Drug Resistant Typhoid Strains

In News

• Recent study of the bacteria Salmonella Typhi, published in The Lancet Microbe, has found emergence of drug-resistant typhoid strains.

Key Findings

• Typhoid fever causes 11 million infections and more than 100,000 deaths per year. 
  • Typhoid fever is a life-threatening systemic infection caused by the bacterium Salmonella enterica serovar Typhi (commonly known as Salmonella Typhi).
• Since 2000, multi-drug-resistant (MDR) S Typhi has declined steadily in Bangladesh and India, remained low in Nepal, and increased slightly in Pakistan. 
  • Strains were classified as MDR if they had genes giving resistance to antibiotics ampicillin, chloramphenicol, and trimethoprim/ sulfamethoxazole.
  • Now these are being replaced by strains resistant to other antibiotics. 
• Global spread from South Asia: 
  • South Asia accounts for 70% of the global disease burden.
  • The genome analysis also reveals that resistant strains – almost all originating in South Asia – have spread to other countries 197 times since 1990.
• New strains: 
  • In recent years, increase in resistant strains are seen that are threatening because of lack of effective antibiotics against this bacterium. 
  • There are strains for which there is only a single oral antibiotic remaining, termed XDR typhoid. 
  • Strains resistant to the antibiotic (azithromycin) have been seen in India, Bangladesh, Nepal and Pakistan. 
• Major emergence & Spread in India:
  • Evidence to date suggests that much of the drug-resistance in typhoid has evolved within India, so there are concerns about the appearance of drug resistance in the country.
  • Surveillance at 18 Indian sites during 2016-20 found typhoid was as common as it was two decades ago, especially in urban areas. 

Government of India’s efforts

• India’s Health Ministry is considering introducing new typhoid conjugate vaccines into the national immunisation program. 
• Two WHO-prequalified vaccines have been developed in India (by Bharat Biotech and Biological E). 

Antimicrobial Resistance (AMR)

• AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. 
• Factors Responsible: 
  • Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.
  • Lack of clean water and sanitation and inadequate infection prevention and control.
• Impact: As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.
• Global Threat: WHO has declared that AMR is one of the top 10 global public health threats facing humanity.

Image courtesy: AMR 

Factors Causing AMR in India

• Inappropriate consumption of broad-spectrum (last resort) antibiotics is high because of changing prescription practice in the healthcare system.
• Inappropriate antibiotic use among the general public like Self-medication to avoid the financial burden.
• The large proportion of sewage is disposed of untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms.

Challenges of AMR

• Antibiotic resistance is emerging as the threat to successful treatment of infectious diseases, organ transplantation, cancer chemotherapy and major surgeries.
• In addition to death and disability, prolonged illness results in longer hospital stay.
• The issue of AMR causes out of pocket expenditure on health care, especially on medicines. 
• The cost of AMR to the economy is significant. The use of high order drugs or second-line expensive antibiotics pushing treatment cost high.
• Neonates and elderly both are prone to infections and are vulnerable.

India’s Initiative on AMR

• To prevent the Over the counter sales of antibiotics, the central drug standard control organisation (CDSO) prohibits medical stores from selling 24 key antibiotics without a doctor’s prescription.
• India’s Red Line campaign which demands that prescription-only antibiotics be marked with a red line, to discourage the over-the-counter sale of antibiotics.
• National Health Policy, 2017, terms antimicrobial resistance as one of the key healthcare issues and prioritises the development of guidelines regarding antibiotic use and check on restricting the growth of antibiotics.
• The National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017 has assigned coordinated tasks to multiple government agencies involving health, education, environment, and livestock to change prescription practices and consumer behaviour and to scale up infection control and antimicrobial surveillance.
• FSSAI has set certain guidelines limiting the antibiotics in food products such as fish and honey.

Way Ahead

• Discovery of new drugs, before the emergence of resistance in germs; and prudent use of available antibiotics.
• Use the available antibiotics carefully to ensure their efficacy for as long as possible.
• AMR requires a united multisectoral approach –
  • Efforts to control prescription through provider incentives should be accompanied by efforts to educate consumers to reduce inappropriate demand, issue standard treatment guidelines.
  • Policy alignment is also needed much beyond the health system. 
  • Solutions in clinical medicine must be integrated with improved surveillance of AMR in agriculture, animal health and the environment.

Source: IE