The ‘antibiotics in your chicken’ story was everywhere in the Indian media (1, 2, 3, 4) today — studies by Delhi-based NGO Centre for Science and Environment (CSE) always manage to generate this level of interest — be it antibiotics in honey, toxic phthalates in toys, polluting car parks or pesticides in cola. These are studies that touch the common man’s life directly and, many a time, help make policy changes by creating the necessary buzz. The peer review process follows the advocacy drive, I am told, “since publishing scientific findings could take time and the issue at hand might need urgent attention.”
Scientifically speaking, what do we know about the chicken-antibiotic story that we didn’t already? One, this is the biggest study done in India to test residues of antibiotics in chicken — 70 chicken samples from Delhi and the National Capital Region (NCR) were tested, 40 per cent samples tested positive, residues of more than one of six commonly used antibiotics were found in 17 per cent samples. All this “points to a large-scale unregulated use of antibiotics as growth promoters by the poultry industry and could be one of the reasons Indians might be developing antibiotic resistance.”
Getting back to the issue of humans developing antimicrobial resistance through use of antibiotics in food animals, way back in 2002, the World Health Organisation (WHO) raised an alarm over this “fast spreading, serious threat to global public health.” WHO estimated that half of the antibiotics produced in the world are being used in farms and not to improve human health (WHO, 2002, Use of antimicrobials outside human medicine and resultant antimicrobial resistance in humans). Antibiotics are administered eight times more for non-therapeutic purposes than for treatment. Antibiotics are given as prophylactics to prevent infections and also to promote growth.
“The prolonged use of low doses of antibiotics in animal feed can create ideal environment for production of antibiotic resistant bacterial strains. The resistant bacteria can be transmitted from animals to humans via contact, food and environment. Infections caused by resistant microorganisms do not respond to the standard drugs, leading to prolonged illness, higher cost of health care and more risk of death.”
So, if you thought your mutton, fish and pork are exempt from the antibiotic-fed category, here’s a rude shocker, by WHO:
This year WHO mentioned in its global surveillance report on antimicrobial resistance :
The use of antibiotics in animal husbandry – including in livestock, poultry and fish farming – are leading to increasing recognition that urgent action is needed to avoid inappropriate use, and to reduce antibiotic usage in animal husbandry and aquaculture, as well as in humans. More data are needed on antibiotic consumption in food-producing animals worldwide, and on the occurrence of antimicrobial resistance in different countries and different production systems, in order to make comparisons between countries and identify priority areas for intervention.
Food-producing animals are reservoirs of pathogens with the potential to transfer resistance to humans. The magnitude of such transmission from animal reservoirs to humans remains unknown, and will probably vary for different bacterial species. The spread of resistance genes from animal bacteria to human pathogens is another potential danger which adds complexity.
So, earlier this month, at the International Conference on Host Pathogen Interactions (ICHPI) in Hyderabad, the issue of antimicrobial resistance raised some sharp reactions. Scientists attending the meet recognised how microbes are constantly fighting back by gaining new resistance mechanisms against drugs. The need for novel and effective antimicrobial drugs was felt, not only to treat emerging infections but also for the success of medical procedures such as organ transplantation, cancer chemotherapy and major surgeries that are commonly preceded by infections especially in developing nations like India.
Scientists at the meet said it was unfortunate to see ‘lack of data’ for India in the recent WHO report on global surveillance on antimicrobial resistance. A brainstorming, therefore, intended to identify international and national organizations and funding agencies for addressing antimicrobial resistance. The scientists and policy makers participating in the brainstorming were looking at existing Indian policies on antimicrobial resistance and their strengths and weaknesses to spot areas that need immediate amendment.
Some key recommendations that came out of the session (and have been sent to India’s Department of Biotechnology and the Indian Council of Medical Research) were: (i) creating awareness about the growing antimicrobial resistance and its impact on animal and human health to the public, doctors and other stakeholders – lobbying with the politicians for this, (ii) regulation of the prescription / sale of antibiotics and standardisation of antibiotic treatment regimen, (iii) collection of epidemiological and surveillance data and maintenance of a nationwide database to monitor and record developing antimicrobial resistance in hospitals, fields and among public, (iv) research to identify novel growth promoters, novel targets to kill microbes, novel combination of approved drugs and alternatives to antibiotics such as probiotics, immunomodulators, anti-virulence drugs, anti-toxins, vaccines and improved sanitary managements, (v) development of community level, rapid, point of care diagnostics/screening tools, (vi) understanding the molecular mechanisms involved in the development of antimicrobial resistance and development of strategies to overcome it, (vii) strict regulation of antibiotic withdrawal period in animal produce and need to monitor food borne illnesses, (viii) development of alternatives to the use of antibiotics in the poultry/aquaculture/veterinary practices, as growth promoters and (ix) as large pharma is not interested in the development of new antibiotics, there is need for enhanced public funding and incentives for small and medium companies.
The scientists have also recommended establishment of a National network for antimicrobial resistance, a coordinating centre for molecular epidemiology, genomics and control of drug resistant pathogens with multiple regional monitoring and surveillance centres. The centre is proposed to give emphasis on hospital and community acquired infections.
Lets hope some of these recommendations get some attention — the near absence of global scientific data in this field means taking the first step would be avant-garde.
The CSE study, therefore, comes at the right time as a pioneering effort to generate public discourse on this very significant threat to public health in India.