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New Delhi: Even as medical experts warn against using antibiotics in animal feeds that trigger resistance to these critical drugs in humans, India is struggling without adequate data while several other nations frame relevant laws to check antibiotic abuse.

Low levels of these drugs that remain in the human body make bacteria resistant to them, leading to ineffective treatment when a person falls ill.

Two reports drew India’s focus towards antibiotic resistance this year. First, a report in Lancet Infectious Diseases in July found that India was the single largest consumer of antibiotics in the world in 2010, followed by China and the US. The report highlighted an increasing resistance to carbapenems and polymyxins, two classes of drugs long considered “last-resort" antibiotics for illnesses without any other known treatment.

The second report was released in July by the Centre for Science and Environment (CSE), an Indian non-governmental organization, based on high-performance liquid chromatography tests of chicken samples from the Delhi-National Capital Region (NCR), which found high levels of antibiotic residue.

The results, according to CSE, confirmed widespread misuse of antibiotics in farms and showed that farms did not stop feeding antibiotics even during the recommended withdrawal period before a bird is slaughtered.

But first, why do poultry and livestock farmers add antibiotics to animal feed?

In 1950, scientists in the US discovered that adding antibiotics to livestock feed accelerated animals’ growth and cost less than conventional feed supplements. This discovery pushed farmers around the world to use antibiotics as growth boosters. However, the problem started when farmers started using antibiotics used to fight microbial infections in humans to accelerate the growth of livestock.

“The quickest way for bacteria to become resistant to drugs is by exposing it to very small doses of drugs, which is why people are advised to always complete their course of medications," says Anurag Agrawal, involved in translational research for lung diseases in the Institute of Genomics and Integrative Biology at the Council of Scientific and Industrial Research. “Consuming these antibiotics through chicken would have the same effect as not completing the course."

With increasing awareness of the dangers of using antibiotics as growth promoters, the US and several European countries have designed policies to phase out or ban their use in the poultry industry.

The US publishes comprehensive data on the use of antibiotics in animals every year. In 2013, it framed a policy to curb antibiotic use in livestock and poultry. As recently as 18 September, President Barack Obama signed an executive order directing federal agencies to implement a new national strategy to check misuse of antibiotics.

In India, there is a complete lack of comprehensive data on antibiotics used for livestock and poultry and antimicrobial resistance.

In the CSE test, 40% of the 70 samples showed the presence of antibiotic residues. While 22.9% contained residues of one antibiotic, the remaining 17.1% samples had residues of more than one antibiotic.

Three classes of antibiotics found in chicken are important therapeutic drugs, crucial for treating bacterial infections and diseases in humans. Although an old class, tetracyclines are still used to treat mild infections. Fluoroquinolones are still very much in use and are the workhorse medicines for lung infections, throat inflections and even tuberculosis. Aminogylycoside is a third class of injectible antibiotics, which are very important for life-threatening whole-body infections such as sepsis.

In 1997, a World Health Organization (WHO) report had said that national policies on the use of antimicrobials in animals must balance the possible benefits to livestock production against the medical risk and public health consequences of their use. It further recommended that the use of any antimicrobial agent for growth promotion in animals should be terminated if it is used in human therapeutics.

“There is no regulatory provision in India to prevent use of antibiotics as growth promoters in poultry and livestock. Antibiotics are heavily used in poultry and can easily enter the human chain and the environment, making pathogens resistant to such antibiotics," says Randeep Guleria, professor of medicine at the All India Institute of Medical Sciences, and a member of the Union health ministry’s 2011 task force to frame the National Policy for Containment of Antimicrobial Resistance.

The policy recommended gathering data by undertaking studies on the use of antimicrobials as animal growth promoters, specifying antibiotics for use in livestock, developing regulations on usage of antimicrobials in poultry and other animals, as well as the requisite labelling requirements in food.

“Although many recommendations have been made to regulate the use of antibiotics in poultry, the implementation has to be multi-ministerial and has not happened till now. Over-the-counter drug antibiotic sales have to be completely stopped. All these require formal policy. It is a long-term commitment. There has to be a resistance policy at hospital level, community level, state level and then national level," Guleria added.

The 2011 policy gave extensive guidelines for the setting up of mechanism for surveillance of antimicrobial resistance (AMR), but not much progress has been made.

A 2011 report by the India working group of the Global Antibiotic Resistance Partnership had said that the highest priority needs to be given to national surveillance of antibiotic resistance and antibiotic use. “Again, data collection requires a multi-pronged strategy, aggressive strategy. ICMR (Indian Council of Medical Research) is doing some work in this direction; we are monitoring AMR at AIIMS, there are some other sentinel sites which are carrying out surveillance. But there is no comprehensive data collection till now," Guleria said.

A WHO report in April pointed to the urgent need for action in a world headed for a post-antibiotic era. The report eerily echoed warnings by the editors of The New England Journal of Medicine as far back as in 1966, when they had said that ignoring bacterial resistance would take the world back to the pre-antibiotic Middle Ages.

This is the second in a series on antibiotic resistance.

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