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Indian Journal of Medical Microbiology, Vol. 29, No. 2, April-June, 2011, pp. 91-92 Guest Editorial Antimicrobial resistance: No action today, no cure tomorrow A Sharma National Professional (Laboratory Surveillance), World Health Organisation Country office for India, Correspondence Address:A Sharma National Professional (Laboratory Surveillance), World Health Organisation Country office for India sharmaan@searo.who.int Date of Submission: 06-Apr-2011 Code Number: mb11025 PMID: 21654100 DOI: 10.4103/0255-0857.81774 The discovery and development of antimicrobials has been hailed as one of the most important advances in the history of modern medicine — reducing the suffering from disease and saving lives. However, these "miracle drugs" are losing their efficacy due to the emergence of antimicrobial resistance. Infections caused by multi-drug resistant organisms are associated not only with higher morbidity and mortality, but also with a prolonged and more expensive treatment as well. Multi-drug resistant organisms are also an epidemiological concern as they may spread locally, regionally or globally through individual contacts, poor sanitation, travel, or the food chain. Antimicrobial resistance is a serious problem that strikes at the core of infectious disease control and has the potential to halt, and possibly to even roll back, progress. Antimicrobial resistance and its global spread not only threatens the continued effectiveness of antimicrobials, but also risks jeopardising global health security. Hence, World Health Organisation (WHO) has declared antimicrobial resistance as the theme for the World Health Day, 2011. The multi-drug resistant superbugs pose a therapeutic challenge to the treating physicians. In addition, antimicrobial resistance is also becoming a problem in some pathogens, with grave effects on some national disease control programmes. Chloroquin resistance in the malarial parasite has forced changes in the treatment strategy, necessitating introduction of the more expensive artemisinin-based combinations. Multi-drug resistant tuberculosis threatens to undo major gains in TB control, with an estimated 100,000 cases emerging every year. In TB drug resistance - as with all anti-microbial drug resistance - the human and economic costs of drug-resistance control are much greater than the missed opportunities for prevention. Inappropriate prescribing and dispensing of anti-TB medicines (i.e., incorrect regimens, monotherapy, inadequate compliance with treatment regimens) is a major public health concern. Drug resistance to first-line anti-retroviral treatment (ART) regimens in HIV has led to higher direct and indirect health costs. Second-line ART drugs cost six times more than the first-line ART regimen in the national programme. The main drivers of the development of resistance are antimicrobial selection pressure and spread of resistant organisms. Use of a broad-spectrum antimicrobial to treat an infection not only impacts the specific pathogen causing the disease, but also kills populations of susceptible organisms that form a part of our normal flora. Indiscriminate antimicrobial use by physicians and the community, over-the-counter availability, and use of antimicrobials as growth promoters in agriculture and animal husbandry are a cause of concern. It is important to understand the dynamics of antimicrobial use and resistance. National and international policy decisions backed by political and social will are needed to provide a more accurate assessment of the problem and interrupt the unacceptable trends. The two main factors that drive the rise and spread of resistant organisms are overuse and misuse of antimicrobials, and the spread of resistant organisms between individuals, communities, and countries. Surveillance of antimicrobial resistance and use is an essential prerequisite to monitor the situation, for effective prevention and containment of antimicrobial resistance and rational antimicrobial use. The WHO has supported the Indian Network for Surveillance of Antimicrobial Resistance (INSAR) by providing a platform for representative Indian microbiology laboratories, in both public and private sectors, to share and monitor the trends of antimicrobial resistance in few organisms of public health importance. There is a need to strengthen the capacity of laboratories in the quality analysis of antimicrobial resistance by providing reliable data for use at the local level as well as for national guidelines. Microbiologists could play a key role in antimicrobial stewardship by standardising antimicrobial susceptibility testing and sharing their data and trends in antibiograms. The emerging multi-drug resistance and its global spread is a grim reminder that antimicrobial resistance and infection control are cross-cutting issues that can only be tackled effectively through a health system′s approach. Concerted action is needed at the local, national, and global level by all stakeholders, working in both human and animal health, to ensure the adequate treatment of patients today and the preservation of the life-saving power of antimicrobials for future generations. The World Health Day, 2011 provides an opportunity to launch sustainable action to contain resistance, to raise awareness and education, and to track and contain the spread of resistance with improved informatics, and clinical decision support by development and use of better diagnostics. WHO will provide technical support to all stakeholders to implement the policies and practices needed to prevent and counter the emergence of antimicrobial resistance. To avoid the spectre of a post-antibiotic era, this is the time for action. WHO is committed to support the government in tackling this challenging public health problem to safeguard the health of all. Copyright 2011 - Indian Journal of Medical Microbiology |
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