Indian Initiative for Management of Antimicrobial Resistance (IIMAR)

A report on the IIMAR participated INDEPTH-ReAct Antibiotic Resistance Workshop – Dr. A.J. Tamhankar
On October 30, 2009 a joint INDEPTH-ReAct workshop was held in Pune, India on the sidelines of the INDEPTH Annual General Meeting held from 26-29 October, in which the Indian Initiative for Management of Antibiotic Resistance-IIMAR also participated. The main agenda of the workshop was `Antibiotic Resistance-the serious global public health threat`. The meeting was attended by 33 participants representing the four continents of Asia, Africa, Australia and Europe, the participating countries being Australia, Bangladesh, Burkina Faso, Kenya, Ghana, India, Malaysia, Mozambique, Nepal, the Netherlands, Sweden, Tanzania, Thailand, Uganda and Vietnam.

INDEPTH is an international organization for the demographic evaluation of populations and their health in developing countries. It is a not-for-profit organisation that currently consists of 34 health and demographic surveillance system (HDSS) sites in 17 countries in Africa, Asia and Oceania.

ReAct-Action on Antibiotic Resistance, is a network that links a wide range of individuals, organisations and networks around the world -Europe, the US, Latin America and Asia- taking concerted action to respond to antibiotic resistance. ReAct has networking nodes around the globe.

During the deliberations of the workshop presentations were made from 14 INDEPTH sites and 5 non-INDEPTH sites including the Indian Initiative for Management of Antibiotic Resistance (IIMAR).The participants found that the situation varies among regions, countries and settings. However from the commonalities observed during the meeting, the workshop participants agreed on the following joint statement:

• Bacterial resistance to antibiotics is a serious global public health threat that must be urgently addressed by the World Health Organization, International organizations and national governments.
• The use of antibiotics is widespread and often uncontrolled –these drugs are freely available from street vendors, pharmacies, unqualified prescribers.
• Antibiotics are commonly used for diseases where they have no effect such as common colds.
• Implementation of guidelines and national policies, if available, are weak.
• Because of the lack of rapid point of care diagnostic tests, as well as poorly developed basic laboratory capacity, antibiotic use is presumptive, without any knowledge of the cause of the infection or the susceptibility of the pathogen.
• ­Data on bacterial resistance are scanty but show in many cases worrying increasing trends of several infections becoming unresponsive to first line antibiotics. There are also examples of neonatal infections caused by bacteria resistant to all available antibiotics except the old and toxic drug colistin.
• Resistance levels in bacteria vary both between and within countries. To support the development of treatment guidelines and recommendations, bacterial resistance needs to be taken into account and surveillance of regional resistance patterns are needed at regular intervals.
• The lack of data on resistance levels and antibiotic use is particularly lacking from low income countries.
• There is an urgent need to document on the global scale the magnitude of antibiotic use, population based studies on the prevalence of resistance and treatment failures, mortality and costs attributable to resistance. The INDEPTH network of Health and Demographic Surveillance System Sites (HDSS) is well suited to conduct such studies.