Bacteria continue to do what they do best - adapt in order to survive. This has led to an increasing incidence of antimicrobial resistance (AMR). Acknowledging this as a global problem, and led by the WHO, most countries are devising national or regional strategies for the prudent use of antibiotics.
In September 2001, WHO launched the Global Strategy for Containment of Antimicrobial Resistance, 67 multi-level interventions. India, with its glaring lack of mechanisms for the monitoring of antibiotic prescribing and usage, can learn much from the experience of countries that have nationally customised data gathering and surveillance systems.
In 1996, the US set up the National Antimicrobial Resistance Monitoring System (NARMS). Under this, the Antimicrobial Resistance Research Unit in Georgia has developed the nation's largest database of resistant bacteria recovered from animals. Scandinavian countries have had surveillance systems and guidelines for use of antibiotics in human medicine for over 40 years.
In the 1990s most European countries launched nationwide monitoring of hospital infections, antibiotic prescribing and usage, and some have made the reporting of specific resistant microorganisms mandatory. Surveillance of antibiotic consumption in human medicine is performed in most at the hospital and community levels. To check over-prescribing of antibiotics, Greece implemented a restrictive reimbursement policy in 1996, with restrictions on prescription of newer antibiotics.
At the EU level, AMR has been monitored since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS), an international network of national surveillance systems for data collection on prescribing policies, usage and resistance levels in different countries. This data gathering is built on a bottom up approach, with information received from community and hospital-specific programmes. 22 EU countries have national programmes for hospital hygiene and infection control and in some countries computer-assisted drug prescribing has helped improve antibiotic use, reduce costs, and stabilise the emergence of antibiotic-resistant pathogens.
Antibiotics in human medicine are also used as growth promoters in animals, often causing resistance in consumers. In a dramatic move in January 2006, the EU banned the use of antibiotics as growth promoters in animal feed completely. Faced with growing concerns, even the McDonald's Corporation has issued a Global Policy on Antibiotics, which required its meat suppliers to phase-out these dual-use antibiotics by end-2004, a decision for which it was honoured by APUA.
Although the effects of AMR are better documented in industrialised countries, it is in the developing world that many second/ third line therapies for drug-resistant infections are either unavailable or unaffordable, and those easily available are over-prescribed and misused. Growing resistance levels are also leading to an increase in self-medication, a growing global trend.
According to a 2006 study on "Self Medication with Antimicrobial Drugs in Europe" published by the CDC, self-medication increases in countries with high levels of resistance and is fuelled by misleading advertising and inadequate information on OTC drugs. In 2000 France adopted measures concerning advertising and promoting, including the insertion of an information notice in all antimicrobial packages. In 2003 the US Food and Drug Administration (FDA) introduced new labelling guidelines for antibiotics, which require labelling by physicians to advise use only for bacterial infections and that too exactly as directed.
Aggressive marketing practices of pharmaceutical companies eager to recover high R&D costs, are adding to the problem. Direct consumer advertising and sales are made worse by the use of the Internet given the poor enforceability of legislation in cyberspace. Feeding a growing demand for antibiotic-based cures for lifestyle-related diseases, Japanese pharma companies have even set up a non-profit organisation called the Self Medication Advocacy Council!