The Madhya Pradesh government plans to fight microbial resistance by setting up surveillance systems to track drug use in humans and in agricultural fields, curbing the spread of infections in hospitals, and regulating the poultry industry. The second State after Kerala to develop an action plan, it will assist seven other States in February to chalk out strategies.
With a surveillance system for animals up and running, the government is going to rope in 13 government colleges, two divisional laboratories and the All India Institute of Medical Sciences (AIIMS), Bhopal to track resistance in humans now, said Pankaj Shukla, Joint Director, National Urban Health Mission, one of the authors of the action plan.
State-wide database
At the hospitals, he explained, microbiologists would perform culture tests on samples taken from patients to single out resistant bacteria, and as a result develop a State-wide database. “Accordingly, we can advise doctors to prescribe only effective medicines,” he said.
Antimicrobial resistance is the ability of microorganisms to develop resistance against drugs. Although the resistance is a natural phenomenon, many factors have contributed to its acceleration, such as the injection of growth promoters in poultry, use of chemicals, including anti-fungal chemicals, in agriculture, and unhygienic conditions in hospitals leading to infections. The result is prolonged illness, extended duration of therapy, increased risk of mortality, higher costs for patients and healthcare.
Keeping an ineffective drug out of supply over a period might result in a fall in bacterial resistance to it, said Mr. Shukla. “Rampant use of chloromycetin in 1950s rendered it ineffective. But it’s being used again to treat typhoid now, after remaining out of supply for 50 years,” he added.
‘Nominal decline’
Under the infection prevention and control component of the plan, prescribing the right medicine that does not cover a broad spectrum of diseases, controlling hospital-induced infections due to unhygienic methods, and scientific disposal of medical waste, could help bring down resistance, said Mr. Shukla. “According to a survey conducted in the State, the resistance has declined over a year, though nominally, when cleanliness was maintained in hospitals,” he added.
Though the State faced more resistance through antibiotics used in animals, antifungal resistance was an emerging issue. “We will focus on agriculture from next year and carry out surveillance on antibiotic use in farming,” Mr. Shukla said.
The plan boasts six strategic points of action to be taken up between one to three years from 2019 — awareness and understanding, knowledge and evidence, infection prevention and control, optimising the use of antibiotics, research and innovations, and collaborations. Moreover, the State government is focusing on inter-sectoral collaboration, while following the ‘one health approach’ (assessing both human and animal health).
Curb OTC sale
In a bid to regulate access to high quality antimicrobials, the government plans to curb over-the-counter (OTC) sale of drugs in a phased manner. “A ban cannot be imposed abruptly. For now, we are restricting the use of only 24 drugs, and developing a mobile application to prevent their sale without prescription,” said Mr. Shukla. An application would also be developed for doctors to optimise drug use and guide them.
The plan further aims at gradually phasing out the use of high priority, critically important antimicrobials for use in animals, and ban the use of antibiotics as growth promoters. In addition, the government plans to adopt a policy for licensing manufactures, distributors and sellers of antibiotics and feed.
