Detection of antibiotics in hospital effluents in India

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

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.

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