Low Cost Device for Rapid testing of Antibiotic Resistance developed in India by BITS professor & her student

Contributed by Akilesh. R and A.J. Tamhankar

A low Cost Device for Rapid testing of Antibiotic Resistance developed in India by BITS professor Dr. Suman Kapur and her student Anuradha P

World Health Organization (WHO) considers antibiotic resistance as one of the three greatest public health threats today. Ensuring availability of effective antibiotics is a highly prioritized area for low- and middle-income countries, where the infectious disease burden is high and access to healthcare is not easy and also not affordable for many.

Government of India, issues a notice on Irrational use of antibiotics in animal/livestock

Contributed by  Akilesh. R and Ashok J. Tamhankar 

Central Drugs Standard Control Organisation (CDSCO),  Government of India, issues a  notice on Irrational use of antibiotics in animal/livestock – A source of spread of antibiotic resistance in humans!

While antibiotic use and abuse in humans has been given due notice in recent times, the other potential source of spread of antibiotic resistance to humans is through animal products which has not been given due regard. Besides therapy antibiotics are used in animals particularly in poultry farming as growth promoters. The use in animals is also a precursor of antibiotic resistance; both through the animal food products as well as the faeces that go into the environment, as nearly 50 % of antibiotics given to animals are excreted within 24 hours.  While in many countries use of antibiotics is banned as growth promoters, it is not so in India. Government of India has now started to take action on this issue. Central Drugs Standard Control Organisation (CDSCO),  Government of India has issued notice in this regard to Drug controllers of all states and union territories in June 2014. The circular in this context generally says the following.

Report on Antibiotic Resistance Threats in the United States, (2013, CDC Report)

 

This report provides a unique look at the threats that are posed by antibiotic resistant bacteria to public health. Though the report talks of US, essentially the same applies everywhere.  Similar things are happening in every society.

Every year, more than two million people are infected in the US with some bacterium that is resistant to antibiotics, and more than 20,000 people die every year due to such infections. Many more Americans die every year from conditions that are complicated by an infection that is resistant to antibiotics. The condition in economically disadvantaged countries will be more disastrous.

Data indicates that most infections that are resistant to antibiotics occur in the general US community, but many deaths that have something to do with antibiotic resistance can occur in health care settings, including nursing homes and hospitals.

The report is a good reference for anyone who needs information about resistance to antibiotics. It is designed to be easy to access for many different audiences. It covers many types of bacteria that can cause severe infections in humans, and the antibiotics that are currently used to treat such infections. Also, Candida, which is a fungus that can cause serious illnesses, also is included because it is showing a higher resistance to drugs that are being used for treatment.

The introduction of the CDC report states that infections that are resistant to antibiotics can cause serious and avoidable costs to an overburdened health care system. In many cases, these infections require longer and more expensive treatments, longer hospital stays, more doctor visits and hospital visits, and the result is more death and disability when compared to infections that can be treated with antibiotics. The total cost to the economy of antibiotic resistance in the US has been hard to figure, but estimates are as high as $20 billion in extra health care costs, and $35 billion a year for additional costs to society in terms of lost productivity.

Antibiotic use is the most important reason that antibiotic resistance is increasing around the world. Antibiotics are some of the most frequently prescribed drugs that are used in human medicine. However, as much as 50% of all antibiotics that are prescribed are not needed, or are not as effective as they are prescribed to be.

Antibiotics also are often used in animal feed to prevent disease, and to promote growth of animals that produce food. Antibiotic use to promote growth is not needed, the CDC report states, and the practice should be stopped.

Another major reason for the growth of antibiotic resistance is the increase of resistant strains of many types of bacteria that are spread from one person to the other, or from sources that are non human in our environment, including food.

There are four actions that the report states will help to fight such deadly infections:

·  Stop infections and stop the spread of  resistance

·         Track bacteria that are resistant to antibiotics

·         Improve use of antibiotics in medicine

·         Promote the growth of new antibiotics, and develop new tests for resistant bacteria

The report states that while many bacterial resistance problems are serious, gram-negative pathogens are a serious problem. They are getting more resistant to all types of drugs that may be considered for treatment. The report notes that the most serious infections are associated with health care, and the most common ones are Enterobacteriaceae, pseudomonas aeruginosa, and acinetobacter.

