Indian Initiative for Management of Antibiotic Resistance (IIMAR)

2012-01-29T11:17:00.007+05:30

Totally Drug Resistant TB in India

TB is already one of the world’s worst killers, up there with malaria and HIV/AIDS, accounting for 9.4 million cases and 1.7 million deaths in 2009, according to the WHO. At the best of times, TB treatment is difficult, requiring at least 6 months of pill combinations that have unpleasant side effects and must be taken long after the patient begins to feel well.

Tuberculosis is a bacterial disease, treated with antibiotics. As has been documented in other places, over time many kinds of bacteria develop resistance to antibiotics. TB bacteria have been especially adept at this. We’ve already seen multi-drug resistant TB, and extensively drug resistant TB. Totally drug resistant tuberculosis was the logical progression, and we’ve reached it.

At least 12 patients were reported infected with TB that has become resistant to all the drugs used against the disease, tech site Wired.com said. The discovery makes India the third country in which a completely drug-resistant form of the disease has emerged, following cases documented in Italy in 2007and Iran in 2009. Because of the mismatch between treatment and symptoms, people often don’t take their full course of drugs — and from that (and some other factors I’ll talk about in a minute) we get multi-drug resistant and extensively drug-resistant, MDR and XDR, TB. MDR is resistant to the first-choice drugs, requiring that patients instead be treated with a larger cocktail of “second-line” agents, which are less effective, have more side effects, and take much longer to effect a cure, sometimes 2 years or more. XDR is resistant to the three first-line drugs and several of the nine or so drugs usually recognized as being second choice.
As of last spring, according to the WHO, there were about 440,000 cases of MDR-TB per year, accounting for 150,000 deaths, and 25,000 cases of XDR. At the time, the WHO predicted there would be 2 million MDR or XDR cases in the word by 2012.

This awful news leaves us with a lot of what-do-we-do-next questions. How do we handle the people who have TDR TB? How do we keep it from spreading? Is this a sign we’re taking the wrong approach to fighting the disease? Here’s hoping we can find some kind of answers.

Since the 1960s, two drugs — isoniazid and rifampicin — have been the standard TB treatment. Although episodes of resistance cropped up periodically, during the 1990s the incidence of multiple drug resistance grew significantly, leading researchers in 2006 to refer to it as extensively drug-resistant tuberculosis (XDR-TB). Surveillance data from the WHO indicate that XDR-TB is present in at least in 58 countries, with an estimated 25,000 cases occurring each year.
Epidemiologist Carole Mitnick of Harvard Medical School in Boston, Massachusetts, agrees that TDR-TB is not new, and points to the history of XDR-TB. “When XDR-TB was first named, it was a phenomenon that had existed but hadn’t gotten much attention before. TB in general doesn’t receive a lot of attention,” she says.
As the full form of TDR-TB suggests, none of the known TB combination drugs work on the patient. All 12 showed resistance to 12 drugs. "The TB bacilli have obviously mutated. The emergence of TDR-TB has grave implications for public health," said Hinduja Hospital's Dr Zarir Udwadia, whose observations have been published in the latest issue of the US-based Clinical Infectious Diseases (CID) peer review journal. His team started isolating TDR-TB cases among patients with pulmonary TB in October 2011.
Dr Amita Athawale, who heads KEM Hospital's chest department, said TDR-TB was a reality in India. "The cases we clinically isolate are just the tip of the iceberg," she said. TB is one of the biggest killers in India, along with heart attack.

Controversy over TDR TB

Mumbai continues to paint a gory picture of extremely resistant tuberculosis (XDR-TB) TB with Bai Jerbai (BJ) Wadia hospital alone having identified at least 11 children infected with XDR-TB after testing 500 children infected with TB in the last three years.Amid the current controversy over TDR-TB, a term which is being rejected by state and government health agencies, Dr Shah told DNA, “We have diagnosed 11 patients with ‘partial XDR-TB’ which shows that the bacteria is mutating fast due to poor and partial treatment.”Dr PY Gaikwad, joint director, health (TB) at the state health department, said, “There is no term like partial XDR-TB. To say XDR, patient needs to have resistance to fluoroquinoline and aminoglycoside both. However, we need to know the details of such patients and also whether the testing lab is accredited. Otherwise, one cannot confirm that the patient has XDR-TB.” He further added that doctors must try to get details of the two missing children with XDR-TB so that the state and BMC can provide help.

2011-12-12T09:55:00.000+05:30

Department of Microbiology & Fermentation Technology, Sam Higginbottom Institute of Agriculture, Technology & Sciences, Allahabad is organizing the Second National Conference on “Antimicrobial Resistance : A Cause for Global Concern” from 6 - 8th February, 2012 at Allahabad. We invite all concerned to attend the conference. We wish the conference every success.

2011-11-22T09:46:00.000+05:30

The ClustrMap`s visits-meter reveals that Today this BLOG recorded 10,010th visit from interested readers.
Taking into account also the visits to the associate blogs, Indo-Asian Antibiotic Resistance Scenario and Global Antibiotic Resistance Scenario, the total visitor number comes to nearly 20,000.
The readers of the BLOG are spread over more than 25 states of India and are from more than 100 countries of the World.
We thank one and all for taking interest in the cause of reducing
the problem of Antibiotic Resistance.

2011-10-17T13:09:00.040+05:30

Fatal resistance

Antibiotic Resistance has spread 'widely and wildly' among the disease causing bacteria. Resistant bacteria are everywhere; in hospitals, in community, inside our body -on our body, in agriculture, in animals, in the environment surrounding us,..... everywhere. You think of a place and they are there. They make the use of antibiotics ineffective, when we take them, when we are ill.

"Down to Earth" magazine has brought out an issue with a cover story on "Antibiotic Resistance", which has contributions by Vibha Varshney, Dinsa Sachan and Sonal Matharu, who have talked to experts in this field, to bring into focus all aspects of this issue. Dinsa Sachan contacted me to elicit my views on the issue, which reflect in the cover story. We are thankful to her and the magazine for helping in spreading the awareness about the problem of the emerging threat of "Antibiotic resistance". - Dr. A.J. Tamhankar

The details of the article can be found at, http://www.downtoearth.org.in/content/fatal-resistance .

2011-10-07T12:35:00.001+05:30

Research partly funded by Indian Initiative for Management of Antibiotic Resistance (IIMAR) wins Best Poster award

Last year under the IIMAR-ReAct cooperation scheme IIMAR had awarded some research grants to students doing research projects in the field of Antibiotic Resistance for their post-graduation. Out of these, Ms Pragya Shakya, an MD student at R.D. Gardi Medical College, Ujjain recently presented a poster based on her research at the 1^st Global forum on Bacterial Infections in New delhi, for which she received the Best Poster award.

