After creating a huge controversy by claiming that foreign patients who were treated in India developed antibiotic resistance, authors of the superbug New Delhi metallo-B-lactamase-1 (NDM-1) bacteria study published in the United Kingdom-based medical journal The Lancet now say that poor sanitation and unregulated antibiotic use presented an immense challenge and should be of great concern to the Indian health authorities and the World Health Organisation.
Responding to queries in the latest edition of the journal, the authors of the controversial study (Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological and epidemiological study) quoted a UN report saying that 650 million people in India did not have adequate sanitation, and the sewage treatment system in Delhi struggled to cater to 50 per cent of the population.
“Such facts, coupled with India's heavy and unregulated antibiotic use, doubtlessly explain why seven of eight returning Swedish tourists experienced gut colonisation with bacteria producing extended spectrum B-lactamases (ESBLs) and why India has the highest community ESBL rate in the world,” they said.
No recognition
India has failed to recognise, let alone implement, the necessary WHO antibiotic recommendations issued in 2001. “Escheriachia coli with NFM-1 have been found as gut colonists in returning travellers (to The Netherlands, Sweden) from India, and might be transmitted via the faecal-oral route, providing a reservoir of future infection,” the respondents, Timothy R.Walsh, Mark A Toleman, Jayanta B.Sarma, Seema Irfan, Neil Woodford and David, have written.
At the same time, the authors have expressed ‘delight' over the efforts by the Indian authorities in developing new strategies to combat the pressing issue of antibiotic resistance. “This development, plus an open and broad engagement with the worldwide scientific community to expand resistance surveillance and to better understand risk factors for NDM-1, will assist us all in combating the problem,” the article said.
Response to criticism
In response to the major criticism from correspondents, Indian officials and hospital surgeons, and those who rejected the link to India, the authors said that this was directed at the sentence: “‘It is disturbing, in context, to read calls in the popular press for U.K. patients to opt for corrective surgery in India with the aim of saving the National Health Service (NHS) money. As our data show(s), such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals.' This quote was taken, by critics of our paper, to be a general warning against medical tourism, which currently caters for 4,50,000 patients per year, generates $2 billion per year, and is expected to increase by 30 per cent per year.”
Used earlier
On the naming of the bacteria, the authors say that NDM-1 follows nomenclature for metallo-B-lactamases that started in 1999 with VIM-1 (Verona imipenemase), and includes SPM (Sao Paulo metallo) and SIM (Seoul imipenemase). “No one objected when two research papers (including an Indian study), which were published before our article, used the NDM-1 epithet. Furthermore, Pseudomonas delhiensis was named after the capital by Indian scientists,” the authors said.
The Indian Network for Surveillance of Antimicrobial Resistance, in its reaction to the article, has recommended mandatory surveillance of drug resistance, and said regulatory policies to control abuse of antibiotics in hospitals and communities should be strictly implemented, especially in developing countries.
The real reason is money. Western corporate world want to prevent foreign patients getting treatment in India which will empty their pocket. $2 billion per year is not a small amount for them to side line.The corporate world want to scare the patients with this super bug. I totally agree with Indian situations, India is sitting on a time bomb , population explosion, which already resulted in many social unrest, but its next chapter would be millions perish with deseases.
I think the sanitation issue is a big one. Having lived overseas for over 20 years I always get real sick when I go to India even though I take many precautions. People in india follow poor Sanitation habbits. Meat is commonly sold without refrigeration. Train toilets throw human excrements on railway tracks all over the country. Even hospital staff are poorly trained for hygiene condition. Sewage system in the country are antiquated. People of India should take criticism positively. Indias success is important not just for India but for the rest of the world.
It is indeed true that in India we can get Schedule H drugs without prescriptions from the local pharmacy store and that does need to be regulated and I know many people among my own friends and relatives who say that the regular medicines dont work for common cold. I know people who ingest 8 ranitidine tablets a day to avoid acidity. Whether the Super Bug came from India or not, there is some serious work to be done here by medical regulatory authorities etc.
Indians have become Americanized in some ways.Due to the third party insurance system, they are shielded from the cost of care and they always demand and get the "latest stuff" for their coughs and colds. Busy docs who see as many as 100 patients per day find it easier to write something and get the patient out than to educate them. Patients are quite rude too. If the docs don't give them what they want they will go somewhere else and get it! India would do well to abolish third party insurance before it starts to face the same hell as the US.
Ayurveda emphasizes on increasing the natural immune power of the body instead of taking antibiotics. These Western scientists call Ayurveda as pseudoscience but they don't have any solution to the problem of antibiotic resistance.
I am a physician and this news is not a big shock to me. nowhere else can you get drugs schedule H including without the prescription of a doctor. Most GPs prescribe antibiotics even for minor viral infections like common cold. It is too common to hear a patient saying to the doctor that he took amoxycillin for 2 doses for cold and he didnt get alright . not to say about quacks. And this false sense of national pride where there is no respect for rules, ethics !! Hypocrisy !!!
We're not really talking about over-prescription of antibiotics by doctors. In India, people can buy antibiotics over the counter as easily as, say, potato chips.
I was regularly updating my self on this topic, I don't know wether it is a blame game or some thing else (may be issue related to MEDICAL TOURISM). But if all the natters mentioned in this article is having any fact. Then we should definatly look for its preventive and precationary measures (instead of criticising/ balaming the INDIAN sanitery conditions), Such as to improve the sanitation level and control/regulated use of anti-biotics.
I think the findings are correct. Indian doctors are obsessed with antibiotic prescription. It is the easiest way to suppress any infection when doctors are not able to diagnose the problem properly. The antibiotic lobby is working hard to promote antibiotics even in live stock sector in the name of 'growth promoters'. It is high time there should be code of conduct for use of antibiotic for manufacturers, doctors and hospitals. Today in medical profession, it money not health, which drives the decision.
Will government and WHO listen? With experience one can say NO.
It's a pity to see the so called next superpower fail again and again on issues like sanitation, sewage, roads and electricity. Our CM will inaugurate a flyover and say Delhi is being developed whereas thousands of colonies do not even have basic living conditions provided to them.
Sanitation may have a relation with disease but basically this is related to the abuse of antibiotics.
It is a general practice in India to prescribe heave doses of latest generation anti-biotics after every surgery. Some times doctors do it on considerations from pharmaceutical companies, some times doctors do it owing to poor sanitation conditions. Even in minor ailments where disease can be cured without anti-biotics or by old generation anti-biotics the doctors in India generally write the latest anti-biotics again owing to graft from pharma companies or owing to concern to cure the ailments as early as possible so as to shine their private practice.India will have to adopt generic medicine regime as against brand name medicine regime as one of the means to curb indiscriminate use of anti-biotics.
I dont think in India, doctors prescribe antibiotics unnecessarily -rather they try to avoid it most often. I have seen many other countries using antibiotics left and right without any regulations. Not to point at others, but this strain can also come to India from a foreigner who sought medical treatment in Delhi.
Poor sanitation and unregulated antibiotic use is alibi. Real issue is slipery base of modern medicine which tags microbes as enemies of health, which they are not. Eighty percent of diseases are either self limited or cured by body's innate immune system, inspite of medicaltreatment and not because of medical treatment. Momentum of drug sale is too big to be checked by medicos.They have therfore learned to make best use of this dilemma as well. They can easily shift blame to drugs and drug systems when fault in fact lies with them. As for sanitation, children who play in sand remain healthier in comparison to chocolate babies of a c environs. How do you explain that?
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