becomes vulnerable. Bacteria gets favorable hygiene which leads to Superinfections, like an infection of the colon called Clostridium difficile,” he told Health Wire.

According to him, the overuse of antibiotics will make infections untreatable leading to thousands of deaths.

Superinfections are the unusual infections which are unrelated to the first infection for which the antibiotic was originally taken, as per Dr. Kumar.

“The second infection emerges due to the unnecessary antibiotic treatment because it disturbs the normal microbiota in the body. Imbalance in the microbiota which stays there for a long time following treatment leads to drug resistance,” he explains.

As per National Center for Biotechnology Information (NCBI), U.S National Library of Medicines when the gut microbiota is reduced, it provides an opportunity for pathogenic microbes to grow and potentially cause a new infection, called superinfection.

“The microbes can come from a person’s own microbiome or from the outside environment. The risk for superinfections is higher when using broad-spectrum antibiotics, as compared to narrow-spectrum antibiotics affecting a smaller number of bacteria. Further, the long duration of antibiotic treatment, immunosuppression and poor health status of the patient increases the risk. Superinfections range from mild infections, that do not need further treatment to very severe infections that can lead to death,” said one of the NCBI studies.

Although the government of India has introduced the National Action Plan on Antimicrobial Resistance its implementation remains a challenge.

The government’s action plan aims to control and contain antimicrobial resistance through a multi-thronged approach. However, the multidisciplinary plan is a daunting task and requires proper implementation.

“Antimicrobial resistance is a serious threat to global public health that requires action across all government sectors and society and is driven by many interconnected factors. Single, isolated interventions have limited impact and coordinated action is required to minimize the emergence and spread of antimicrobial resistance,” said JP Nadda, Minister of Health and Family Welfare at the ‘Inter-Ministerial Consultation on AMR containment’ while introducing the action plan.

The document is based on the National Health Policy 2017 which highlights the problem of antimicrobial resistance and calls for a rapid standardization of guidelines regarding antibiotic use, limiting the use of antibiotics as over-the-counter medications, banning or restricting the use of antibiotics as growth promoters in animal livestock, and pharmacovigilance including prescription audits inclusive of antibiotic usage – in the hospital and community.

In addition, the ministry also identified AMR as one of the top 10 priorities for its collaborative work with WHO for 2018–2019.

Public health experts suggested some tough and long term measures to bring the change.

“The action plan requires strong policy decision and huge public awareness so that people don’t take antibiotics unnecessarily,” Dr. Kumar said adding that use of antibiotic should be put in schedule X of the Drug and Cosmetic Act so that these can’t be given over the counter without a prescription.

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