Viewing this video may also be helpful

http://www.youtube.com/watch?feature=player_embedded&v=tQZnhjJnD5E

(Graphics courtesy  : http://onlinemphdegree.net/antibiotic-resistance/ )

"Hand Hygiene week- 2013"

(Contributed by Dr. Megha Sharma, R.D. Gardi Medical College, Ujjain, M.P. India)

WHO has recommended '5^th May' as 'Hand hygiene day' which is celebrated in many countries. The week before or after the Hand hygiene day is celebrated as 'Hand hygiene week'. The purpose is to remind the health care workers (HCWs) about the importance of possessing clean hands during patient care. This directly relates to the decrease in the health care associated infections (HAIs). HAIs are the infections that result in long term disability and longer duration of hospitalization and treatment with antibiotics. The hands of the HCWs are the major cause of spread of HAIs in any medical facility.

Acknowledging the importance of hand hygiene- "Hand Hygiene week- 2013" was celebrated in a tertiary care hospital in Central India from 29^th April 2013 to 05^th May 2013 under the collaborative research project (APRIAM). The institute, R.D. Gardi Medical College, Ujjain is hosting the research project (APRIAM) in collaboration with Karolinska Institutet, Stockholm, Sweden, since 2007. Dr. Cecilia Stalsby Lundborg (Prof, Global Health-IHCAR, Karolinska Institutet, Sweden), Dr. A.J. Tamhankar (National Coordinator, IIMAR, Prof, RD Gardi Medical College), Dr. Ragini Macaden (Prof, St. John's Research Institute, Bangalore) and Dr. V.K. Mahadik (Medical Director, RD Gardi Medical College) are the esteemed pioneers and mentors of the project APRIAM.

The project aims at improving antibiotic prescribing and maintaining hygiene in the study settings. The project coordinator and team leader (Hygiene team) Dr. Megha Sharma along with her team associates; Dr. Vishal Diwan, Dr. Anshu Jain, Amit Pawar, Dr. Love mehra, Dr. Devendra Parmar, Himanshu, Jeetendra Jat and Jaipal, developed and conducted the  "Hand Hygiene week- 2013" activities in the facility.

The objectives to conduct the activity were to sensitize the HCWs regarding importance of maintaining hand hygiene and to encourage the HCWs to maintain hand hygiene during patient care. All the activities were designed locally and were conducted in a joyful and interesting yet informative and purposeful manner.  

The celebration was inaugurated on 29^th April 2013 by Honorable Medical Director, Dr. V. K. Mahadik in presence of Dean Dr. J.K. Sharma, Medical Superintendent Dr. S. Sharma and other staff members.

For the active participation of the HCWs; competitions such as Poster competition: with theme "Use of alcohol based hand rub in prevention of healthcare associated infections", Slogan writing: with topic “Use of gloves in patient care” were planned. Crossword puzzles related to hand hygiene, use of antibiotics and importance of alcohol based hand rub were provided to assess the knowledge of the HCWs. Answers to the puzzle were displayed on the following day.

One of the most popular activities was- “Add colours to life: Keep your hands clean”. Colour full hand prints of all HCWs were printed on the white sheet. Soap and water was provided to wash hands. Single use paper napkins was provided to dry hands thus to convey the message of “Use single use napkin/ towel to dry up your hands”.

Live videos and slideshows were displayed, both in Hindi and English, on computer screen at the site. This activity was mainly to target the persons accompanying the patients and visitors. The videos mainly demonstrated “How to wash hands?” and the importance of hand washing and maintaining hygiene.

Demonstration and training sessions for the community- This activity was conducted for the persons accompanying the patients such as attainders and visitors present in the hospital. The team demonstrated the 6 steps of hand washing and the participants followed it. Soap, water and single use paper napkins were provided to the participants.