The title of presentation was ‘Antimicrobial resistance among commensal E.coli isolated from stool samples of school-going children in Ujjain, India’. Pragya found high resistance to penicillins, cephalosporins, tetracyclines and cotrimoxazole among the isolated commensal E.Coli. Strains resistant to penicillins and cephalosporins were also more likely to be resistant to fluoroquinolones. ESBL production (13%) among commensals indicated its spread in the community. The paper also concluded that frequent use of antimicrobials for self limiting illnesses in the community can be a factor responsible for development of resistance in bacteria.

Community level surveillance of commensal bacteria appears to be a pre-requisite for designing antimicrobial stewardship programmes.

IIMAR congratulates Pragya.

2011-10-02T22:54:00.000+05:30

1st Global Forum on Bacterial Infections in New Delhi,

October 3-5, 2011.

The 1st Global Forum on Bacterial Infections: Balancing Treatment Access and Antibiotic Resistance will focus on aspects of antibiotic access and resistance with particular relevance to low- and middle-income countries.
The meeting will bring together policymakers, clinicians, public health programme managers and research experts from a variety of disciplines and sectors to introduce and evalutate policy innovations designed to work in low-resouce countries.

2011-09-19T10:42:00.000+05:30

The Path of Least Resistance
The BBC radio recently broadcasted A 30 min long radio program on the ABR problem, with reflections of Dr David Livermore of HPA, Professor Otto Cars of ReAct, and Chief Medical Officer of UK Dame Sally Davies. The Audio of the radio program is available here.

2011-09-07T10:00:00.000+05:30

Why Subir Ghosh left a pharmaceutical company ??

Subir Ghosh spent the first three years of his professional career in sales and marketing of a pharmaceutical company. Then he left it and opted for other carriers……….WHY ???????

Subir Ghosh stumbled upon http://save-antibiotics.blogspot.com/ liked it and expressed his wish to join IIMAR.

When I realized that Subir Ghosh had worked with a pharmaceutical company once and because of his experience at the company, is deeply concerned about antibiotic use or really to say ANTIBIOTIC MISUSE, I requested him to contribute something for us. He suggested a piece from his site http://www.write2kill.in. We have edited it suitably to make it fit here.

We will welcome any other similar contributions.

While Subir tells us a story from his life, the same trend exists all over the world. And corrective measures are required all over the world, then and then only there is some salvation. Let us hope the stakeholders in this area become awake and do something remedial.

Over to SUBIR………

…………….When I was in XXXX pharmaceutical company in 1988, the compnay had just reintroduced its phenoxymethyl penicillin. A wonderful drug to start with. But the company would simply not meet the demand, because at that time it had already launched norfloxacin, and was on the verge of launching ciprofloxacin. And for other things there was always cephalexin (at that time).

Shortly after I landed in Agartala towards the end of 1988, some seemingly philosophical questions confronted me. ..…This was, after all, my first job and I intended to retain it. Come hell or high water. The issue of a philosophical dilemma was posed because I was a simpleton, and hadn’t still lost my innocence. There was reason for me to be upset over the question of what was right, and what wasn’t.

It was still early in one’s life to throw away ideals to the winds. So I started off as ethically as I would. Within weeks it dawned on me that I was living in a fool’s paradise. I was in Tripura as a medical representative, to sell drugs for a leading pharmaceutical company. Here you couldn’t meet your sales targets if you behaved like a gentleman. For, everyone else around wasn’t. A gentleman, I mean. From the doctors to the retailers, from the stockists to the company warlords. It didn’t matter how you sold your medicines, as long as you did.

After the first month (when I failed to meet my target), I decided to hard-sell. From the doctors to the retailers. I tried every trick in the trade. …… I didn’t give a damn, and neither did the doctors. My targets were the young docs there, of my age; they took to me well. I started doing relatively well for myself. My company’s products did well too. For me it was a job, it was a question of livelihood. Till one fine day……

That fine day was an early morning when the 1988-89 winter days were in their last throes. Morning OPD hours would always be chaotic. If I was there, the young docs knew it was fun hour.

Till I threw a poser at the boss of the lot. “You sure my products figure in your prescriptions”, I smiled with a glint. The friendliness may have been there in my smile, but not in the eyes. This particular boss and all his understudies were in my pocket. I had befriended them, then bought off their allegiance with my unending samples and overflowing gifts. And so this animal, proceeded to prove his loyalty. The patient he was examining was a young and pregnant tribal girl. Young, very young to be a mother. Still in her teens, I still am sure. The doctor scribbled the prescription and showed it off shamelessly. To yours truly. It took me a moment to realise what he was asking this girl to ingest over the next few days. It was norfloxacin, 2 tabs TID, for five days.

If you are not in the business of drugs, then you wouldn’t know what it meant. So, let me explain to you as briefly as I can.

That was the time when antibiotics were becoming drugs of the past, antibacterials were in. The first to hit the market big time was this antibacterial called norfloxacin. It was potent, and it was expensive. During those days my company sold it at Rs 8 per tab. Of course, over time prices dropped drastically as the demand skyrocketed. But then, coming back to the drug itself. This was reckoned to be a powerful drug for many reasons, one of them being the fact that its half-life was on the higher side. In other words, it would remain in the bloodstream longer. For this very reason you did not require too much of it, and not certainly so frequently as you had to swallow the earlier-day antibiotics. If the girl to whom this was prescribed followed the regimen, at the end of the course she would have little other than norfloxacin flowing in her blood. No, she wouldn’t have died. But this was something that, to me, was simply not done.

I looked at the girl again. She seemed resigned to fate. She stood there without uttering a word. All the monosyllabic speaking was done by the gnarled old man. Her father he was, obviously; one who too seemed resigned to fate. They were tribals. …. The girl’s pachra and risha (skirt and blouse, to us) were wearing out. A look at the two and you would know they did not live off more than Rs 10 a day. I looked at the girl, into her eyes. She was staring at the prescription, a semblance of hope in her eyes. Her gaze sapped something inside me.

No, this is just not done. The prescription is an overkill for a urinary tract infection (UTI), dangerous in fact. I was furious with the physician. The banter went to hell, and I made the man rewrite the prescription, making him drop my product and opt instead for a much mild antibiotic. The doc didn’t like it a wee bit; this after all I had made him do in front of his juniors. The bonhomie between me and the doctors ended then and there.

On my part, I made up my mind that whatever happens or doesn’t, I am not going to make a career out of selling medicines. Then on, I hated the pharmaceutical industry. It was ruthless, it was powerful. Without scruples. And it did the dirty job through callous medical representatives.

I did work as an MR for a short while again because I needed a job. But I couldn’t do as well as I had earlier. You can’t sell medicines if you play it straight. The pharmaceutical industry was rich and influential. The MBBS folks did not know so much about drugs as the B Pharms did. There was nothing called a level-playing field. And MRs would do anything to meet targets. You coaxed or armtwisted pharmacists. You cajoled or bought off doctors. …. the pharmaceutical industry was on a roll. If there were losers in this coldblooded game, it were the patients. The people. The people have no idea how much of gunieapigs they are being reduced to. Pharma companies actually control our lives more than you would believe ……... Reality is scarier.

