One of the first tweets that I have seen from the government rightfully focussed on antimicrobial resistance and creating an awareness about it in the form of a quiz. Since this is such an important topic, I am writing this article to put down some thoughts on AMR, causes and effective ways of dealing with it.
What is antimicrobial resistance (AMR)?
AMR happens when microbes of any kind (bacterial, viral or fungal) develop mechanisms that help them to evolve, thereby resisting the effects of the antimicrobial medicine used against them. That means they can't be easily destroyed and treating them in a patient becomes very hard or sometimes impossible, leading unfortunately to death!
Main cause of AMR?
Mainly overuse or misuse of antimicrobials by individuals for themselves, in farming and livestock rearing are all causes.
Another major cause is improper disposal of:
- Unused antimicrobials
- Water and waste segregation that does not focus on the leaching of medicines into the environment
Why is AMR a cause for concern?
From data in 2019, about 700,000 people die of infections caused due to resistant pathogens every year world over.
In addition to this, the pollution of our environment and water due to improper disposal of unused antimicrobials is also another big problem, leading to further AMR being developed by all kind of microbes leading to creation of 'superbugs'.
What corrective measures/awareness is required in an individual capacity?
- Antibiotics should only be consumed when absolutely required and prescribed by a doctor. They should also be taken in the right way, the right dosage and completion of a full course, as not doing this could also lead to AMR.
- Disposal of antimicrobial drugs - Please read more about the individual drug and manufacturer's recommendations. Some have take-back policies, some have collection sites to receive drugs back, mail-back programs, or recommended safe options to discard at home.
However, not all countries have these options and many governments do not require pharmaceutical companies to take responsibility for the proper disposal of unused/expired medicines.
Need of the hour?
Humankind now needs governments, with their policies in place and pharma companies, with their moral & ethical responsibility to step up and do the needful.
In India for example, The Municipal Solid Waste Management (MSWM) Rules, 2016 categorises expired drugs rightfully as 'domestic hazardous waste' and mandates that they be segregated, stored in separate bins and disposed in line with the Biomedical Waste Management Rules, 2016 that mandate that the drugs be incinerated at high temperatures.
Unfortunately, due to poor enforcement of the MSWM policies, there is poor management of hazardous waste, including unused/expired drugs & antimicrobials in the country. Waste segregation is an important area for the country where there is a lot of improvement, but policies have to be made clear and their implementation tight to bring everything together to fruition.
Shared responsibility:
This responsibility for safe discarding of medicines however cannot begin and end with governments alone. Pharmaceutical companies, wholesalers and distributers of medicines, hospitals and any other relevant industry partners should step up and this should be considered a legal responsibility. Very importantly, this properly defined method/flow of medicines will also prevent illegal secondary trade of controlled use medicines.
Other important government stakeholders like pollution control boards, drug regulation boards and other important groups in society are also going to play a vital role in proper implementation of responsibility on the ground! Transparent and well-defined policies and procedures will be vital if this is to be successful.
The above issues are true of many developed and most developing countries, and one would hope that the efforts of the G20 in unifying healthcare response also tastes success in implementing certain universal policies such as safe disposal of antimicrobials to safeguard our environment.
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