Kerala, recognized for its high doctor-patient ratio and remarkable literacy rate, has lately taken a pioneering move toward addressing antimicrobial resistance (AMR) with Operation AMRITH (Antimicrobial Resistance Intervention for Total Health). The program implements the original H1 rule, which was implemented by the Indian government in 2011, and forbids over-the-counter (OTC) antibiotic sales without a prescription.
AMR is a global concern because it happens when microorganisms, including bacteria, viruses, fungi, and parasites, change and no longer respond to antimicrobial medicines, making it more difficult to treat diseases. The abuse and overuse of antimicrobials, a lack of access to clean water and sanitation, ineffective infection prevention and control, and insufficient awareness all contribute to the emergence of AMR.
In India, doctors write about 50-70% of antibiotic prescriptions that are deemed unneeded and illogical. One main reason is a shortage of laboratory facilities capable of accurately diagnosing bacterial infections. Furthermore, patient demand for antibiotics, spurred by misunderstandings about their efficacy, adds to the problem.
While the H1 regulation was implemented in 2011 to govern antibiotic sales, its efficient implementation proved difficult due to the country's heterogeneous healthcare system. In 2013, changes were made to limit the OTC limitation to second- and third-line antibiotics, ensuring access to life-saving antibiotics in rural places.
Kerala's Operation AMRITH has reinstated the original H1 rule, which requires a doctor's prescription for any class of antibiotics. The state's high doctor-patient ratio and literacy rate aid in the efficient enforcement of this rule. However, the impact on drug-resistant illnesses may be delayed, with effects lasting several years. Nonetheless, the campaign is likely to foster an antibiotic-respecting society and spur additional anti-AMR efforts.
To effectively address AMR, a multifaceted approach is required. Aside from enforcing OTC regulations, efforts should be directed at improving physicians' prescribing practices and requiring hospitals to publish healthcare-associated infection rates. This information, ideally made public, promotes transparency and motivates steps to prevent hospital-acquired illnesses.
Improving public health infrastructure, sanitation facilities, and governance is critical to reducing illness transmission and antibiotic use. Additionally, rationalizing antibiotic usage in hospitals, limiting the growth-promoting use of antibiotics in agriculture, and educating patients about drug restrictions are critical.
Kerala can help reduce AMR by requiring hospitals to declare the frequency of hospital-acquired infections. It is also critical to support entrepreneurs in developing novel antibiotics, diagnostics, and vaccines, as seen by the success of businesses in Karnataka and Maharashtra.
While implementing the H1 rule is a great beginning, the larger difficulty is tackling the underlying causes of AMR. A comprehensive plan that takes into account all of the elements that influence antibiotic resistance rates is required for long-term success.
Inputs from various sources
(Rehash/Susmita Bhandary/MSM)