Life with Antibiotics- A Conversation with Professionals

Dr Sangeeta: Antibiotics are lifesaving medicines that are needed to kill bacteria. Antimicrobials term is a broader term and includes medicines that act on bacteria, virus, fungi. In humans, we use them for prevention (prophylactic)and treatment (therapeutic) of various infections like bad throat, pneumonia, typhoid, urinary tract infections etc.

Dr Prejit: Antibiotics are “Wonder drugs” that has revolutionised medicine. In the food sector, antibiotics are used for four broad purpose

• Therapeutic use i.e., for treatment of bacterial infections
• Metaphylaxis- control of infection in livestock farms to avoid the spread of infection
• Prophylaxis- for preventive measures after surgical operation
• Growth promotion- to have better feed conversion and gaining more weight

Dr Sangeeta: Animal use has got bigger share of antibiotic use- nearly 70-80% is being used in animals of total production of antibiotics. Not to forget, antibiotic use in humans has also increased globally over the years due to an increase in GDP and improved access but at the same irrational use has also increased. A balance is required between access and excess antibiotic use.

Dr Prejit: Reports says that Antibiotics are used in animals three times more than humans. In 2017, the global consumption of antibiotics in the veterinary sector was more than 93K tonnes of which nearly 50% was contributed from china and, India shared 2.2 %. Between 2000 to 2015, the consumption of Antibiotics in India has increased nearly 103% which is of major concern. Population and economy of India are increasing simultaneously. GDP per capita has been increasing for the past 40 years and the living standard of people have been improved. In turn, they have the money power to purchase protein-rich food and hence there is an increase in meat demand. This demand has been facilitated by the expansion of intensive systems of farming and hence the use of antibiotics and growth promoters in animals have increased to maintain the health and productivity of these animals.

Dr Sangeeta: Antimicrobial Resistance (AMR) is the biggest threat to us. Pathogens or germs stop responding to antimicrobials, illness and hospitalisation will become prolonged. Higher antibiotics will be needed for the treatment which might be more expensive, more toxic in nature and increased mortality.

AMR is like a silent pandemic. Duringcovid-19, we have faced the helplessness of not knowing the effective drug for the treatment of disease. We will be landing in the same situation if we do not control the AMR, as the Magnitude of the problem is high. Just because of the silent nature of the problem, we are not doing enough to control AMR. One in 3 seconds will die because pathogens would not respond to existing antibiotics by 2050 which will be much more than the COVID deaths.  Not just lives, it will also leave a drastic economic impact on us.

Dr Prejit: As of today, more than 3 billion have succumbed due to covid-19 while this number can be tripled i.e. 10 million by 2050 when it comes to the case of a silent pandemic such as AMR if we continue to use antibiotics in the same way as we do now. The animal requires a healthy diet, great living and minimal suffering.

Another problem is not practising withdrawal period in the food industry, i.e. the minimum period of time from administering the last dose of Antibiotics and the production of meat or other animal-derived products. Antibiotics or their metabolites become deposited in animal tissue and once human consumes it, apart from AMR they might get hypersensitivity reactions and other complications.

Dr Sangeeta: AMR is a multistakeholder and multidimensional problem and one department or authority can’t be the only stakeholder for this issue. Doctors are important stakeholder while other sectors like patient factors, regulatory, promotional -manufacturing and pharmaceutical, healthcare system-related factors are equally important. Patient demand quick recovery to continue their work and earnings and all of this lead to misuse/overuse of Antibiotics. The use of antibiotics is the key driver, we have started using antibiotics for small cuts and injuries which do not warrant antibiotics. This misuse/overuse causes resistance. Regulations exist but effective enforcement is needed along with coordination between various departments.

Dr Prejit: In 2017, the Union Ministry of Health outlined a National Action Plan to combat AMR which is aligned with Global Action Plan. It outlines priorities and interventions by considering harmonised approach across the various sector. The biggest impact of the plan in India is banning the use of colistin in food animals which is the last resort Antibiotic in Human medicine. The main stakeholders include Central Drug Standard Control Organisation (CDSCO) which is the apex body for drug regulation, FSSAI, line departments such as DADF etc. The Drugs and Cosmetics Act, 1940 details that certain drugs should not be available over the counter and not be sold without the prescription of a registered medical or veterinary practitioner. Finally, there are international bodies like FAO, WHO and OIE who provide leadership roles to regulate the use of antibiotics.

Dr Sangeeta: Antibiotics are precious drugs that need to be preserved and we need to look for alternatives for them rather than using them in a non-sustainable way.

Dr Prejit: We need to conserve the use of Antibiotics for saving the life of man and animals as no new class of antibiotics were discovered since the late 1980s. A sustainable food production system should have stringent policies and phase out of the use of growth promoters. Such a food system must concentrate on Good animal husbandry practices such as Farm biosecurity measures, hygiene, adopting certain guidelines based on the diseases, judicious prescription of drugs like using narrow-spectrum drug first, right diagnosis of treating the right disease and vaccinations. The future farmers can market their product as "Antibiotic-free" or " raised without the routine use of antibiotics" which adds more value to their produce.

The discovery of antibiotics and their immense capabilities to combat and destroy bacteria and treat infection was one of the most significant advancements in human history. Even in the presence of this high efficacy of medicines’ great discoveries, we are threatening the folds of past work done in the health industry and mortally jeopardizing people's health. Our major treatments like surgeries, organ transplants, cancer therapy, maternal surgeries, and more are due to antibiotics and will be reversed due to misuse/overuse of antibiotics in the farming industry. Superbugs/AMR can make medicines less effective and put health systems under extreme pressure during pandemics.

By decreasing the demand for animal protein foods, we can, in turn, reduce the reliance on farmed animals and higher welfare production systems- with more space, fewer antibiotics, healthier growth and more natural environments- more feasible. We can transform our food systems to be more sustainable and kinder to animals, and significantly improve the overall health of animals and humans.