Researchers in Singapore discover safer and better alternative to triclosan

Contributed by: Siddarth David & Dr. Tamhankar
 

The researchers at the Institute of Bioengineering and Nanotechnology (IBN) in Singapore have made a break through discovery and found an alternative to triclosan. Triclosan an antibacterial compound is widely used in household cleaning products but recently, its application is increasingly being restricted due to concerns about its contribution to antibiotic resistance in bacteria. This required alternatives in order to continue the struggle against antibiotic resistance. 

The new substance consists of "imidazolium oligomer" can penetrate the cell wall of the bacteria and destroy them. In tests, the substance killed 99.7% of Escherichia coli in less than 30 seconds. It eradicated 99.9% of the bacteria Staphylococcus and Pseudomonas and Candida within two minutes. This compound is also safe for use in humans because it carries a positive charge that targets the more negatively charged bacteria, without destroying red blood cells. The imidazolium chains are in the form of a white powder, which forms a gel when mixed with alcohol. The researchers say it could be easily incorporated in sprays and hand gels used for hand washing in healthcare settings and at home.

This is a wonderful discovery, given the rising antibiotic resistance and the need for simple techniques such as hand washing which will reduce microbial infections and thereby the over use of antibiotics. While this compound is yet to be used in manufacturing soaps, hand-washing with regular soap is still very effective in reducing infections and should be followed rigorously at hospitals and homes.

Mismanagement in Poultry Farms a threat for antibiotic resistance in India

Contributed by: Siddarth D & Dr. Tamhankar

A recent report, has shown that antibiotics are being indiscriminately used in some of India's poultry farms that supply to commercial outlets like Suguna Chicken, McDonalds and KFC in the country. The report uncovered that in the state of Telangana, poultry framers were using antibiotics on chickens without any set instructions. Interviews with farmers indicated that antibiotics, permitted only for veterinary use in India, were often viewed as vitamins and supplements by the farm owners and given to chickens. Poultry farmers were using levofloxacin, ciprofloxacin and gentamicin as regular medicines for the poultry without being aware of the consequences of using them. 

This alarming finding, reinforces the findings of study conducted by the Centre for Science and Education (CSE), New Delhi which found that nearly 40 per cent of poultry being sold in Delhi had high levels of antibiotics like ciprofloxacin.  S.K. Dutta, assistant commissioner of the department of animal husbandry in the Ministry of Agriculture and Farmers Welfare reacted to the report by saying that antibiotic use in animals was a critical area that has yet to be dealt with by policy, leaving many farmers to use them without prescriptions from their chemists. He stated that new measures would be introduced to address this problem.

Without clear policy guidelines in the country, India has yet to regulate the use of antibiotics in animals, which therefore remains unchecked and under studied. This report should be a waking call for health policy makers and experts that while there has been considerable work done on controlling antibiotic use in humans, neglecting use in animals can be serious obstacle in the battle against antibiotic resistance.

 

Basics can slow antibiotic resistance more effectively

Contributed by: Siddarth David & Dr. Tamhankar

The latest report from the Review of Antimicrobial Resistance a two-year effort created by Prime Minister David Cameron, supported by the Wellcome Trust to examine solutions to the rise of resistance, have highlighted that basic hygiene and improved sanitation can be a very effective tool in the process. It has indicated how the lack of clean water and sanitation both create diseases that demand antibiotic use, and also spread antibiotic-resistant bacteria.

The report highlighted that in just four emerging economies (India, Indonesia, Nigeria and Brazil), 494 million cases of diarrhoea each year are treated with antibiotics, a number that could rise to 622 million cases by 2030. If infrastructure were improved, 60 percent of those courses of antibiotics could be foregone. The report says that contaminated water also allows bacteria to cycle between humans and the environment, spinning up the dissemination of resistance genes. 

The Review also found that persistent neglect of simple tasks such as washing hands is fuelling the spread of resistance. As few as 30 to 40 % of hospital staff wash their hands as often as they should and interestingly doctors perform poorer than nurses or staff who are lower in the hierarchy. 

This shows that addressing the issue of antibiotic resistance is a multi-pronged approach and neglecting basic public health issues like clean water, safe sanitation and hygiene practice can play major role in reducing antibiotic use and therefore resistance. We need India need to also deal with the these public health issues in the efforts to curb antibiotic resistance.

 

Antibiotic Resistance in children increasing across the globe: UK Study

Contributed by: Siddarth David & Dr. Tamhankar

A study published in the British Journal of Medicine (BMJ) showed that antibiotic resistance among children is rising.  A team of UK researchers from University of Bristol and Imperial College London set out to review studies investigating the prevalence of antibiotic resistance  in urinary tract infections caused by E. Coli, responsible for over 80% of all urinary tract infections (UTI) in children.  

The results show a high prevalence of resistance to some of the most commonly prescribed antibiotics for UTI in children. The study also found an association between previous exposure to antibiotics and subsequent resistance in the same child. The researchers also reviewed global studies on the topic and concluded that it was global phenomenon. If current trends persist, expert warn, it could lead to a serious situation in which relatively cheap and easy-to-administer oral antibiotics will no longer be of practical benefit to young UTI patients. 

This calls for a stronger approach to tackle the challenge of antibiotic resistance through stronger policies and regulations from the manufacturing to the prescribing to the consumption.

 

India and WHO host International Conference on Antimicrobial Resistance in New Delhi

Contributed by:  Dr. Tamhankar & Siddarth David

Last week in New Delhi the International Conference on Antimicrobial Resistance was held by the Ministry of Health and Family Welfare, India and the World Health Organization (WHO) Regional Office for South Asia. The conference aimed to highlight the health and economic problems created by excessive use of antibiotics and the measures taken to address them. 

