threat of superbugs

Younger than two and pumped with antibiotics – medicating children is spreading drug resistance

Unnecessary and incomplete antibiotic dosage creates drug-resistant bugs that we do not have the tools to battle.

Too many children are given antibiotics before the age of two years, adding to the problem of antibiotic resistance in country, a new study for the World Health Organisation has found.

The study conducted by an international team of medical researchers including doctors from Vellore’s Christian Medical College, followed children across eight countries, including India, from birth until they were two years old. More than 2,000 healthy children born between November 2009 to February 2012, including 251 children were enrolled in Vellore.

Incomplete treatment or unnecessary use of antibiotics makes pathogens resistant to the drugs used and therefore, the drug ineffective in treating the person infected with drug-resistant the bugs. “Since we have limited antibiotics, it is not a good thing to use antibiotics when it is not required,” said Dr Gagandeep Kang of Christian Medical College, who led the study in India.

India has a serous antibiotic resistance problem, which it has woken up late to and struggling to cope with. Alarms first went off in 2008 when a so called superbug was discovered to have originated in New Delhi and therefore named after the city. The New Delhi Metallo-beta-lactamase-1 enzyme conferred resistance in bacteria to a large number of drugs. Drug resistance has been spreading in India due to several factors – unregulated prescription and sale of antibiotics by doctors and pharmacies; factories manufacturing the drugs not treating effluents properly, letting antibiotics enter water and the environment; and even the use of antibiotics in poultry farms, thereby entering the food cycle.

In September 2016, a group of researchers found that nearly 60,000 newborn babies die from antibiotic resistant neonatal infections in India every year after contracting sepsis that is untreatable because the bacteria causing the infections is resistant to drugs.

The new WHO study, published in the Bulletin of the World Health Organisation this month, showed that a large number of children were given antibiotics to treat problems like diarrhoea and respiratory infections, even when antibiotic treatment was not needed. More than half the children had received antibiotics before they were six months old. The other study sites included Dhaka in Bangladesh, Fortaleza in Brazil, Bhaktapur in Nepal, Naushahro Feroze in Pakistan, Loreto in Peru, Venda in South Africa and Haydom in United Republic of Tanzania.

Antibiotics, even when not needed

The researchers conducted surveillance for antibiotic usage and checked the proportion of diarrhoea and respiratory illness episodes that were treated with antibiotics. As per international guidelines, the study states, antibiotics are recommended only for diarrhoea with bloody stools and for acute lower respiratory tract infections, but not for non-bloody diarrhoea and upper respiratory infections, like a simple cold and cough.

A sizeable proportion of children in the study were given antibiotics when it was not required. Of the 251 children who were followed by the Vellore researchers, 24.1% of the total number of 913 non-bloody diarrhoea episodes were treated with antibiotics. More than 45% of the 61 bloody diarrhoea episodes were treated with antibiotics.

A similar pattern followed even for the treatment for respiratory illnesses, often cold and cough. More than 23% of the 2,325 episodes of non-specific respiratory illnesses were treated with antibiotics. In case of acute respiratory illnesses, like pneumonia and bronchitis that affect the airways and lungs, 39.8% of the 913 episodes were treated with antibiotics.

The data indicates that many cases of acute respiratory tract infections and bloody diarrhoea were not treated with antibiotics.

Most childhood diarrhoea and respiratory illnesses caused by viruses and therefore antibiotics are ineffective, said Kang who led the Vellore arm of the study. “For cold, cough and fever, until we have some kind of evidence that the infection is bacterial, no antibiotics should be prescribed. In case the child becomes sicker or has pneumonia, you should use antibiotics.”

Kick to the gut

Often poor patients in India and other Asian countries seek medicines from pharmacies instead of prescriptions from doctors. “ While many doctors say that patients demand antibiotics, it is not true,” said Kang. “They demand treatment. The doctors tell them that they would provide strong medicines, which is totally inappropriate. Frequently children are given injectable antibiotics, which can lead to even more resistance.”