During the week, the team also visited district government hospital to conduct the activities. This was in relation to make the HCWs of the hospital, a part of the hand hygiene activities.

Feedback for the concept of the hand hygiene week was taken from the HCWs with the help of a locally developed feedback form.

Prize distribution-Prizes were distributed for various competitions. The WHO Surveillance officer, Indore region, Dr. Sudhir Soni was invited as chief guest for the occasion. Dean, Dr. J.K. Sharma and many respected senior staff of the institute were present for the occasion.

Overall more than 500 HCWs participated in various activities during the "Hand Hygiene Week 2013". The whole event was appreciated by the HCWs and the print media as well.

Government of India to crack whip on India`s pharma-doctor nexus

 The government of India is all set to crack the whip on India's shameful pharma-doctor nexus. The National Development Council (NDC), led by Prime Minister Manmohan Singh, will meet on December 27 to discuss bringing a legislation requiring drug companies to mandatorily disclose payments made to doctors for research, consulting, lectures, travel and entertainment. Doctors involved in ghost writing to promote pharma products will also be disqualified.

The official NDC document says, "Mandated disclosure by pharmaceutical companies of the expenditure incurred on drug promotion, and penalty on the company and vetting of drug related material in continuing medical education would be considered."

The Planning Commission says pharmaceutical marketing and aggressive promotion contributes to irrational use of drugs and therefore there is a need for a mandatory code to identify and penalize unethical promotion by pharma companies. The government will also make compulsory the use of generic names or the International Non-proprietary Name (INN), instead of brand names, at all stages of government procurement, distribution, prescription and use.

"Brand manufacturers will be encouraged to bid for government procurement, but should provide medicines in generic names," the document says.

Health minister Ghulam Nabi Azad recently said the ministry had received several complaints on this unholy pharma-doctor nexus.

According to the Medical Council of India (MCI), it received 702 such complaints in 2011-12 of which 343 were referred to state medical councils. In 2010-11, MCI received 824 such complaints following which it cancelled the registration of 10 doctors and warned four others.

Drug companies were recently caught red-handed writing scientific recommendations of their own products and submitting them to the Drug Controller General of India (DCGI) after getting them endorsed by top doctors for quicker marketing approval.

Usually, scientific recommendations are submitted by experts after they have studied a drug's content. The endorsement is considered a crucial testimony that convinces the DCGI to trust the drug's effectiveness, in turn, allowing it to be launched in the market.

Some of India's top medical experts — even heads of departments — from the country's most prestigious medical institutes such as PGI Chandigarh, CMC Vellore, AIIMS Delhi and St John's Medical College, Bangalore had signed recommendations for drug companies which may have been written by the companies themselves.

A recent study by the Planning Commission's high-level expert group (HLEG) said the pharmaceutical industry spent more than 25% of its annual turnover on sales promotion alone as compared to a paltry 7% on research and development in 2008-09.

India plans to soon introduce the 'Uniform Code of Pharmaceutical Marketing Practices' after which the word "safe" cannot be used on a drug without qualification and it must be stated categorically that a medicine has no side-effects, toxic hazards or risk of addiction.

The code says, "No gifts, pecuniary advantages or benefits in kind may be supplied, offered or promised to persons qualified to prescribe or supply by a pharmaceutical company. Gifts for the personal benefit of healthcare professionals (such as tickets to entertainment events) also are not be offered or provided. Companies must not organize meetings to coincide with sporting, entertainment or other leisure events. Venues that are renowned for their entertainment must not be used."

It adds, "Any hospitality offered to healthcare professionals must not be extended to spouses. Funding of healthcare professionals to compensate them for the time spent in attending the event is not permitted."

Planning Commission member Syeda Hameed recently took the example of the Food and Drugs Administration (FDA) of the US and how it has mandated strict regulations to curb unethical promotions.

These include mandated disclosure by pharmaceutical companies of the expenditure incurred on drug promotion, ghost writing in promotion of pharma products to attract disqualification of the author and penalty on the company and vetting by FDA of drug related material in CME.