2011-09-06T10:28:00.002+05:30

On behalf of and with encouragement from IIMAR, Mohini Adke, Assistant Professor, KTHM college, Nashik, Maharashtra, India, has started the cause - STOP- Antibiotic Resistance on `facebook`. Please join the cause here http://www.causes.com/causes/search?q=stop+antibiotic+resistance

Response to the article

2011-07-15T10:05:00.000+05:30

Anti-microbial resistance – Who is responsible? Lab or clinician?

Response by - Dr. R. D. Kulkarni

Professor & Head, Dept. of Microbiology, SDM College of Medical Sciences & Hospital, Dharwad - 580009 (Karnataka)

	Statements in the Article Response
1	My strong feeling is that we Microbiologists, especially those with MBBS, MD hold joint responsibility for this sorry state of affairs.	Yes agreed. They also should own the responsibility. The drug resistant strains develop in the community and are transported to the hospital where they concentrate. Use of antibiotics as a reflex without logic, at all levels including (and mainly) the peripheral, private health care setting are the factories of drug resistant pathogens. It is never taught in the medical colleges during the medicine lectures or clinics that not only the infections but the antibiotic also should be diagnosed. Choice of antibiotic is a logical and analytical process. But unfortunately most of the clinicians including the busy academicians learn about the antibiotics from the pharmaceutical houses. Microbiologists in the lab are certainly responsible but are not the culprits. The one, who write antibiotic prescriptions for material gains like foreign trips, plush cars, free conference registrations, pleasure trips under the banner of academics etc. are the once who have created the menace. The MD or MBBS microbiologists’ contribution is their ignorance and apathy to the problem. They consider that it is not their responsibility to act. They are satisfied only to preach, not practice.
2	Most Microbiologists are safely ensconced in their labs with no inkling of what is going on in the wards.	Yes, agreed.
3	A lot of importance is given to making an impeccable report that cannot be proved wrong by anybody.	Not true. Most microbiologists do not feel that it is important to take pains in preparing an impeccable report. The common assumption is that most clinicians do not understand and try to understand anything about the report and microbiology.
4	Gram-negative bacilli in two samples of blood is a dire emergency.	The problem of drug resistance can hardly be related to blood culture. This is an investigation performed only in the big hospitals of the metropolitan cities. Most tertiary care centers also do this investigation rarely. Forget PUO, blood culture is hardly ever ordered for diagnosis of typhoid fever. The biggest practice of medicine is in the community; and not in elite hospitals, where the drug resistant pathogens are generated. In the elite hospitals and academic institutes also protocols and policies are used cosmetically only as a façade.
5	Generally the report is given only after a thorough identification (this may be important in case of Stenotrophomonas maltophilia-very rare).	Yes it is important to provide the report after through identification.Stenotrophomonas maltophilia or Haemophilus or brucella or E. coliwill be identified only after through identification and the treatment varies as per the pathogen. All are Gram-negative bacilli from blood culture must not be subjected to direct sensitivity. This may be a useful option for neonatal septicemia or urinary tract infections. The important issue is that Gram-negative bacilli form other samples like endotracheal tube, catheter tips etc. are unnecessarily sent to the laboratory for culture and sensitivity. The ‘laboratories report and clinicians treat’ the contamination.
6	The patient is saved if a direct sensitivity is done and report given as GNB sensitive to –xxx antibiotics.	For therapy before identification and sensitivity report empirical antibiotics are there. Unfortunately our clinicians feel that we have only pipracillin (taxzobactam), Imipenem, meropenem as the empirical antibiotics. No one wants to follow the policy established at the center. A commercial and non-scientific term; ‘Higher Antibiotic’ is successfully established in the medical world by the people who have vested interest in the sale of antibiotics.
7	Another strategy is to phone up and suggest a drug for Gram neg sepsis to the clinician. It will also prevent misuse of high-end antibiotics. Clinicians are very happy to get a quick result from Microbiology and are incredulous when you phone the first time. They ask “But don’t you need 48 hrs to say that?”	Most clinicians consider it below dignity to take an opinion from a microbiologist or a pharmacologist. They however, are ready to catch a suggestion from a medical representative who is a BSc or even BA. What we need to implement is not just a judicious policy but a wise and sane attitude. Microbiologists feel that clinicians are callous and clinicians feel that microbiologists are not practical.

NB –

Most of the ideas employed in the usage of antibiotics are borrowed especially from America. We have certainly a very good pool of experienced thinkers. Let us not inflate the facts to scary levels. MRSA may be a frightening term in US but in India a lot of hospitals have reported isolations rates above 50%. However, there are hardly any reports of deaths because of MRSA in uncomplicated infections in this country. The same is the case for ESBL and AmpC producers.

Let us not be obsessed with the fear psychosis of intractable drug resistance. The only organism which is really posing a problem is acinetobacter especially in the neonatology units.

Let us understand the problem. Assess it on the basis of facts as we see them around us without being prejudiced by American viewpoint. A lot of effort is really essential for MDR and XDR tuberculosis which is addressed less emphatically compared to the other pathogens.

`Regulations to prevent Antibiotics Resistance & Promotion of Rational use of antibiotics`- Suggestions to Planning commission Constituted working Group

2011-07-11T10:39:00.000+05:30

Dear all

Is there anything you would like to see included in `Regulations to prevent Antibiotics Resistance & Promotion of Rational use of antibiotics`. Dr Mira shiva is a member of the Planning commission Constituted working Group on `Regulations on Drugs & Food`. She will make an endeavor to include these suggestions in the final document. Pl send your suggestions to antibio.resistance@gmail.com.

Dr.A.J.Tamhankar

Anti-microbial resistance – Who is responsible? Lab or clinician?

2011-07-09T16:18:00.002+05:30

Let us all Join together------

Several associations scattered all over India are working for spreading the knowledge about the problem of `Antimicrobial Resistance` (AMR) and making efforts to reduce the menace. IIMAR encourages all such efforts and wishes that we should all be together in solving the problem of AMR.

Towards this, we will make available space here for all these organizations to introduce themselves to others, so that several joint efforts can be launched.

Let us know today about the `Academy of Clinical Microbiologists` www.clinicalmicrobio.org .

A group of Microbiologists in Trivandrum , mainly working in the Govt. Medical College have formed `Academy of Clinical Microbiologists` to promote clinical microbiology which is totally neglected by microbiologists and generally discouraged by clinicians. The Group now has over 200 members all over India and a Triennial conference is held regularly, next one being due in October 2011, tentatively on 15th and 16th.

Dr. kavita Raja, Professor of Microbiology, SreeChitra Tirunal Instt. of Medical Sciences and Technology, Trivandrum, Kerala, informed about it. I requested her to also write about her ideas.

From my personal discussions with many I have generally found that many MBBS,MD clinicians do not have much interaction with the lab microbiologists and recommend the antibiotics from experience or then sometimes there are ego problems. Dr. Kavita Raja gives her opinion about this and many other things. We thank Dr Kavita for coming forward to give a write up. She suggests a a three-tier set-up in the labs with a doctor in charge of issuing reports that have a suggestion for treatment, a Medical microbiologist with PhD in charge of different sections in the lab and graduate technicians to carry out all the procedures.