The use of antibiotics could also have some harmful developmental effects, research shows, like changing the healthy bacterial environment of the gut, or the gut microbiome.

Mostly, the ill-effects of excess use of antibiotics is not known yet. “The bacteria has various kind of functions in the gut, but we do not know yet how it affects gut function,” said Kang.

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As India turns 70, London School of Economics asks some provocative questions

Is India ready to become a global superpower?

Meaningful changes have always been driven by the right, but inconvenient questions. As India completes 70 years of its sovereign journey, we could do two things – celebrate, pay our token tributes and move on, or take the time to reflect and assess if our course needs correction. The ‘India @ 70: LSE India Summit’, the annual flagship summit of the LSE (London School of Economics) South Asia Centre, is posing some fundamental but complex questions that define our future direction as a nation. Through an honest debate – built on new research, applied knowledge and ground realities – with an eclectic mix of thought leaders and industry stalwarts, this summit hopes to create a thought-provoking discourse.

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Is it time to re-look at constitution and citizenship in India?

The Constitution of India is fundamental to the country’s identity as a democratic power. But notwithstanding its historical authority, is it perhaps time to examine its relevance? The Constitution was drafted at a time when independent India was still a young entity. So granting overwhelming powers to the government may have helped during the early years. But in the current times, they may prove to be more discriminatory than egalitarian. Our constitution borrowed laws from other countries and continues to retain them, while the origin countries have updated them since then. So, do we need a complete overhaul of the constitution? An expert panel led by Dr Mukulika Banerjee of LSE, including political and economic commentator S Gurumurthy, Madhav Khosla of Columbia University, Niraja Gopal Jayal of JNU, Chintan Chandrachud the author of the book Balanced Constitutionalism and sociologist, legal researcher and Director of Council for Social Development Kalpana Kannabiran will seek answers to this.

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Can India punch above its weight to be considered on par with other super-powers?

At 70, can India mobilize its strengths and galvanize into the role of a serious power player on the global stage? The question is related to the whole new perception of India as a dominant power in South Asia rather than as a Third World country, enabled by our foreign policies, defense strategies and a buoyant economy. The country’s status abroad is key in its emergence as a heavyweight but the foreign service officers’ cadre no longer draws top talent. Is India equipped right for its aspirations? The ‘India Abroad: From Third World to Regional Power’ panel will explore India’s foreign policy with Ashley Tellis, Meera Shankar (Former Foreign Secretary), Kanwal Sibal (Former Foreign Secretary), Jayant Prasad and Rakesh Sood.

Are we under-estimating how critical water is in India’s race ahead?

At no other time has water as a natural resource assumed such a big significance. Studies estimate that by 2025 the country will become ‘water–stressed’. While water has been the bone of contention between states and controlling access to water, a source for political power, has water security received the due attention in economic policies and development plans? Relevant to the central issue of water security is also the issue of ‘virtual water’. Virtual water corresponds to the water content (used) in goods and services, bulk of which is in food grains. Through food grain exports, India is a large virtual net exporter of water. In 2014-15, just through export of rice, India exported 10 trillion litres of virtual water. With India’s water security looking grim, are we making the right economic choices? Acclaimed author and academic from the Institute of Economic Growth, Delhi, Amita Bavisar will moderate the session ‘Does India need virtual water?’

Delve into this rich confluence of ideas and more at the ‘India @ 70: LSE India Summit’, presented by Apollo Tyres in association with the British Council and organized by Teamworks Arts during March 29-31, 2017 at the India Habitat Centre, New Delhi. To catch ‘India @ 70’ live online, register here.

At the venue, you could also visit the Partition Museum. Dedicated to the memory of one of the most conflict-ridden chapters in our country’s history, the museum will exhibit a unique archive of rare photographs, letters, press reports and audio recordings from The Partition Museum, Amritsar.

This article was produced by the Scroll marketing team on behalf of Teamwork Arts and not by the Scroll editorial team.