The indiscriminate usage of antibiotics to treat COVID-19 patients is likely to make antimicrobial resistance (AMR) the next big public health crisis in India and globally, said experts on 29 July.

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The World Health Organisation identifies AMR as one of the significant threats to global health and estimates that it will contribute to 10 million deaths by 2050. Calling for harmonised action on AMR, a group of researchers, led by Professor N K Ganguly, former Director-General of Indian Council of Medical Research (ICMR), have on 29 July released a white paper. A recent study led by researchers at the Barnes-Jewish Hospital in Missouri, US, showed that a total of 16.29 billion doses of antibiotics were sold in India in 2020. Adult dose usage increased from 72.6 per cent in 2018 and 72.5 per cent in 2019 to 76.8 per cent in 2020. The study, published in the journal PLOS Medicine, indicated that almost everybody who was diagnosed with COVID-19 received an antibiotic in India.

"AMR is a bigger threat than COVID-19, we need harmonised on-ground action on human, animal, and environmental fronts to prevent its escalation into a public health emergency. India and many low and middle-income countries are already seeing a surge in drug resistance, even in common infections. I worry that due to COVID-19, the AMR situation has worsened. We need collective and immediate actions to curtail the aftermath," said lead author Professor Nirmal Kumar Ganguly, in a statement. Besides direct intake of antibiotics, the drugs are also used indiscriminately in the animal husbandry and livestock industry. This allows for the spread of AMR as drug-resistant bacteria find their way into the food chain.

Another often ignored reason for the spread of AMR is the discharge of untreated effluents by pharmaceutical manufacturing units and hospital wastewater. It degrades the environment and affects animal and human health by increasing AMR, the experts said. "To understand the emergence and mitigation of drug-resistant hotspots, we need better surveillance. Surveillance data in India is very limited. The effective antimicrobial agents are rapidly diminishing from the quiver of the available standard of care treatment options. This is a major concern," Professor V Samuel Raj, Director of the Centre for Drug Design Discovery and Development and Dean Academic Affairs, SRM University, Sonipat. The White paper recommends the need to bring about behavioural change to limit the overuse of antibiotics in humans and misuse of antibiotics in the agriculture and livestock industry.

It called for the development of mechanisms and standards for harmonised surveillance of AMR in animal, human and environmental ecosystems.