Dr.A.J. Tamhankar

Anti-microbial resistance – Who is responsible? Lab or clinician?

Dr. KAVITA RAJA

India has a large pool of scientists, doctors and technicians working in Microbiology. Now they are either duplicating each other’s work or competing to get a higher status in the lab/Hospital. This has resulted in a total divide between the clinician with his patient and the lab with different categories of workers. The patient does not benefit from the millions invested in highly advanced tests. Test reports from Microbiology often reach after treatment has been decided or after discharge /death of the patient. The antibiotic sensitivity done in labs so meticulously, ends up in the wastebasket. A full course of empirical therapy that seeks to cover all bacteria, fungi and even sometimes viruses, not to mention protozoa leads to a rising resistance by all the microbes mentioned.

My strong feeling is that we Microbiologists, especially those with MBBS, MD hold joint responsibility for this sorry state of affairs. Most Microbiologists are safely ensconced in their labs with no inkling of what is going on in the wards. A lot of importance is given to making an impeccable report that cannot be proved wrong by anybody. Gram-negative bacilli in two samples of blood is a dire emergency. Generally the report is given only after a thorough identification (this may be important in case of Stenotrophomonas maltophilia-very rare). The patient is saved if a direct sensitivity is done and report given as GNB sensitive to –xxx antibiotics. Another strategy is to phone up and suggest a drug for Gram neg sepsis to the clinician. It will also prevent misuse of high-end antibiotics. Clinicians are very happy to get a quick result from Microbiology and are incredulous when you phone the first time. They ask “But don’t you need 48 hrs to say that?”

The present policy is that Microbiologists with MD and MSc PhD are clubbed together as “Microbiologist” and most doctors even do not know that there is a doctor in the lab. I have NO bias against the scientists in Microbiology, but my idea is that they have to be given an independent existence in a lab. They should deal with the quality control and general day-to-day management of the lab, while the doctor Microbiologist should form a link between the lab and the clinician - this is the CLINICAL MICROBIOLOGIST.

The Clinical Microbiologist should be an expert in use of antibiotics and Doctors with MD should be encouraged to undergo training under a practising clinical microbiologist for a year. The Clinical Microbiologist should conduct Ward rounds and help in prescribing antibiotics to culture positive cases. When he/she becomes confident and the clinicians start relying on her, even empirical antibiotic prescribing can be taken up.

This will control wanton use of antibiotics in hospitals, better quality in the lab due to the services of a PhD and cheaper, effective infection control. I am actually practising this in my hospital, which is a superspecialty one and those who follow my advice find that their patients, if infected have sensitive organisms only!!!!

I feel that all doctors working in Microbiology should join and work to promote clinical microbiology, which may be the answer to this AMR problem.

Why cant we in India also have a three-tier set-up in the labs with a doctor in charge of issuing reports with a suggestion for treatment, a Medical microbiologist with PhD in charge of different sections in the lab and graduate technicians to carry out all the procedures. The manpower is there, but totally disorganized. The whole system has to be revamped with the Govt. insisting that every lab in a referral hospital should have all three categories and that one cannot be substituted for the other. Each category should then be allotted different designations, like-

Consultant/ Professor – Doctor

Scientist/Senior scientific officer – PhD with MScMicrobiology/MScMLT

Technician/Senior Technologist – BScMLT/MscMLT

Technical assistant –DMLT

In the above hierarchy, technicians will also have much scope for further studies and promotion prospects commensurate with level of education. Scientists can be graded as A,B,C,D,E etc. on seniority or merit basis ,as is done in other Departments.

Another advantage here is that different doctors can be put in charge of different sections and they can hone their skills in each area. They are not bothered with the day-to-day management of the lab, like seeing if the coagulase test is being done with fresh plasma or whether the technician is counting the colonies in the Urine culture. They can concentrate on conveying the relevant information on treatment to the clinician and also follow-up on the patients

The scientists in their respective sections can ensure quality control and also engage themselves in developing new tests or improving the existing tests. They are not bothered by doctors asking for this or that result. They can take up training programmes, PhD guideships etc without compromising on the quality of reporting in the lab.

Technicians and Technical assistants will find that when they are two categories, they complement each other’s work.

A well-organised set-up like this only, can even think of tackling the AMR menace. The authorities will do well to understand the important role played by each category and support their activities in a proper manner, without clubbing all as “Lab people”. Without such a lab no amount of discussions, guidelines or propaganda about resistance will help in eradication MDR organisms. This problem is a highly technical one unlike the AIDS epidemic, which is a social one, so it has to be tackled by technical and scientific means.

2011-04-12T11:21:00.003+05:30

India declares its National Policy for containment of Antimicrobial Resistance (See text in the side column)

2011-04-08T03:03:00.015+05:30

Activities of `IIMAR` Members on `World Health Day on Antimicrobial Resistance`

KTHM science college, Nashik, Maharashtra

Mr. Sandip Nerkar, a Ph.D. scholar, along with Dr. Pethkar, Professor of Microbiology, arranged an awareness programme regarding `antimicrobial resistance` in KTHM science college, Nashik for students. In this programme along with explaining the problem of antimicrobial Resistance to the students, they were also motivated for a campaign to visit hospitals/clinics in the city and explain and handover the IIMAR brochures/leaflets on awareness about Antimicrobial resistance to physicians. The students visited at least 100 clinics/hospitals in the Nashik city in Maharashtra and the physicians were motivated to make rational use of antibiotics.

Pravara Institute of Medical Sciences,Loni, Maharashtra

The Centre for Social Medicine in collaboration with Departments of Community Medicine, Pharmacology and Microbiology of the Rural Medical College, celebrated the World Health Day 2011 from 2.30 pm to 4.30 pm on 7th April by organizing a Seminar on the Main theme: Combat Drug Resistance. Dr. Ashok Patil, Chief Executive Officer of PMT-PIMS inaugurated the Seminar and addressed the participants.
Dr. Deepak Phalke & Dr. (Mrs) S.S Avachat from Community Medicine, Ms. Namrata Tendulkar, an MBBS student, Dr. Sunil Devrukar from Microbiology and Dr. (Ms)Geeta Patil from Pharmacology Departments delivered lectures on the `WHO Theme of Antimicrobial Resistance` at the Seminar. Concluding remarks were delivered by Dr. Ravindra Kute of Indian Medical Association. The Seminar was attended by Female Health Workers, Women SHG members, General Practitioners, Pharmacists, general public and staff members.

