GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK.
Department of Pathology and Microbiology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India.
J Antimicrob Chemother. 2022 Sep 6;77(Suppl_1):i10-i17. doi: 10.1093/jac/dkac212.
Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action.
To review the current situation with respect to AMR in India and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize further rises in AMR and to improve patient outcomes.
National AMR initiatives, antibiotic use and prescribing in India, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens (Streptococcus pneumoniae and Haemophilus influenzae) were identified. National and international antibiotic prescribing guidelines for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from a local clinician and clinical microbiologist were sought to contextualize this information.
Many initiatives have been launched since AMR was recognized as a national priority and organizations such as the Indian Academy of Paediatrics and the Global Antibiotic Resistance Partnership have worked to build awareness. The Indian Ministry of Health and Family Welfare published a 5 year national action plan on AMR. However, the burden of infectious disease and consumption of antibiotics in India is high. There have been national surveillance studies generating local data along with international studies such as Survey of Antibiotic Resistance (SOAR) and Antimicrobial Testing Leadership and Surveillance (ATLAS). For common RTIs, clinicians use a range of international and national guidelines. However, a more standardized inclusive approach to developing local guidelines, using up-to-date local surveillance data from community-acquired infections, could make guidelines more locally relevant. This would encourage more appropriate antibiotic prescribing and improve adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.
抗菌药物耐药性（AMR）是对全球公共卫生的最大威胁之一。除其他因素外，抗生素的不当使用也是耐药菌选择的驱动因素。由于不必要的抗生素处方，COVID-19 可能加剧了 AMR。需要了解国家层面的知识，以了解应对措施的选择。
审查印度目前的 AMR 情况以及解决 AMR 的举措。确定需要更多信息的领域，将为最大限度减少 AMR 的进一步上升和改善患者结局提供行动呼吁。
确定了印度的国家 AMR 举措、抗生素使用和处方情况，以及特别是针对关键的社区获得性呼吸道感染（CA-RTI）病原体（肺炎链球菌和流感嗜血杆菌）的药敏数据情况。还审查了当地常用的特定 CA-RTI（社区获得性肺炎、急性中耳炎和急性细菌性鼻-鼻窦炎）的国家和国际抗生素处方指南，以及当地抗生素的供应情况。为了使这些信息具有背景意义，还征求了当地临床医生和临床微生物学家的意见。
自 AMR 被确认为国家优先事项以来，已经启动了许多举措，印度儿科学会和全球抗生素耐药性伙伴关系等组织努力提高认识。印度卫生部和家庭福利部发布了一项为期 5 年的 AMR 国家行动计划。然而，印度的传染病负担和抗生素消费仍然很高。已经进行了国家监测研究，生成了本地数据，同时也进行了国际研究，如抗生素耐药性监测（SOAR）和抗生素测试领导力和监测（ATLAS）。对于常见的 RTIs，临床医生使用了一系列国际和国家指南。然而，采用一种更标准化、更具包容性的方法来制定当地指南，利用社区获得性感染的最新本地监测数据，可以使指南更符合当地情况。这将鼓励更合理地使用抗生素并提高遵医嘱性。这反过来又可能限制 AMR 的发展并改善患者结局。
