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prime concern: Antibiotics
last word: Mamata banerjee |
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prime concern: Antibiotics Called “superbugs”, these new bacteria have a unique ability to produce enzymes which inactivate antibiotics. Many papers have documented the emergence of dangerous bacterial strains. Called carbapenem-resistant enterobacteriaceae (CRE), these gram-negative bacteria are resistant to even carbapenems, the strongest antibiotics known. The US-based Centre for Disease Control has shown that the CRE kill one in two patients who develop bloodstream infections from them. The infections these bacteria cause can become difficult, even impossible to treat. Evidence shows the most common strains of enterobacteriaceae becoming resistant to antibiotics are E. coli and Klebsiella pneumoniae. These germs live in the gut of humans, but can cause severe infections if they travel to the bladder, blood or other areas. They can cause sepsis, urinary tract infections and pneumonia, and be potentially fatal. Deadly enzyme This explains why there has been huge concern around India since UK-based researchers reported a new antibiotic resistance phenomenon in the form of enzyme NDM 1 (New Delhi metallo-B lactamase 1) in 2009. It was produced by a gene which British scientists found in a Swedish patient who had undergone surgery in New Delhi. The gene could be transferred between bacterial species, in this case Klebsiella pneumoniae and E. coli, and gave them resistance. Multi-drug resistant enterobacteriaceae were later found by researchers in hospitals in Chennai and Haryana and in patients represented in the National Reference Library, UK. A study showed NDM 1 in drinking and seepage water in Delhi, adding to concerns that resistant bacterial strains were circulating in the community in India, though normally one would find them in hospital settings. While resistant E. coli causes mild to life-threatening diarrhoea, Klebsiella pneumoniae causes pneumonia. Imagine what would happen if there were no medicines left to treat these germs. Dr VM Katoch, head, Indian Council of Medical Research (ICMR), undertaking studies to determine the causes of resistance, says: “Antibiotics lose effectiveness sooner because of overuse. A lot of antibiotics are being prescribed in hospitals to prevent infections which can be avoided by washing hands and limited use of medical equipment like catheters; isolation facilities and wash basins.” In 1999, the US National Academy of the Sciences had revealed that every time an antibiotic was used, the probability of the development of resistant bacteria increased. Hence, experts stress prescription regime based on diagnostic tests rather than symptoms which patients present with. “Doctors often prescribe antibacterial drugs for viral illnesses. This is because they avoid tests. Sometimes there are no laboratories, and sometimes the patient is unwilling to undergo a test. Doctors should rely on testing to avoid wrong prescriptions,” says a leading doctor in Delhi. Remedial action Another problem is the absence of a national policy to prevent over-the-counter sale of even the fourth-generation antibiotics like carbapenems. Post-NDM 1, the Health Ministry had set up a taskforce to recommend a policy. The committee had advised a dedicated Schedule H1 in the Drugs and Cosmetics Act to regulate the sale of antibiotics. At present, Schedule H lists 536 prescription medicines of all categories. The panel wanted colour coding of third-generation antibiotics and newer molecules like carbapenems to be available only in tertiary hospitals. The suggestions were put on hold with Health Minister Ghulam Nabi Azad raising concerns: “If you limit access to antibiotics and make prescription a law, how will the poor in rural areas get life-saving medicines? Where are the doctors to prescribe medicines in villages?” The policy is being fine-tuned to address these concerns and hospital surveillance for monitoring resistance has been launched in some places. The ICMR is studying the causes of resistance. Evidence of links between the long-term use of antibiotics and resistance recently came from a 10-year analysis at Sir Ganga Ram Hospital, New Delhi, of multidrug-resistant blood stream infections caused by E. coli and Klebsiella pneumoniae. “Our study highlights an alarming increase in resistance and antibiotic use and emphasises prompt remedial action by reducing the consumption of antibiotics through surveillance,” says Dr Chand Wattal. High drug resistance coupled with high antimicrobial consumption of around 201.2 to 226.5 defined daily doses per 100-bed days in tertiary-care hospitals in India needs serious introspection by stakeholders, he says. Irrational use of antibiotics is a leading factor in the emergence of antimicrobial resistance stands widely documented in the Global Antibiotic Resistance Partnership (GARP) report, which had Dr NK Ganguly of the National Institute of Immunology as an author. Though NDM 1 was the most widely known form of antimicrobial resistance in India, several studies now show significant rates of resistance to a wide range of antibiotics. “Many studies document resistant organisms which cause hospital-acquired infections, including pneumonia, bloodstream infections, wound and surgical site infections and meningitis. Resistance has also been reported in bacteria acinobacter, pseudomonas and salmonella,” the report states.