`Centre for Public Health (CPH)` and SOCHARA, Bangalore, Karnataka

Dr. Ravi Narayan, `Community Health Advisor` to `Centre for Public Health (CPH)` and also `Equity Society for Community Health, Awareness, Research and Action (SOCHARA)` informs that as contribution to the World health day theme this year on Drug resistance, CPH and SOCHARA have released a document that arose as part of the proceedings of a National seminar entitled 'Role of Public Health professionals and the Community in the Control of Antibiotic Resistance'- Report of a panel discussion.`

KIIT University, Bhubaneswar, Orissa

An orientation programme on the ‘Rational Use of Antibiotics’ was held at School of Biotechnology, KIIT University on 7th April 2011 on the occasion of World Health Day. Mr Krushna Chandra Sahoo, a Ph.D. scholar, Dr Priyadarshi Soumyaranjan Sahu, School of Biotechnology, KIIT University and Dr Soumyakanta Sahoo, Super Religare Laboratories Limited, Kalinga hospital, Bhubaneswar, organized the programme. Dr. Mrutyunjay Suar, Director, School of Biotechnology, KIIT University presided over the programme. Prof B. C Das, Dean cum Principal, KIIMS was the chief guest of the programme. A rally was conducted involving the students of school of Biotechnology who visited different campuses under KIIT University.

R.D. Gardi Medical College, Ujjain, Madhya Pradesh

On the Occasion of World Health Day - R.D. Gardi Medical College, Ujjain organized Education cum Awareness programmes on rational use of antibiotics for general public and community members. The programmes were held in the Social Centres at Shajapur and at Rajgarh in Madhya Pradesh. Dr. Sherly T.D. and Dr. Mercy of R.D. Gardi Medical College Ujjain discussed and presented the importance of antibiotics for mankind and emphasized the rational use of antibiotic. The presentations were followed by question and answer sessions in which community members asked queries related to the use of antibiotics. Specially designed Pamphlets on Rational use of antibiotics in local language were also distributed to the participants. (Report by Dr. Vishal Diwan)

Sample of the Antimicrobial Resistance campaign brochure prepared by IIMAR. (cliking on the photograph enlarges the image, you can download and print it then. Some more brochures are also available and they can be supplied by us. Brochures in Tamil, Hindi, Marathi are also available.)

The World Health Day - April 7th 2011 - will focus on Antimicrobial Resistance.

2011-04-03T05:26:00.019+05:30

The World Health Day- April 7th 2011 will focus on Antimicrobial Resistance. I will suggest/request that please try to arrange various programmes on or around this day.

IIMAR has ready brochures for distribution to GENERAL PUBLIC, PHYSICIANS AND PHARMACISTS. We can release it to anybody who wants to use it for creating antimicrobial resistance awareness.

Some other Resources are mentioned below-
Brochure- http://www.who.int/world-health-day/2011/world-health-day2011-brochure.pdf
Toolkit- http://www.who.int/world-health-day/2011/WHD2011-toolkit-EN3.pdf
Fact-sheet -- http://www.who.int/world-health-day/2011/WHD201_FS_EN.pdf
Slide-show - http://www.who.int/entity/world-health-day/2011/WHD_AMR.pps

A special section on World Health Organization´s website has now been created -- http://www.who.int/world-health-day/2011/en/index.html for more information.

Many programmes are being arranged at various places in India. Some of them are mentioned below in brief.

The R.D. Gardi Medical College, Ujjain, Madhya Pradesh is arranging awareness programmes in Shajapur and Rajgarh districts of Madhya Pradesh.
The BJP doctor cell in Gujarat is arranging a medical camp and awareness programme at vadodara, Gujarat.
Centre for Social Medicine at Pravara Institute of Medical Sciences (PIMS - A Deemed University) at Loni in Maharashtra is organizing a Seminar on the WHO Theme on 7th April 2011 inviting General Practitioners, Pharmasists and village level health workers of Ahmednagar district at PIMS- Loni. The Faculty from Departments of Community Medicine, Microbilogy and Pharmacology of Rural Medical College, Loni will be the resource persons for the Seminar.
Doctors' College of Nursing, Pudukkottai, Tamilnadu informs that Due to the election in Tamilnadu, they cannot organise any public program on April 7th. They plan to organize a week-long camp on the theme of Antimicrobial resistance on following lines tentatively from 20th April.
1. Inaugural program - Intercollegiate meet for Students' awareness
2. Physician awareness campaign
3. Pharmacist awareness campaign
4. General Public awareness campaign
5. Community health awareness
6. Interschool competitions
7. Theater and drama among general public - Valedictory program
The SRIMUTHUKUMARAN MEDICAL COLLEGE HOSPITAL & RESEARCH INSTITUTE, CHENNAI is organising a seminar on `Antimicrobial Resistance` with a special address by Dr. Jawahar - a scientist from Indian Council of Medical Research.

Antibiotic use and Resistance in India

2011-01-09T13:38:00.004+05:30

For current situation about antibiotic use and resistance in India read December 2010 issue of Journal of Association of Physicians in India http://www.japi.org/antibiotic_special_dec_issue_2010/index.html

Global Handwashing day

2010-10-15T13:21:00.002+05:30

WASH YOUR HANDS
-After you come home from work and school
-After you come home from a visit to public and crowded places
-After visiting a toilet
-After holdong your hand against your mouth while coughing or sneezing
-After handling animals
-Before preparing or serving or eating food
-Before and after being with somebody who is ill

Coughing and sneezing

OTTO CARS wins 2010 APUA award.

2010-09-21T17:16:00.003+05:30

The Alliance for the Prudent Use of Antibiotics (APUA) has named Otto Cars, (on the right in the photograph) M.D., chairman of ReAct – Action on Antibiotic Resistance, based in Uppsala, Sweden, as recipient of its 2010 leadership award.“Otto Cars has provided outstanding leadership in the worldwide effort to contain antibiotic resistance,” said APUA President Stuart B. Levy. “His energetic commitment to fostering international political action on the global aspects and consequences of antibacterial resistance continues to make an important difference, and we are delighted to recognize his vital work.”

2010-09-03T13:59:00.005+05:30

International conference at Uppsala University, Sweden

``The Global Need for Effective Antibiotics - Moving towards Concerted Action``
You are welcome to watch here the webcast of the opening session on Monday, September 6th starting at 13.00 CET.
13:00 – 13:15:

Uppsala Choir School, Conductor: Gunnel Haulin
Introduction by Conference Moderator Niklas Ekdal
13:15 – 13:40:

Welcome Addresses
Anders Hallberg, President, Uppsala University
H.R.H. Victoria, Crown Princess of Sweden
Karin Johansson, State Secretary of Health, Sweden
Andreas Heddini, Executive Director, ReAct
13:40 – 14:10

Setting the Scene: The Global Picture of Antibiotic Resistance
Otto Cars, Professor, Chairman of ReAct, Sweden
Zulfiqar Bhutta, Professor and Department Chair, Aga Khan University, Pakistan
14:10 – 14:25

Reflections from a Global Perspective
Guénaël Rodier, Director, Division of Communicable Diseases, Health Security, & Environment, World Health Organization, Regional Office forEurope

IIMAR –ReAct : Agreement for cooperation on antimicrobial resistance management

2010-07-02T22:43:00.006+05:30

`Indian Initiative for Management for Antibiotic Resistance` – IIMAR -and `Action on Antibiotic Resistance`- ReAct (Sweden) have entered into an `Agreement for cooperation` to work together towards developing programmes for promotion of management of Antibiotic Resistance in particular in India and also at international level.