The event  saw senior representatives from the Government of India, join health ministers from across the region, and representatives from industry and civil society to discuss important aspects of this global problem. The event re-iterated the need for all the countries in the region to adopt for national action plan to combat the problem. 

The health minister Mr. J P Nadda said that India is committed to combating Antimicrobial Resistance (AMR). However, a collective action is required by all stakeholders within the country and also by all countries within the region. India, will be very happy to work with other Member States to achieve the common goal of AMR containment. He further stated that the complexity of AMR is also fuelled by numerous stakeholders impacting and impacted by AMR.

These include the consumers or the patients who take the medicine, doctors who prescribe, pharmacists who dispense, the industry which manufactures, the Government which regulates, the research organizations which innovate, the animal and agricultural sector which contribute to the food chain, the hospitals which treats the patients, the Civil Society which articulates the peoples’ perspectives, and the media which can focus attention on this important issue. Given this scenario, the Health Minister pointed out that it is imperative that all stakeholders connected with AMR contribute to pave the way for effective action to combat AMR. He also pointed out to the grave economic consequences that countries across the world are facing due to non-rational use of antibiotics. He emphasized on correct prescription practices, prescription audits and digital repository of patients’ medical history among other important measures to be taken to combat the growing misuse of antibiotics. He extended India’s commitment and resolve to work with other countries towards combatting this problem. 

Also present at the conference were, Mr. Tandin Wangchuk, Health Minister of Bhutan; Mr. Ram Janam Chaudhary, Health Minister of Nepal; Mr. Mohamed Habeeb, Minister of State for Health, Maldives; Dr. Poonam Khetrapal Singh, Regional Director, World Health Organization, South East Asia Region and Dr. Keiji Fukuda, Assistant Director General, World Health Organization. 

The Indian health minister also used the platform to launch the media campaign of 'Medicine strips with Red Line' that sought to help create mass awareness against misuse of antibiotics. This event was in keeping with the 68^th session of the World Health Assembly proceedings presided over by India in Geneva in May 2015 which adopted a Global Action Plan on antibiotic resistance . It planned to prepare a blueprint with specific actions and timelines for the WHO as well as member states to address the growing threat of resistance.In the coference, Dr. A.J. Tamhankar, national coordinator of Indian Initiative for Management of Antibiotic Resistance (IIMAR)  was invited to present his views on "Role and Perspectives of Civil Society in combating Antimicrobial Resistance".  IIMAR expressed the views that 

• Civil society and Governments or institutions (WHO) should have a Symbiotic Relationship.Civil groups should be used as Ears, Eyes and Extended appendages by institutions/Govt.- EEEs. Eyes and ears for getting information from society; Appendages for spreading useful messages.

• Healthcare worker`s organizations should be used extensively to create awareness. Scientists, microbologists, Healthcare Workers should be encouraged to form local civil Societies to spread AMR awareness.
•  Antibiotic residues and Antibiotic resistant bacteria in Environment,  Antibiotic use in Animals  (both therapeutic and growth promoters), and industrial effluents are a major threat and must be given due importance in policies on AMR containment. Current emphasis on Clinical and human AB/ABR monitoring and related interventions alone will NEVER solve the AMR problem. 
•  Following “Location Specific Integrated Antimicrobial Resistance management strategy ” (Tamhankar, 2008). And A “One Health approach” (For Role model -see 'Protocol paper on one health' -BMC public health, 2015) is the need of the hour.             
• (On behalf of Dr. Tamhankar, Dr. Ramesh  Nachimuthu, Joint Coordinator, IIMAR presented the views). 

The deliberations were conducted in the following 9 session:

1.  Antimicrobial Resistance: The Global Picture and follow up on WHA Resolution.   Chair : Dr Poonam Khetrapal Singh, Regional Director, WHO, SEARO,       Co Chair: Mr  B. P. Sharma, Secretary Health, MoHFW

2.  Rational use of antimicrobials, Chairs: Hon’ble Mr Ramjanam Chaudhary, Minister of Health, Ministry of Health, Co-Chair: Prof(Dr.) Jagdish Prasad, DGHS

3. AMR in health care setting: Infection prevention and Control, Chair: Dr Carmem Lúcia Pessoa-Silva, WHO HQ, Co-Chair:  Dr Rajesh Bhatia  

4. Policy/Strategy perspective for combating AMR: International experiences, Chair : Dr S. Venkatesh, Director, National Centre for Disease Control, New   Delhi, Co Chair: Professor Thet Khaing Win (Mr) Permanent Secretary, Ministry   of Health, Myanmar. 

5. Surveillance for AMR in humans, animals and the environment, Chairs : Prof. Dame Sally Davies, Chief Medical Officer, UK, Co-Chair: Dr Henk Bekedam, WHO Representative to India.

 6. Industry Perspectives: R &D on Combating AMR and Follow up on the Industry  Declaration on AMR, Chairs : SEAR Minister ( Bhutan) Co-Chair: Dr Sudanshu Pant, JS, Department of Pharmaceuticals, MoHFW

7. Role of Regulatory Authorities in combating AMR, Chair : Mr Pawan Aggarwal,  CEO, FSSAI, Co-Chair: Mr KL Sharma, JS (Drugs), MoH&FW

 8. Research and Innovation for Combating AMR, Chairs: Dr SoumyaSwaminthan, Secretary DHR and DG ICMR, Co- Chair: Prof. Vijay Raghavan, Secretary, DBT

9. Civil society Perspectives for Combating AMR( Panel Discussion) Chairs : Dr AK Panda, Addl Sec, MoHFW, Co-Chair: Dr Arun Thapa, DPM, SEARO