Distressing reports of antibiotic pollution call for urgent steps to curb pollution and create awareness about the growing reality of antibiotic-resistant bacteria (‘Ground Zero’ page – “The superbugs of Hyderabad”, November 18). Special cells can be created within our respective pollution control boards to monitor pharmaceutical industry waste and ensure that the issue gets undiverted attention. The red line campaign — of marking a red line on antibiotic prescriptions in order to help curb their irrational usage — was lauded at the global level. The campaign needs to be intensified. Finally, a collaborative and participative approach between the pharmaceutical sector and the public will check the growing misuse of antibiotics.
Archana Venkatamadhvaraj,
Thoothukudi, Tamil Nadu
Antimicrobial resistance (AMR) is the latest woe to affect the medical world, leaving millions of hapless patients to suffer from multi-drug resistant pathogens. Mercenary pharmaceutical companies appear to be turning a blind eye towards the perilous impact that untreated or rather poorly-treated effluents can cause to humans and the environment, further magnifying the problem. Public awareness on AMR must be ramped up. Stringent action against pharma companies that violate norms must also be pursued. Vigilant monitoring by Central and State pollution control bodies can go a long way in curbing effluent discharge to water bodies. There must be research on superbugs, thereby better equipping our health-care system in fighting multi-drug resistant pathogens.
Anjali B.,
Thiruvananthapuram
The detailed article has established beyond reasonable doubt that the efficacy of existing antibiotics to treat infections is almost reaching the end. Very often we, as medical practitioners, come across bacterial cultures in which organisms are susceptible to no other drug except colistin these days. The infamous case of NDM-1 haunts researchers studying antimicrobial resistance. It is a fact that the hazardous levels of antibiotic effluents from the pharma industry are a potent source of the emergence of antimicrobial resistance.
Interestingly, there is also untreated liquid waste from mortuaries being disposed of, untreated, into water bodies which is leading to a toxic explosion of resistant bacteria. This is the case with a general hospital in Hyderabad which dumps its waste in the Musi.
Autopsy procedures generate blood, shreds of tissue and necrosed flesh as waste which is then washed into the drains. When all these join sewers which contain hospital waste, another story happens. As blood and flesh are a rich culture media for bacteria, hospital waste contains suboptimal levels of antibiotics excreted by in-patients. Sewer lines also harbour bacteria. Bacteria grow in this waste which serves as a culture media. Liquid waste management in mortuaries is not regulated in India and is a serious violation of Biomedical Waste Management Rules. The Kerala medico-legal code has guidelines on how liquid waste from mortuaries is to be managed.
It says: The blood and other waste products of postmortem examination, under any circumstances, should not be allowed to flow in to the common drainage. The postmortem table should have a drainage line directly from it and leading to a tank constructed in the similar manner as that of septic tank. A soak pit may be constructed to drain the effluent fluid from the tank. The size of the tank may be in accordance to the number of postmortem examinations conducted in the particular mortuary, in every year. The site of the tank should be behind the mortuary building. Only water used to clean the floor of the mortuary and its premises should be allowed to drain to the common drainage.
Dr. Kattamreddy Ananth Rupesh,
Hyderabad
There are reports to show that Indian and Chinese drug makers routinely release untreated waste fluid containing active ingredients into the surrounding soil and waterways. A study published in the Journal of Hazardous Materials shows how antibiotic concentrations downstream of drug manufacturing plants in these countries exceed those expected in someone being treated for infection. Pharmaceutical pollution of any type can be deadly, threatening habitats and drinking water sources. The release of antibiotics into soil, streams, rivers and lakes creates a perfect storm for antimicrobial resistance to develop and spread. Superbugs, like any disease, have no respect for national borders. There need to be four vital steps: first, Indian drug makers should require their suppliers to stop polluting. Second, India and China must toughen their regulations regarding pharmaceutical plant pollution and crack down on the violators. Third, retailers should demand that all antibiotics they sell are produced through safe, non-polluting manufacturing processes. Finally, the general public must demand action by pharma businesses and the officials concerned.
K.M.K. Murthy,
Secunderabad