The activities will generally focus on

Antibiotic resistance awareness and management - Field activities
Antibiotic resistance awareness and management -Web based activities
Aid to post-graduate students in Indian Universities for projects on infections, resistant bacteria, resistance management and similar projects
To promote, network and cooperate with South Asian, South-East Asian and Asian Initiatives on antibiotic resistance management

While ReAct will put forward funds (about Rs 10 Lakhs) for this programme and will also make available its expertise, IIMAR will actively pursue the activities in India and the Asian region. ReAct has a vast experience in promoting management of Antibiotic Resistance at the national level in Sweden and is also internationally working towards achieving the goal.

All concerned are requested to please come forward to take part in this programme to conduct these activities at their home base. While you volunteer your time and efforts, IIMAR provides support and funds.

Contact: antibio.resistance@gmail.com

SAVE LIVES: Clean Your Hands

2010-05-08T03:19:00.001+05:30

SAVE LIVES: Clean Your Hands is part of a major global effort led by the World Health Organization (WHO), to support health-care workers to improve hand hygiene and thus stop the spread of life-threatening, health care-associated infection (HCAI)
The SAVE LIVES: Clean Your Hands annual initiative is part of a major global effort led by the World Health Organization (WHO) to support health-care workers to improve hand hygiene in health care and thus support the prevention of often life threatening HAI.
This initiative is part of the WHO Patient Safety First Global Patient Safety Challenge, ‘Clean Care is Safer Care’ programme aimed at reducing HAI worldwide, which was launched in October 2005. The clear and central feature of Clean Care is Safer Care thus far has been to target efforts on the importance of clean hands in health care. The programme has galvanised action at many levels including, as at November 2009, Ministers of Health from 121 countries having pledged commitment to reducing HAI and support the work of WHO. Thirty eight nations/sub-nations have also started hand hygiene campaigns during this time.
SAVE LIVES: Clean Your Hands was deemed a natural next phase of the Clean Care is Safer Care programme, moving the call to action from a country pledge of commitment to the point of patient care. The central core of SAVE LIVES: Clean Your Hands is that all health-care workers should clean their hands at the right time and in the right way.
SAVE LIVES: Clean Your Hands incorporates a global annual day to focus on the importance of improving hand hygiene in health care as well as WHO providing information and materials to support these efforts and sharing information on the activities of the many others who take action at local, national and regional level.
A suite of tools and materials have been created from a base of existing research and evidence and from rigorous testing as well as working closely with a range of experts in the field. The tools aim to help the translation into practice of a multimodal strategy for improving and sustaining hand hygiene in health care.

Second anniversary of the formation of IIMAR

2010-03-11T16:22:00.002+05:30

11th March 2010 happens to be the second anniversary of the formation of IIMAR. The IIMAR- INDIAN INITIATIVE FOR MANAGEMENT OF ANTIBIOTIC RESISTANCE was formed on 11th March 2008 during the IX Sir Dorabaji Tata Symposium on Antimicrobial Resistance held at the JRD Tata Auditorium, IISC, Bangalore. At the small meetings of like minded persons held on the evenings of 10th and 11th March, everybody felt that resistance to antibiotics is assuming significant proportions in India and something needs to be done about it and thus IIMAR came into existence. Amongst the initial coordinators, myself and Dr Mira Shiva continue while Dr Sujith Chandy could not continue due to personal preoccupations.
India is a country of continental proportions and the problem was how to continue the existence of the initiative without any infrastructure and funds. That's where, I thought of creating a `virtual existence`- `the existence on the Internet`- which was free and only required my perseverance, and intellectual labour. For this, the facility of a blog web space, created by Google came very handy. It helped IIMAR to be in touch with all the members and also with everybody concerned about the ABR problem all over the world.
After some preliminary work three interconnected blogs were created, which came into being during the months of May-June 2008. Although I am working single-handedly, I have tried to improve on the blog contents thereafter continuously. From time to time new features have been added, the most recent being the `Indo-Asian antibiotic resistance scenario` and the `Global antibiotic resistance scenario`.
People are generally not pro-active in nature, but I appeal to you all to come forward with any help that you can give in this regard in any form- funds, contribution to blog, running a particular feature –anything you like.
Sincerely yours
A.J. Tamhankar

Detection of antibiotics in hospital effluents in India

2010-01-18T18:18:00.001+05:30

Industrial production of antibiotics and their large scale availability is an important phenomenon of the 20th century. Easy availability of antibiotics made previously fatal diseases treatable and thereby contributed to improved health and well-being globally. However, the large scale use also had a potential to contaminate the environment, as after consumption, a considerable amount of antibiotics is not metabolized by the human body and excreted. These antibiotics ultimately enter the aquatic environment either as active compounds or metabolites. The likely adverse effects of these contaminants on aquatic ecosystem as well as the underlying public health implications are a very disturbing thought. Further, the effect of such a contamination on the development of bacterial resistance is also a matter of grave concern. Hospital effluent is an important contributory source of antibiotics to the environment. While information is available on antibiotic residue levels in hospital effluent from high-income countries, information on antibiotic residue levels in effluent from Indian hospitals is not available. This information gap is now no more.
A team of scientists from the R.D. Gardi Medical college, Ujjain, India (Vishal Diwan and A. J. Tamhankar) and from Karolinska Institute, Stockholm, Sweden ( Cecilia Stalsby Lundborg) have quantified the antibiotic residues in the effluents from two hospitals in the Ujjain district of Madhya Pradesh (with help from SIIR, Delhi). They found that antibiotics of all major groups are entering the aquatic environment through hospital effluent. They detected metronidazole, norfloxacin, sulphamethoxazole, ceftriaxone, ofloxacin, ciprofloxacin, levofloxacin and tinidazole in the range of 1.4–236.6 microgram/litre . The high concentration of fluoroquinolones in their results is a cause of special concern, as these can cause genetic modification of bacterial strains. The situation can become problematic in India because of resource constraints to treat wastewater for removal of antibiotic contaminants. More studies are needed in this area to bring out both – the problems and the solutions. (CURRENT SCIENCE, 97, NO. 12, 1752-1755; 25 DECEMBER 2009)

A Radio Talk by N.Ramesh - IIMAR`s Trichy coordinator on Antibiotic Resistance and IIMAR

2010-01-07T10:44:00.001+05:30

On 7th January 2009, All India Radio Tiruchirappalli broadcasted at 7.00 AM, a talk in Tamil by N.Ramesh- IIMAR`s Trichy coordinator- on the topic " Antibiotic Resistance and IIMAR"
N.Ramesh is a Doctoral Research Scholar at the Department of Microbiology, School of Life Sciences,Bharathidasan University, Tiruchirappalli.

2009-11-16T17:06:00.007+05:30

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.

