The fight against antibiotic resistance on the agenda of Madhya Pradesh

Following KeralaMadhya Pradesh, India's second largest state, will implement its action plan on containment of antimicrobial resistance, focusing on the treatment of hospital effluents and limiting the use of antibiotics in livestock and livestock. poultry.

In the central Indian state, AMR control initiatives, aligned with the National Action Plan and the Global Action Plan on Antimicrobial Resistance, are already under way, including Indo-Swedish management collaboration. antibiotics for the prevention and control of infections and the treatment of wastewater.

"Awareness of the rational use of antibiotics by the public and stakeholders, as well as surveillance in the human, animal / food and environmental sectors, for the development evidence-based policies are key points in the six priorities of our plan, "said Pankaj Shukla, Health Services Directorate, Madhya Pradeshsaid Mongabay-India.

The State of Madhya Pradesh's Contingency Project on Antimicrobial Resistance Containment (MPSAP-ARC), accessed by Mongabay-India, focuses on priorities such as reducing of the incidence of infection through effective prevention and control of infection (IPC), optimizing the use of antimicrobial treatments. health workers, animals and food; and promoting investments in antimicrobial resistance activities, research and innovations.

The launch of annual susceptibility testing reports establishing the susceptibility pattern of clinically significant pathogens to a variety of antibiotics, by the Indian Institute of Medical Sciences (AIIMS) Bhopal, constitutes a milestone in promoting the antimicrobial stewardship program.

Antibiotic stewardship refers to a set of coordinated strategies to improve the use of antimicrobial drugs with the aim of improving outcomes for patients' health, reducing antibiotic resistance and reducing unnecessary costs.

Shukla thinks that with the coming into force of this plan (in April), the state will make every effort to combat antimicrobial resistance.

Speaking on the sidelines of the National Food Conclave of the Center for Science and the Environment (CST)Shukla said: "We insist on the establishment of liquid treatment plans in all hospitals to prevent possible antibiotic contamination in the water and urge the poultry and livestock sectors to use antibiotics only for sick animals and birds, but not for the promotion of growth. "

Invisible problem of pollution by antibiotics in the water

The World Health Organization (WHO) defines the RAM as "the ability of a microorganism (such as bacteria, viruses, and certain parasites) to prevent an antimicrobial (such as antibiotics , antivirals and antimalarials) to act against him. As a result, standard treatments become ineffective, infections persist and can spread to others. "

One of the sources of development of antibiotic resistance is the presence of antibiotics in the environment, which generates outbreaks of resistant bacteria through a bacterial exposure to antibiotics.

And despite the Madhya Pradesh still leading the government poll for the cleanest Indian cities, scientific evidence has emerged about the "invisible" problem of antibiotic pollution. Over the years, scientist data highlighted water pollution by antibiotics and the presence of bacteria / antibiotic resistance genes in the Madhya Pradesh rivers such as the Shipra River, considered sacred among the mbades, particularly in the context of coliforms and E. coli.

Examination of hospital effluents in a 2009 study uncovered the presence of widely used drugs such as metronidazole, norfloxacin, sulfamethoxazole, ceftriaxone, ofloxacin, ciprofloxacin, levofloxacin and tinidazole.

It is argued antibiotic residues in the aquatic environment are diluted relative to their concentrations in therapeutic applications and can therefore be harmless. "However, exposure to sub-therapeutic levels for long periods of time may be an ideal condition for the selection and propagation of the resulting resistance," according to a study by researchers from the Department of Health. Environmental Medicine, RD Gardi College of Medicine, Ujjain, Madhya Pradesh. and Karolinska Institute, Sweden.

Vishal Diwan, Associate Professor, Department of Public Health and Environment, R.D. Gardi Medical College, observed that tCurrent antibiotic resistance (in-country) remains focused on clinical endpoints, while antibiotic resistance in the environment is not a priority due to lack of evidence and awareness.

Diwan is part of the research group of the Faculty of Medicine that has been working in the field of antibiotic resistance for more than ten years. The focus is on all aspects of antibiotic resistance in hospitals, communities and the environment.

He believes that solving problems related to antibiotic resistance requires the integration of several approaches (clinical, environment and behavior).

"Surveillance of infections / resistance is necessary not only in a clinical setting, but also in an environmental setting. It's the need of the hour. Policymakers, academics, and the media also need to focus on the environmental component, which also plays an important role in spreading antibiotic resistance, "said Diwan, a researcher at Karolinska Institute, said Mongabay-India.

Altering human behavior remains an underutilized and critical pathway to combat the misuse of antibiotics and to limit the spread of antibiotic resistance genes from its many sources, Diwan said.

"Our qualitative studies on hand hygiene and waste management show that there is a deficit between knowledge and current practice. The focus should be on organizational changes, training and monitoring to solve this problem, "Diwan said.

Pankaj Shukla maintains that the state's emphasis on surveillance in the environment and animal sectors would strengthen efforts to limit the exposure of water bodies to antibiotics and resistance genes. so as not to affect public water supply facilities.

Antibiotics as growth factors in poultry

The draft plan stressed that the surveillance of antimicrobial resistance in "animals is as essential as for human health", because animal foods are also the main route of exposure of animals. animal man. pathogens of food origin.

By virtue of this, the plan calls for improving the appropriate use of antimicrobials in animals and in agriculture, particularly in forage and forage land, and to restrict the use of Antimicrobials of critical importance to animals, fisheries and agriculture.

"The problem relates to the feces of animals and poultry that are drained into the water. Until now, the Department of Food and Drug Development has agreed to test the presence of antibiotics in feeds for livestock, poultry and fish, "said Shukla, nodal manager of the # 39, quality badurance at the National Health Mission.

The CST highlighted the large-scale unregulated use of antibiotics as growth factors in the poultry industry. In one study In New Delhi and the National Capital Region, the CST stated that 40% of the chicken samples had antibiotic residues and that more than one antibiotic had been found in 17% of the samples.

According to the National Institute of Highly Secure Animal Diseases in Bhopal, Madhya Pradesh, the increased demand for protein in India has resulted in intensive agriculture badociated with the use of antibiotics.

"Laws are needed to regulate the indiscriminate use of antibiotics in poultry because farmers are using antibiotics as an alternative instead of complying with better hygiene and sanitation," notes the draft. plan, adding that there is currently no disease in fish tanks and growth factors. are not applied in fish tanks.

Amit Khurana, program director of the CST's Food and Toxins Unit, believes that the use of antibiotics (in livestock) considered extremely important to humans should be phased out. The CST has always advocated a complete stop of the use of antibiotics as growth factors in animals intended for food.

"All states should develop and implement their own action plans on antimicrobial resistance," he said.

With Kerala's emphasis on organic farming, Shukla also hopes that organic farming will have a positive impact on the RAM containment efforts.

Madhya Pradesh account more 1.48 lakh hectares of land area in organic farming, most of the area devoted to organic farming in the country.

"Antimicrobial resistance is a public health problem as well as an environmental problem and we plan to treat it in a multisectoral way," Shukla added.

Image of the banner: The Superhero vs. Superbugs programs aim to engage with the general public at all levels of society to improve our understanding of antibiotic resistance, to raise awareness of this global threat, to change our behavior and create a society of intelligent users of antibiotics. Photo by superheroes against Superbugs / Wellcome Trust / DBT India Alliance.

(Sahana Ghosh attended the National Food Conclave at the invitation of the CST, New Delhi)