Superbug ‘pandemic’ stalks India as antibiotic resistance jumps 10pc in a year

India faces a “pandemic” of superbugs, the country’s top public health experts have warned, as resistance to common antibiotics has jumped by 10 per cent in just one year

In the fifth edition of its annual report on antimicrobial resistance (AMR), the Indian Council of Medical Research warned that urgent action is needed to prevent a major health crisis caused by the rampant misuse of antibiotics.

“The resistance level is increasing to five to ten per cent every year for broad spectrum antimicrobials, which are highly misused,” said Dr Kamini Walia, who led the ICMR’s report.

“Antibiotic resistance has the potential of taking the form of a pandemic in the near future if corrective measures are not taken immediately.”

The report, published this week, warned that only 43 per cent of pneumonia infections in India could be treated with first line antibiotics in 2021 – down from 65 per cent in 2016.

It added that tuberculosis infections rose by 19 per cent in 2021, partly driven by a rise in multi-drug resistant infections. By 2032, it is predicted that it will not be possible to treat 85 per cent of TB cases in India with common drugs.

AMR already kills as many as 1.4 million people worldwide each year, and India is at the forefront of the crisis. According to government statistics, resistant infections already claim the lives of 700,000 Indians annually – and some experts say this is an underestimate, due to poor healthcare surveillance across the country.

A 20th Century killer

“We could absolutely see a pandemic driven by AMR infections in India,” said Ramanan Laxminarayan, director of the One Health Trust, a global public health think tank. “It is certainly within the realms of possibility, it could be next year or over the next two decades.

“Bacterial infections were the biggest killers in the early 20th Century and we risk going back to that time where there are no effective antibiotics and infections can spread rapidly,” he added.

AMR infections are a growing threat worldwide but a perfect storm of factors means India has become a hotspot.

The country has one of the world’s most underfunded and understaffed healthcare systems – with only one-in-five rural healthcare clinics having a doctor present – and it is common for doctors and pharmacists to overprescribe antibiotics in lieu of repeated check ups. People can also purchase medicines online or from the private sector without a prior consultation.

In 2011, a study by the Indian government found that up to 50 per cent of antibiotics used in Delhi – home to some of the country’s best healthcare – were unnecessary.

There are also quality concerns over many of the antibiotics used. In 2019, more than 47 per cent of antibiotics consumed had not been approved by the country’s official pharmaceutical regulatory body.

If antibiotics consumed are weak, then it allows bacteria in the body to develop resistance to a full strength version of the medicine.

Meanwhile awareness around AMR infections remains low. Many threadbare Indian hospitals do not follow sanitation protocols, meaning drug resistant pathogens can spread rapidly as a secondary infection amongst those admitted.

It is also common for hospitals and pharmaceutical factories alike to ignore regulation around the disposal of medical waste, due to poor enforcement, resulting in untreated products usually ending up in India’s rivers. Overuse is also rampant in animals, linked to the agricultural industry.

A study by Toxics Link in 2022, an Indian NGO, found levels of pharmaceutical antibiotics in the River Yamuna, one of India’s largest rivers, at levels which pose a serious threat to human life.

While the ICMR study is important in raising awareness of the growing problem, public health experts agree the Indian government must now do more to identify exactly where AMR infections are taking hold.

It is also widely accepted that resistance swelled during the Covid pandemic. A brutal second wave quickly overwhelmed India’s meagre healthcare system and doctors across the country began wrongly prescribing the antibiotic azithromycin to desperate patients.

“What we need is certainly better use of vaccines, we need infection control in hospitals and strict protocols for disinfection, as well as a massive education of the Indian population that helps to discourage the unnecessary use of antibiotics,” said Dr Laxminarayan.

“It is a huge task ahead but it is the biggest threat as far as infectious diseases go in south Asia in the future.”

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