Anti-Microbial Resistance - The Next Pandemic
                     Anti-Microbial Resistance - The 
Next Pandemic
The emergence of AMR in microorganisms is a phenomenon driven by the 
Darwinian selection process, with microbes having developed robust mechanisms 
to evade elimination by anti-microbial agents.
Sir Alexander Fleming, a Scottish researcher working in the laboratory at St. 
Mary’s Hospital in London first identified Penicillin in 1928 and revolutionized 
medicine with the discovery of the world’s first antibiotic. By the time World War 
II ended in 1945, US companies were making 650 billion units of Penicillin a 
month! At the same time, Fleming predicted that use of non-lethal doses of the 
drug to cure infections would make bacteria resistant to Penicillin.
Let us fast-forward to the present - pharma companies in news says that-The 
WHO has now projected that Anti-Microbial Resistance (AMR) in bacteria, viruses
and parasites is emerging as one of the greatest challenges to public health and 
could lead to the emergence of a post-anti-microbial era – where a simple 
infection could be fatal. Thus AMR, a natural consequence of excessive anti-
microbial usage, coupled with sluggish development of novel drugs, and poor 
anti-microbial stewardship, is today a global, multi-factorial problem with 
immense complexity. This phenomenon is not only intrinsically linked to human 
health and behaviour, but also inherently connected with our entire ecosystem 
including animal health, food production, agriculture and the environment.
A large number of drugs are of microbial origin, produced by environmental fungi 
or bacteria, and are also available as synthetic modifications, except for 
sulphonamides and fluoroquinolones which are synthetic. pharma companies in 
news says the emergence of AMR in microorganisms is a phenomenon driven by 
the Darwinian selection process, with microbes having developed robust 
mechanisms to evade elimination by anti-microbial agents. Pharma companies in 
news say, however, not much evidence to suggest that selection of anti-microbial 
resistance occurs in the natural environment. It is noteworthy that in a pristine 
(i.e. free from external anti-microbial selection pressure) ecosystem, anti-
microbial resistant and non-resistant species co-exist in a stable balance.
According to pharma industry updates the link between human anti-microbial use
and emergence of resistance is established, several factors contribute to the 
complexity of the problem such as bacteria-drug interactions, bacteria-host 
interactions, mutation rates of bacteria, evolution of anti-microbial resistance 
clones as well as transmission rates of resistance determinants between 
microorganisms. The emergence of resistance is likely to be specific to each drug 
and to each microorganism, as well as the effect of changes in its use. There is 
also the need for addressing an integrated approach to be adopted across both 
community and health-care structures.
In the light of the recent pandemic, this looming global crisis takes on even more 
significance due to the increase in anti-microbial use coupled with the invasive 
procedures that are associated with the treatment of COVID19 patients, resulting 
in a heightened risk of emergence as well as spread of AMR. According to pharma 
industry updates, data from around the world, especially Asia, has implicated that
more than 70% of patients undergoing Covid-19 treatment receive anti-microbials
though only 10% were actually suffering from antibacterial or antifungal 
infections, further contributing to the AMR crisis!
Use of anti-microbials in clinical medicine has exposed human microbiota to 
unprecedented high concentrations of drugs, resulting in the development of de 
novo resistance within an individual during treatment. A better understanding of 
resistance mechanisms could facilitate novel approaches to diagnostics and 
therapeutics. It is evident that several complementary, overlapping, collaborative 
and synergistic approaches with common goals will be essential to ensure and 
sustain access to effective anti-microbial therapies.
In response to the gravity of the situation, the United Nations adopted a 
resolution and reaffirmed the WHO Global Action Plan on AMR, which is reflected 
in the strategic objectives of the National Action Plan (NAP) on AMR set up by the
Government of India in 2017, based on national needs and priorities. In addition 
to the five priorities of the Global Action Plan on AMR, India has a sixth priority 
dealing with India’s leadership in AMR. The NAP on AMR includes:
 
Improving awareness and understanding of AMR through effective 
communication, education and training
Strengthening knowledge and evidence through surveillance
Reducing incidence of infection through effective infection prevention and control
Optimizing use of anti-microbials in health, animals and food
Promoting investment for AMR activities, research & innovation
Strengthening India’s leadership in AMR
In this regard, developing effective strategies and interventions in the Indian 
context, planning effective antibiotic stewardship in India, promoting investments
for AMR activities, research and innovation, as well as strengthening India’s 
commitment on AMR are of paramount importance.
The need for rapid diagnostics to regulate indiscriminate prescription of anti-
microbials is vital. The availability of rapid diagnostic tests to distinguish between 
viral and bacterial infections in primary point of care settings could significantly 
improve clinical management of undifferentiated fever, thereby helping to 
optimize anti-microbial prescriptions and limit irrational anti-microbial usage. 
According to pharma industry updates collaboration, coordination as well as 
synergistic interaction between surveillance networks can enable standardized 
collection and analysis of samples, as well as avoiding redundancy. In this regard, 
sample collection and analysis with enhanced focus on the AMR profile and the 
dissemination of results should follow the recommendation of the WHO Global 
Anti-microbial Resistance Surveillance System (GLASS), which promotes and 
supports a standardized approach to the collection, analysis and sharing of AMR 
data at a global level, by encouraging and facilitating the establishment of 
national AMR surveillance systems that are capable of monitoring AMR trends 
and harnessing reliable and comparable data.
Anti-microbial stewardship has been recognized as a key component of the fight 
against AMR. A comprehensive understanding of why anti-microbial prescriptions 
are often doled out without diagnostic testing could help to restrict the 
inclinations to use anti-microbials indiscriminately. According to pharma industry 
updates understanding and evaluating the relative contribution of different 
drivers of AMR development could greatly facilitate rapid progression toward a 
global solution for AMR. With the focus on patient level interventions to eliminate
Covid-19, it is important to evaluate its collateral effects on management of anti-
microbial resistance. It is a matter of concern that the ongoing pandemic is 
exacerbating existing challenges to optimal antibiotic stewardship and thereby 
elevating the threat to patient safety and public health via antibiotic over 
prescription leading to acceleration of bacterial resistance.
As an important step towards tackling the global AMR menace, the United 
Nations has decided to observe November 18 to 24th, 2020, as World Anti-
microbial Awareness Week [WAAW], with aims to increase awareness of global 
Anti-microbial Resistance (AMR) and to encourage best practices among general 
public, health workers and policy makers to contain further emergence and 
spread of drug resistant infections.
It is now obvious, that along with other global challenges that threaten human 
existence and the planet, global cooperation is an absolute necessity to reduce 
the evolution and spread of AMR—the next pandemic in the making.