2009-11-07T15:03:00.008+05:30

Joint EU - US task force to combat antimicrobial resistance
On Tuesday 3rd November, at the EU-US Summit, President-in-Office of the Council of the EU Fredrik Reinfeldt and US President Barack Obama decided to establish a `joint task force to combat antimicrobial resistance.`
The increase and spread of antimicrobial resistance is a rapidly growing global problem. Without access to effective antimicrobials, there is a risk that modern medical treatments such as operations, transplants, intensive care, cancer treatment and care of premature babies will become impossible or associated with major risks. Its impact in the form of human suffering and socioeconomic costs is probably even greater in developing countries and therefore various health organisations in India need to work towards getting this issue on the government agenda. Time magazine has also concurrently focused on this subject with an article A Looming Drug Crisis: The Dearth of New Antibiotics in which Professor Otto Cars, director of ReAct - Action on Antibiotic Resistance says that " We are facing a rapidly spreading pandemic and there is a desperate need for new antibiotics". The Indian media also needs to focus on this issue and spread awareness.

Video interview of Venki Ramakrishnan-This years Nobel Prize winner, whose work will help development of new antibiotics

2009-10-28T09:36:00.005+05:30

Nobel Prize 2009 given to Pioneering Work that will help in making of new antibiotics

2009-10-08T15:01:00.007+05:30

An India born Indian American, Dr. Venkatraman Ramakrishnan,

currently affiliated to MRC laboratory of Molecular biology, in

Cambridge, UK was awarded Nobel Prize for chemistry for his

work on ribosome’s that will help develop new antibiotics. He shares the prize with Dr. Thomas Steitz of Yale University, Connecticut, USA and Dr. Ada Yonath of Weizmann Institute of Science in Israel.

Ribosomes (from ribonucleic acid and "Greek: soma (meaning body)") are complexes of RNA and protein that are found in all cells with nuclei. To most people, ribosomes are tiny. Tens of thousands would fit on the sharpened tip of a pencil. But to scientists, ribosomes are huge. Each is a molecular machine. The ribosome is part of the mechanism that translates the DNA sequence into the protein sequence (proteins are translated from mRNA, mRNA is transcribed from DNA, so DNA is not 'translated' directly into protein). Ribosomes from bacteria, archaea and eukaryotes have significantly different structure and RNA. The differences between the bacterial and eukaryotic ribosomes are exploited by

pharmaceutical chemists to create antibiotics that can destroy a bacterial infection without harming the cells of the infected person. Due to the differences in their structures, the bacterial 70S ribosomes are vulnerable to the antibiotics while the eukaryotic 80S ribosomes are not.
The work of the Nobel Prize winning trio will advance the design of antibiotic drugs. Many of today's antibiotics work by sabotaging bacterial ribosomes. By comparing the overall structure and internal channels and caverns of bacterial ribosomes with those of higher organisms such as humans, researchers may be able to design compounds that clog the works of bacterial ribosomes but leave human ribosomes alone. This could lead to new antibiotics that are highly effective and have minimal side effects.

2009-09-09T11:44:00.057+05:30

A Highly successful Antibiotic Resistance Awareness Campaign at Tiruchirapalli, Tamil Nadu, India - A report by Dr. A. J. Tamhankar

An Antibiotic Resistance Awareness Campaign of the INDIAN INITIATIVE FOR MANAGEMENT OF ANTIBIOTIC RESISTANCE (IIMAR) was conducted at Tiruchirapalli- (also called `Trichy`) - in Tamil Nadu, in India on 25th August 2009. The programme consisted of explanation of the emerging problem of Antibiotic Resistance at a person to person level to eminent persons of Tiruchirapalli and also to the Physicians, Pharmacists and the general public in Trichy. This was accompanied by the distribution of Antibiotic Resiatance awareness brochures to all these people. The brochures addressed to the Physicians, Pharmacists and the public at large were different from each other. The programme started with the release of the brochures at the hands of Dr.M.Ponnavaikko, the Hon’ble Vice Chancellor of the Bharatidasan University (BDU). The inaugural function was attended by the Registrar of BDU, and also the faculty of the university. In the photograph we see (from right) Dr.N.Thajuddin -HOD, Dept of Microbiology, Dr.M.Ponnavaikko -the Vice Chancellor (releasing the first brochure to the Registrar), Mr. Nachimuthu Ramesh -Trichy Coordinator of IIMAR campaign, Dr.T.Ramasamy -Registrar of BDU and Dr.V.RajeshKannan and Dr. Dhanasekaran of the Dept of Microbiology. All these dignitaries joined IIMAR. The campaign at Trichy was organised in collaboration with two other organizations- the district unit of the Human Rights Organization and a local Social Organization "Sneham". Amongst the next two photos, in the first we see smt. S. Sujatha, Worshipful Mayor of Tiruchirappalli, and in the second, the commissioner of the Municipal corporation of Trichy, Mr. T.T. Balsamy, (extreme left in the next photo) being given the brochures and being

explained the problem of antibiotic resistance. Also present in the photo

are Trichy District Coordinator of Human Rights Organization and also of `Sneham` Social Organization, Mr.Paul Guna Loganath and Mr. N. Ramesh. After campaigning with the Mayor and the commissioner of the city, the campaign moved to the District collector`s office. The District Collector, Mr.T. Soundiah (in the centre of the next photograph) was explained the importance of the rational use of antibiotics and also how if we fail to use the antibiotics rationally, how our future generations will suffer. Mr. Soundiah assured his full cooperation to the campaign and joined IIMAR. At the collectorate with Mr. Soundaiah was also present the Dean of the Government Hospital Dr. C. Balasubramanian (seen in the photo along with Mr. soundiah), who offered his full cooperation to the campaign and Joined IIMAR. The full support of Dr. C. Balasubramanian was amply evident by his actions and here, in the photo on the left we can see the Public Relations Officer of the hospital exhibiting the brochures on the notice board. The IIMAR campaigners then distributed the brochures amongst the physicians of the hospital as well as the physicians of the Geethanjali medical centre and discussed the problem of antibiotic resistance with them.
The Pharmacists form an important link in the supply of antibiotics to the customers/patients and they need to be involved in any campaign on rational use of antibiotics. Several Pharmacists were contacted. The photo shows the campaigners explaining to the staff of VASAN Medicals -with the help of brochures specially made for pharmacists-, how the pharmacists can help in the rational use of antibiotics.
The legal fraternity is an influencial component of any community. The practicing lawyers (photo on the left) and also the sub-judge Mr. M. Gomathi Nayagam, Secretary, District Legal service Authority,Tiruchirappalli (seen in the photo on the right) were also contacted in the campaign and made aware of the spreading antibiotic resistance problem.

The campaign also had in its programme the distribution of the brochures to the public at large and also explaining to them the importance of rational use of antibiotics. In this effort, IIMAR was joined by The District Zonal Planning Officer, who personally came along with the campaigners to distribute the brochures. The brochures for the common man were made in the local language `Tamil`. The local populace showed a keen interest in understanding the problem.

