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.

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

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

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.

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.