Antimicrobial resistance (AMR) is on the rise globally with the threat more severe in developing countries such as India. Antimicrobial resistance occurs when bacteria develop the ability to withstand the drugs (antibiotics) designed to kill them. This happens due to overuse and misuse of antibiotics. Every time a person takes antibiotics, sensitive bacteria get killed but resistant ones survive and multiply. Repeated use of antibiotics can increase the number of drug-resistant bacteria often referred to as “superbugs”.
How do bacteria resist antibiotic drugs?
Bacteria can resist antibiotics by “neutralising” it and making it harmless, throwing it out of their bodies or changing its outer structure to make the antibiotic useless.
Why is it dangerous?
This can be dangerous as resistant bacteria can enter the human body through food and water and render particular antibiotics used to treat infections like, say diarrhoea, ineffective. This can result in the person continuing to suffer from the condition which could even become fatal and also increase the risk of spreading it to others.
How do food and water harbour antibiotic-resistant bacteria in India?
Increasing water pollution from untreated sewage and hospital and industrial effluents loaded with antibiotics being released into water bodies lead to the growth of antibiotic-resistant bacteria in water sources. Samples from food products such as poultry, fish, eggs, milk have also been found to harbour antibiotic-resistant bacteria. This is because low doses of antibiotics are routinely used to prevent infection and as growth promoters in livestock. Recent studies show that a large number of smallholder farmers are into dairy business. Milk samples in India are found to be loaded with antibiotics.
Why are antibiotics used excessively among livestock?
A recent study titled The social biography of antibiotic use in smallholder dairy farms in India published in the journal Antimicrobial Resistance and Infection Control explores the factors responsible for the excessive use of antibiotics in dairy farms in India by interviewing smallholder dairy farmers, veterinary officers, veterinary field assistants, pharmacists, drug distributors and civic officials from peri-urban areas of Guwahati, Ludhiana and Bangalore.
The study finds that:
- Most of the farmers lack awareness of antibiotic use and treat livestock on their own
A majority of the farmers do not know the difference between antibiotics and non-antibiotic medicines. Many a time, they administer antibiotics to the farm cattle irrespective of the severity of the disease. The choice of drug is based on the ease of availability and on the recommendation of fellow farmers or advice obtained from elders. Most of these people who advise them are commercial dairy farmers who have a rapport with pharmaceutical representatives and drug distributors. Farmers bring their livestock to veterinarians only after all attempts at treating them have failed to show results.
- Shortage of trained caregivers and support systems lead to irrational prescription
Acute shortage of trained veterinarians leads to untrained caregivers such as veterinary field assistants and informal prescribers who have a tendency to indiscriminately prescribe antibiotics. Although labs and diagnostic support services are available, most are ill-equipped. The better ones are expensive and not affordable for the farmers. Also, there are no disease screening programmes specifically directed at cattle in smallholder dairy farms.
Veterinarians do not depend on lab reports to treat sick animals. This is because farmers spend a lot of time and money in trying out alternatives and go to the veterinarian only when nothing else works and the condition gets serious. Veterinarians thus have no choice but to begin treatment almost immediately to save cattle.
- There is no support system in place for farmers
None of the farmers refer to extension services and perceive them to be of poor quality. Many choose to not attend these sessions because of their belief and reliance on traditional knowledge that has been practised over generations. Extension department officials claim that relevant services are offered to local dairy farmers on a regular basis. However, when asked about the specific activities related to the use of antibiotics and their role in maintaining the health of animals, many fail to mention any particular programmes.
- Scarcity of trained pharmacists encourages informal drug distribution
The scarcity of trained pharmacists in the peri-urban areas leads to a majority of the drugs being distributed by informal drug distributors. Even if a pharmacist is present, a prescription-based purchase is very less in all these areas.
- Absence of regulation hinders controlled use of antibiotics
Veterinary doctors and senior state-level officials express the need for strict regulations to deal with the rampant use of antibiotic growth promoters and non-therapeutic use of antibiotics. Many senior officials say that there is an absence of evidence-based guidelines for the prudent use of veterinary antibiotics.
- Direct marketing of antibiotics to users increases irrational use
Antibiotics are directly marketed at the village level and many a time, community leaders or commercial dairy farmers act as mediators between medical representatives and smallholder dairy farmers. This is beneficial to all as farmers get the drugs at a discounted rate, without having to travel far while pharmaceutical representatives meet their targets easily and the status of village elders get elevated.
- Market demand and pressure to produce more impact quality and safety
Smallholding dairy farms operate at very thin profit margins and the farmers are forced to maintain productivity in their animals to sustain their livelihoods. A majority of these farmers are either unaware or ignore the concept of withdrawal time (i.e. a time period required for the animal to process the antibiotic given in case of illness and the amount of time necessary for the product concentration in the milk to decrease to safe, acceptable levels) due to high production pressures and absence of regulatory mechanisms. This leads to high concentrations of antibiotics in the milk samples.
What needs to be done to change the situation?
The study concludes that increasing community awareness related to veterinary antibiotics, framing and implementing an effective drug distribution policy, imposing penalties on defaulters, and strengthening of veterinary human resources both in terms of quantity as well as competence can help in dealing with this situation in the long run.
By Abhimanyu Singh Chauhan