The campaign coincided with the Global Antibiotic Resistance Partnership- GARP -India Inaugural meeting in New delhi In India.

(Note: Separate brochures for the Physicians, Pharmacists and the Public at large have been prepared by Dr. A. J. Tamhankar using material from several authentic sources.)

Mr N. Ramesh-Ph.D scholar at BDU, Trichy and IIMAR`s star campaigner at Trichy joins me to report further----

"Under the overall guidance of the National Coordinator of IIMAR- Dr.A. J.Tamhankar we planned to conduct the Antibiotic Resistance awareness programme in and around Trichy region. For that we prepared attractive multi-colour brochures with the direction of the National Coordinator-IIMAR and planned to distribute them to Common people, Physicians and Pharmacist using separate brochure for each of them. The local advisory committee consisted of Dr.V.RajeshKannan and Dr.N.Thajuddin. The Vice-chancellor was kind enough to give permission to the campaign and very aptly suggested to make the brochures for the common man in the local `Tamil` language. We distributed a total of 2500 brochures during the campaign day. All the higher authorities responded very nicely and suggested to conduct the campaign in municipal wards as well as in villages because this is the first time any`Antibiotic resistance awareness campaign` was being conducted in the area. They have promised to support such an effort. The doctors at the Geethanjaly medical centre asked us to conduct this programme in rural areas. The pharmacist also responded very well and they were asking that the `government must develop rules regarding the judicial use of antibiotics and do something with the prescription format also`. They suggested to-do the awareness programme on radio and Television.
And finally, we distributed the brochures to common people on Uraiyur four road, GH road, Thillai Nager, Collector off road, in and around Trichy bus stand and in and around university campus. Everybody`s response was very good; especially our university staff -they voluntarily took extra copies from us to distribute in their local area. Now, daily at least one or two of them tell me that `the brochures have given very good information which we did not know till now and now we realise what are all the problems that will come if we do not use antibiotics properly. "

Acknowledgement:
IIMAR expresses its sincere thanks to the members of the local advisory committee- Dr.V.Rajesh Kannan and Dr.N.Thajuddin of the Dept of Microbiology, Bharathidasan University who supported whole heartedly this awareness programme and saw to it that it became a great success. IIMAR also expresses thanks to the Vice Chancellor and Registrar of the BharatiDasan University for giving permission to conduct this programme under its auspices and also staff, scholars, and students of the university who cooperated in this effort. Last but not the least we wholeheartedly thank the local press for their cooperation and particularly the `Malaimalar` daily news paper for publishing reports of the event. And Off course thanks to all our well wishers and many annonymous supporters.

Antibiotic Resistance Management Initiative spreading across India

2009-08-22T15:49:00.008+05:30

Two events, one- where IIMAR is taking up its first public programme for spreading the message about Rational use of Antibiotics and the other in which IIMAR is an active participant, are taking place across the Indian nation during the week starting 24th August 2009.

GARP-India Meet on 24‐25 August, 2009
GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP (GARP) – A five Nation project by Resources for Future, USA, is holding `GARP‐India Inaugural meeting` at New Delhi on 24‐25 August, 2009 on the topic `Antibiotic Resistance in India: Current Status and Avenues for Policy Change'. The meeting will be chaired by Prof. N.K. Ganguly, Chairman of the GARP‐India National Working Group; Distinguished Biotechnology Fellow, Adviser, National Institute of Immunology and Adviser, Honorable Minister of Health and Family Welfare. Dr. A.J. Tamhankar, National Coordinator of IIMAR is participating in this meeting and will project the views of members of IIMAR. This meeting will help in evolving a road map for future activities on antibiotic resistance management.

IIMAR campaign on Rational use of Antibiotics starts at Trichy on 24th August 2009

While the GARP meet is being held in New Delhi in the Northern part of India, coinciding with this, during the week beginning 24th August 2009, in the Southern part of India at Trichy in Tamil Nadu, IIMAR is starting its campaign to spread awareness about rational use of Antibiotics.
At Trichy, the campaign will be conducted by Mr. Ramesh Nachimuthu, a young doctoral student of Bharatidasan University with able support by seniors of the microbiology department, his doctoral supervisors and his /friends and colleagues. The Vice-Chancellor of the University is giving full encouragement to this activity.
Dr. A. J. Tamhankar, National Coordinator-IIMAR has been coordinating this effort for quite sometime now and the campaign will now take place starting 24th August. During the campaign, brochures creating awareness about rational Use of antibiotics will be distributed to Physicians, pharmacists and the general public.
The distribution material is available with Dr. Tamhankar and all others who are interested in taking up this type of activity can contact him at antibio.resistance@gmail.com to obtain the material.

Director General, ICMR Dr. V. M. Katoch and his associates join IIMAR

2009-03-29T17:58:00.010+05:30

(Photos: Dr. Tamhankar explaining Dr. Katoch about IIMAR and Dr. Katoch signing to join IIMAR)

Dr. V. M. Katoch, Honourable Secretary to Govt. of India, Ministry of Health and Family Welfare- Department of Health Research and Director General, Indian Council of Medical Research (ICMR) joined `Indian Initiative for Management of Antibiotic Resistance (IIMAR)`. At the `National conference on Antimicrobial resistance` organised by AAI-DU at Allahabad, India, Dr. A.J. Tamhankar explained to Dr. Katoch about the formation of `Indian Initiative for Management of Antibiotic Resistance (IIMAR)` and requested him to join IIMAR, to which he readily agreed. Like us Dr. Katoch has a view that a comprehensive, integrated and all inclusive view needs to be taken in the management of diseases as

well as in the management of `antibiotic resistance`.
Along with him Senior Deputy Director General (SrDDG) Dr. K. Satyanarayana and Assistant Director General (ADG) Dr. Sadhana Srivastava (ICMR) and Dr. D. Chattopadhyaya, ADG, Directorate of Health Services, also joined IIMAR.
We are honoured by their gesture and welcome them amongst us.

Occurrence of antibiotics and antibiotic resistant bacteria in hospital associated waters of India

2009-02-01T13:03:00.001+05:30

See http://wewantantibiotics.blogspot.com

ABR marker in Bt Brinjal- Is it hazardous for ABR?

2009-01-04T17:36:00.003+05:30

Dear friends
Dr. Mira Shiva informs that
A company in India is developing genetically engineered Brinjal incorporating the Bacillus thuringiesis gene.
The Antibiotic Resistant Marker being used for Bt Brinjal is NEOMYCIN . Horizontal transfer of genes & Genetic pollution & other Public Health Concerns need to be addressed as Biosafety studies done by the Company are inadequate. The GEAC Meets on 14th Jan 09.
All of you need tocomment on this proposal in this space so that Dr. Mira Shiva takes it up at the appropriate forum.

.

JOIN the Indian Initiative for Management of Antibiotic Resistance -IIMAR

2008-05-07T15:53:00.003+05:30

join the initiative by sending email to antibio.resistance@gmail.com. Articles, links etc. are welcome at this email address, we will include them on this and allied web pages with full credit to the contributor.