Ranjit Devraj
NEW DELHI, Aug 20 2010 (IPS) – Howls of protest from doctors and officials in India have followed the naming of the New Delhi Metallo-1 (NDM-1), a gene that can transform infectious bacteria into superbugs that are resistant to the most powerful antibiotics. But other experts hope that the furore on this issue may lead to a rethink on the widespread practice of using medicines indiscriminately.
A joint Indo-British study published in the Aug. 11 issue of the prestigious medical journal Lancet Infectious Diseases links the entry of the NDM-1 gene into Britain with patients who availed of treatment in Indian and Pakistani hospitals.
The protests from the union health ministry as well as representatives of India s medical tourism industry that attracts four million foreign patients a year and is estimated to be worth 3 billion dollars are primarily directed at the gene being named after the Indian capital.
While the title and the contents (of the Lancet article) broadly describe the antibiotics resistance profile of gram negative bacteria and its mechanism due to NDM-1 the conclusions are loaded with the inference that these (resistant genes) possibly originated in India and it may not be safe for UK patients to opt for surgery in India, a health ministry statement said.
Leading heart surgeon Naresh Trehan said labelling the bug NDM-1 was ridiculous because the Lancet team did not pick up the samples from New Delhi. Trehan, who is chairman of Medanta The Medicity, a 250 million dollar private medical facility in Gurgaon, just outside Delhi, called the study a part of a commercially motivated campaign aimed at the medical value travel industry.
The Lancet article has already prodded R.K. Srivastava, India s director- general of health services, into ordering a safety review of all central government hospitals as well as taking another look at the country s hospital infection control policies.
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Dr. Mira Shiva, a physician and founder of the People s Health Movement, who is an outspoken campaigner for the rational use of medical drugs said, Whatever the merit of the Lancet report the fact remains that there is a sore need to regulate the use of antibiotics in India. Let us hope this controversy will sensitise people to the close link between antibiotic misuse and drug- resistance.
Karthikeyan Kumarasamy, the first author of the British study, was quoted by The Times of India on Wednesday as saying: There is a lot of noise about the study, but everyone agrees that hospital bugs abound in India. The needless use of antibiotics has taught many bugs the art of survival.
Saying a uniform antibiotic policy was urgently needed, Kumarasamy added, Even if we start working on a new class of antibiotics now (to deal with NDM- 1 superbugs), it may take several years to deliver, but we can t shy away from the need to use drugs judiciously.
Kumarasamy and co-author Prof. Timothy Walsh of the department of infection, immunity and biochemistry at the School of Medicine, Cardiff University, reported isolating the NDM-1 gene which confers resistance to even carbapenems, the most powerful antibiotics that are used as a last resort in serious bacterial infections.
In their study of 37 specimens of NDM-1 isolated by laboratories in Britain, 17 came from people who had travelled to India in the past year. The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed, they recommended.
Because India does not have a registry of hospital-acquired infections it was not possible to accurately determine the threat level from NDM-1 in this country.
Indeed, it was only this month that India got round to passing the Clinical Establishments Bill to deal with a healthcare system ridden with corruption, unaccountability and unethical practices. The bill provides for a national register of all medical establishments and prescribes penalties for violation of standards and protocols, though these are yet to be set up.
But campaigners for rational drug use are sceptical about the bill and say it will have limited value in the surveillance and control of infection.
At the Delhi Society for the Promotion of Rational Use of Drugs (DSPRUD), Prof. Sangeeta Sharma believes that of prime concern is the common practice of antibiotics and other medicines being sold over-the-counter without proper prescriptions.
The result is that you have people using antibiotics for everything ranging from insect bites to septicaemia, with no thought given to the possibility of developing drug resistance either at the individual or community level, Prof. Sharma said.
Laws on prescription exist but are routinely ignored by patients or by pharmacists who see themselves as businessmen first. Already pharmaceutical companies are finding returns from new antibiotics diminishing because they become ineffective before the costs of developing them are recovered, she added.
Sharma said it is important for doctors to resist pressures to prescribe next- generation antibiotics for minor ailments like colds and diarrhoea and reserve them for emergencies.
Sharma, who has co-authored such DSPRUD publications as Essential Drugs Formulary and Standard Treatment Guidelines said it was important for doctors, patients, hospital administrations, agricultural users, drug manufacturers and retailers to pull together.
Infectious organisms adapt quickly to antibiotics and the more they are used the faster the bacteria become resistant a fact that must be kept constantly in mind by all the stakeholders, Sharma said. The Lancet article is a wake-up call.
