India needs to take urgent initiatives to formulate an effective national policy to control the rising trend of antimicrobial resistance, including a ban on over-the-counter sale of antibiotics, and changes in the medical education curriculum to include training on antibiotic usage and infection control.
‘The Chennai Declaration: A roadmap to tackle the challenge of antimicrobial resistance’ published in the latest edition of Indian Journal of Cancer has recommended that an Infection Control Team (ICT) be made mandatory in all hospitals. Regulatory authorities and accreditation agencies such as the National Accreditation Board for Hospitals and ISO must insist on a functioning ICT during the licensing and accreditation process.
The recommendations include offering Post-MD/DNB (internal medicine) sub-specialisation in Infectious Diseases at all post-graduate centres that offer sub-speciality training, compulsory training in infection control and infectious diseases training in under-graduate and post graduate curriculum in all specialities. The Medical Council of India should introduce one-week antibiotic stewardship and infection control training in the third, fourth and final year of MBBS and two-week training at the PG level.
Recommending the setting up of a National Task Force to guide and supervise the regional and State infection control committees, the paper suggests that the National Accreditation Board for Hospitals & Healthcare Providers (NABH) insist on strict implementation of hospital antibiotic and infection control policy, during hospital accreditation and re-accreditation processes.
The paper on The Chennai Declaration has been written by A. Ghafur, D. Mathai, A Muruganathan, J.A Jayalal, R. Kant, D. Chaudhary, K. Prabhash. O.C. Abraham, R. Gopalakrishnan, V. Ramasubramanian, S.N. Shah, R. Pardeshi, A. Huilgol, A. Kapil, J.P.S. Gill, S. Singh, H.S. Rissam, S. Todi, B.M. Hegde and P. Parikh, all experts in their respective fields.
Surveillance
“The Indian Council of Medical Research should broaden the antimicrobial resistance surveillance network, incorporating hospitals from government and private sectors in addition to providing funds for research on antimicrobial resistance, drug development and infection control,” the paper says. There is an urgent need to standardise microbiology laboratories in India, the paper points out while highlighting the role of media and non-governmental organisations in creating awareness on the dangers of misuse of antibiotics.
The paper also speaks of the need to regulate antibiotic usage in veterinary practice.
Antimicrobial resistance is a serious global challenge. Every continent and country face the menace of antibiotic resistant ‘super bug,’ though the extent and the severity of the problem varies.There is at present no functioning national antibiotic policy or a national policy to contain antimicrobial resistance in India. The policy published in 2011 has been put on hold due to non-availability of major recommendations.
India, with more than 20,000 hospitals, more than a billion population, wide cultural diversity, and a large medical community, will find the resistance problem an issue very difficult to tackle unless wholehearted and joint efforts are initiated to tackle it on a war footing, the Chennai Declaration says.
The paper was drafted at the pre-conference symposium of the second annual conference of the Clinical Infectious Disease Society (CIDSCON) held in Chennai in August.
