Antibiotic Consumption and Bacterial Resistance in India

Abstract

Antibiotics have had a tremendous impact on human health over the past century; unfortunately, all of the benefits to health conferred by effective antibiotics are now being threatened by the spread of pathogens with the ability to resist the antimicrobial activity of these valuable drugs. It is believed that in the developing world, in particular, high rates of infection and rampant overuse of antibiotics have led to significant accumulation of resistance in bacteria against a wide array of antibiotics. Existing data suggest that antibiotic resistance has become more widespread in India than in perhaps any other country, but in the absence of a coordinated, central surveillance system, the full extent of the resistance issue in India has been difficult to assess. So, in an attempt to gather reliable, up­‐to‐date data on the status in India of antibiotic consumption and resistance in some of the more common hospital‐acquired bacterial infections, a retrospective data collection on pharmacy consumption and antimicrobial susceptibility testing from January-­June 2013 was conducted with twelve tertiary-­care hospitals from different parts of India. The data submitted from these facilities suggest that resistance has reached high levels in Gram-­negative bacteria in India to almost all of the antibiotics available to treat them, including the most powerful, high-­end antibiotics, which are also being consumed at higher levels in recent years. Resistance in Gram-­positive bacteria, meanwhile, is also high against certain drugs but it appears from the data that more therapeutic options remain available for these bacteria than for the Gram-­negative species. Given the lack of recent investment in antibiotic discovery by major pharmaceutical companies, particularly in drugs to treat Gram-­negative infections, the immediate strategies to confront this issue must aim to preserve the existing antibiotics that have retained their effectiveness. Interventions that have been successful in other resource-­poor countries and are grounded in ecology and evolutionary biology, such as improvement of infection control in hospitals, education of physicians on resistance, national policy to restrict overuse of high-­end antibiotics, and central surveillance of resistance, must be pursued aggressively in India.