Antibiotic intake in India rises by 30% in a decade, says report
Antibiotic use in India has risen sharply, with about a 30% increase in their per capita use during the past decade, according to the State of the World’s Antibiotics 2021 report released on Wednesday, highlighting concerns over widespread and growing resistance to the drugs.
The percentage change in total use between 2010 and 2020 has also been about 48% (47.40%), says the report by Washington-based Center for Disease Dynamics, Economics & Policy (CDEEP).
A major concern is the vast increase in the use of antimicrobials in the animal health sector, both in India and globally. In India, the resistance rate against common antibiotics such as ampicillin among chicken has been as high as 69.7%. The resistance rate against anibiotic treatment for E.Coli and Salmonella has been 16.5%.
The estimated total use of antimicrobials in animals in 2020in Indiawas 2,160.02 tonnes, which is expected to reach 2,236.74 tonnes by 2030.
The enormous increase in the demand for animal protein has rapidly increased the use of antimicrobials in the animal health sector, where these drugs are used not only to treat and prevent infections, but also to promote rapid growth.
China and India represented the largest hotspots of resistance, with new ones emerging in Brazil and Kenya,” according to the report.
Research by CDDEP and collaborators found that in 2013, the global consumption of all antimicrobials in food animals was 131,109 tonnes, and projected to reach 200,235 tonnes by 2030.
“The main concern is that antibiotic consumption, particularly in the animal sector, is rising. This increases the risk of zoonotic infections that could cause epidemics in hospitals,” said Ramanan Laxminarayan, director of CDDEP.
Antimicrobial consumption in animals is nearly triple that of humans and is a primary driver of the scale-up in animal protein production. Since 2000, meat production has reached a plateau in high income countries but has grown by 64%, 53%, and 66% in Asia, Africa, and South America, respectively.
Antibiotics are the most commonly prescribed medicines in the world to treat bacterial infections. The use of these drugs has gone up sharply over the past decade or so in many countries, largely in low- and middle-income countries (LMICs).
According to the CDDEP report, global antibiotic consumption increased by 65% between 2000 and 2015, and the rate of antibiotic consumption increased by 39%, 32 from 11.3 to 15.7 defined daily doses (DDDs) per 1,000 people.
Resistance to first-line antimicrobial agents is rapidly emerging among the pathogens that cause HIV, malaria, and typhoid fever, threatening global progress in eliminating these infectious diseases.
“If you compare with another large country like China, it is using less antibiotics per capita than India. Consequences of antimicrobial resistance for a country like India will be more detrimental as prescribing second and third line antibiotics for India will be more expensive,” said Laxminarayan.
Specifically, resistance rates to ciprofloxacin, commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for E. Coli and from 4.1% 13 to 79.4% for K. pneumoniae in 33 and 34 countries, respectively.
In the United States, an estimated 2.8 million antibiotic-resistant infections each year contribute to more than 35,000 deaths.
In Canada, antibiotic resistance to first-line antimicrobials was 26%, and the number of deaths directly attributed to antimicrobial resistance was 5,400 in 2018.
Easy access to antibiotics in many LMICs in Africa and Asia is also leading to over or misuse of these drugs.
“Most patients coming to us from small towns have already been put on stronger antibiotics. We are very careful with our choice of antibiotics, but most of these patients are already resistant to first or second line of drugs,” said Dr Yatin Mehta, chairman of Institute of Critical Care & Anesthesiology at Medanta hospital.