SEATTLE — In recent years, the world’s usage of antibiotics has skyrocketed. While they are certainly powerful tools that can help support our immune system, antibiotics are by no means the perfect solution to protecting our bodies from harmful bacteria or maximizing agricultural and livestock production.
In particular, the dramatic rise in sales of unapproved, unsafe antibiotics in India has led to serious concerns about increased drug-resistant bacteria. To suppress the further spread of antimicrobial resistance, the Indian government must emphasize regulating the use of antibiotics.
According to a recent study, India is the largest consumer of antibiotics for human health in the world, and the harms of this excessive use of antibiotics remain excruciatingly clear. Sixty thousand newborns die every year due to antibiotic-resistant infections. And the problem is only worsening.
The unregulated sale of fixed-dose combination (FDC) drugs, which put two microbial drugs into one pill, seriously endangers India’s battle with antimicrobial resistance. These FDCs have grown in popularity in recent years with a 38 percent increase in sales from 2007 to 2012.
One of the main concerns with FDCs lies in the overwhelming number of unapproved drugs in circulation. Out of the 118 FDCs available in India, an alarming 75 of them remain unapproved by India’s drug regulator, the Central Drugs Standard Control Organization. Despite the fact that selling unapproved medicines is illegal in India, pharmaceutical companies continue to sell huge volumes of FDCs that have yet to be evaluated for potential harm.
Another example of India’s misuse of antibiotics is the unreasonable use of third-generation antibiotics to treat infections. A staggering 62 percent of children hospitalized in India are on at least one type of third-generation antibiotic. National health guidelines dictate that the first line of treatment should involve drugs such as penicillin. This means that doctors should prescribe second- or third-generation drugs only after the primary round of antibiotics fails.
Resorting to third-generation antibiotics as the first treatment for infections only increases the likelihood of antimicrobial resistance, leading to the need for much stronger and more expensive drugs to fight off future infections. In 2014, India was found to have the highest proportion of third-generation-resistant E. coli out of the 51 countries studied.
Misuse and Resistance
The fear of the spread of “superbugs” is not unfounded, as drug-resistant infections are one of the most serious threats to human health. The more that bacteria are exposed to antibiotics, the faster they grow resistant. In fact, the WHO estimates that 10 million people a year will die around the world from drug-resistant bacteria by 2050.
Troublingly, researchers also found that India’s use of antibiotics in animal feed – a major contributor to increased antimicrobial resistance – will increase by 82 percent by 2030. This may be partially due to farmers’ lack of access to safer alternatives as well as how easy it is to purchase over-the-counter antibiotics, even if they are counterfeit or ineffective. While feeding animals antibiotics may offer short-term benefits, the long-term harm undoubtedly outweighs any increases in livestock production and value.
Farms in several Indian states witnessed the growth of drug-resistant bacteria not only in the farms themselves but also in the soil of the agricultural lands surrounding the farms. It was even found that certain portions of the Ganges River, one of the largest rivers in India, had levels of antibiotics resembling those that doctors try to have in patients’ bloodstreams.
Furthermore, researchers uncovered a frighteningly high rate of resistance in bacteria. All the E. coli samples were resistant to at least three classes of antibiotics, which is called multi-drug resistance. Likewise, 92 percent of the K. pneumoniae samples — which can lead to pneumonia, meningitis and urinary tract infections — exhibited multi-drug resistance.
Threat to Human Life
With many farms lacking appropriate health protocols, these resistant bacteria could jeopardize human life. The animals from the farms, fruit and vegetable produce and even contaminated bodies of water all serve as likely sources of bacterial infections, which can only be treated by a few specific medications. Hospitals will then be forced to spend more on expensive care, and people will stay sick longer than they would have from normal bacteria.
In addition to the health concerns from drug-resistant bacteria, India could be facing economic consequences for the high levels of antibiotics in their food and produce exports. The European Union may begin placing restrictions or even ban imports from the Indian seafood industry due to antibiotic residue found on several shipments of shrimp. Europe has held steady on their zero tolerance policy for antibiotics and has subsequently continued to increase sampling on imports. With nearly 18 percent of India’s seafood industry consisting of exports to Europe, any form of restrictions would be devastating to the national economy as well as local economies.
Simply removing antibiotics from livestock and agricultural production is not the answer, as antibiotics remain crucial to animal health and food safety. However, farmers should not continue using these drugs as an alternative to proper hygiene protocols or safety standards. There must be more research on cost-effective methods, such as cheaper animal vaccinations, that could replace antibiotics.
Controlling the use of antibiotics in food production must become a top priority for India’s government. Another major step that could be taken towards combating antibiotic misuse is banning the sale of unapproved FDCs and implementing further regulations on the industry. The benefits of such actions are truly worthwhile as it would reduce health care costs, improve economic productivity and avoid potential disasters from drug-resistant bacteria.
– Akhil Reddy