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last word: Mamata banerjee
Mamata has rightfully earned the ‘credit’ for ending the over-three-decade rule of the Marxists in Bengal, completing two years in office as Chief Minister on May 20. With the spirit of a fighter raging inside, Mamata is not the one to give up on anything easily, with consequences the last thing on her mind. Having fought the Left parties, she went on to pick a quarrel with old mates in the Congress as well as the BJP, her one-time partner in the NDA. Today, she is in running battles with certain sections of her own state. Burden of legacy For any new government, two years may be too early for a serious assessment, particularly when it follows prolonged “misrule” by the previous government run by a party diametrically opposite in its ideology. No one thus really expected miracles. Mamata started with the long-standing issues, despite the financial concerns of the state. Loan interest of Rs 22,000 crore and salaries and pensions of over 2 million employees stared the government in the face immediately. Anyhow, she galvanised the government and provided people some relief by establishing rule of the law. When she took over, Darjeeling was burning in the wake of fresh agitation by the Gorkha Janmukti Morcha for ‘Gorkhaland’. The Jangalmahal and Lalghar areas in south Bengal were experiencing frequent kidnappings and killings by Maoists. No political leader — not even the then all-powerful Chief Minister Jyoti Basu and later Buddhadeb Bhattacharjee — had dared visit these “danger zones”. In contrast, Mamata was prompt in making to these areas. She interacted with the aggrieved parties, and her efforts bore fruit. Today there is free movement of people in those areas and relative normalcy has returned in Darjeeling. Problem of plenty Mamata went in for rapid industrialisation and agricultural development through many programmes. She also worked for the welfare of the Backward Classes and undertook massive rural development works. As hard as she tried, Mamata, however, failed to fulfil her commitment of returning 400 acres to the farmers of Singhur, and the Nandigram issue remained unresolved. She had been advised poorly on both cases. The state’s “wrong decisions” were overruled by the Supreme Court. Taking on too many issues at once may have been her undoing. Her detractors say Mamata and her aides, egged on by certain party colleagues and journalist friends, moved too fast without clear goals or reading the track. Expectedly, the team floundered long before achieving much. The popularity ratings dropped, as people saw the problems but could see no solutions. She also ended up antagonising some her loyalists in both the government and party. Several senior IAS and IPS officers are looking for a slot at the Centre. At the political level, too, she seems to have been left alone after losing friends in the UPA as well as NDA. She never had any friends in the CPM or other opposition parties. So much so, many old friends in her own Trinamool Congress have started keeping distance. Loose talk The government also drew flak for certain hasty decisions and odd utterances by the Chief Minister, like her remark that a young SFI leader’s death in police custody was a simple case of accidental death. She blundered again in claiming that a Park Street rape had been concocted by the CPM and others to malign her government. A senior IPS officer probing the rape case was demoted for submitting a report contradicting her statement. In a huff, the mercurial Mamata also ordered the arrest of a professor for “conspiring” against her in a cartoon after she whimsically named Mukul Roy for the Railway Minister’s post in place of Dinesh Trivedi. Reckless was also visible when she ordered the arrest of a farmer who questioned her in a public meeting about her promise of selling fertilisers at low prices. The Saradha shock The latest and most setback thus far came when instead of coming down heavily on her party men involved in the Saradha chit fund scam, she chose to shield them. Mamata has denied any involvement, but the people are suspicious of the TMC’s role in the Saradha group. Thus far more than 25 affected people have ended their lives. Nearly every day investors gherao chit fund officials, but Mamata is still reluctant to order a CBI probe into the scam. Assam, Tripura and Jharkhand, where too cases have been registered against the Saradha group, have given consent for a CBI inquiry. A judicial commission set up by Mamata to look into the scam is receiving thousands of complaints, but no concrete step has been taken to return people’s money. Settling the various fronts she has opened should keep Mamata busy for the rest of her term.
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THE indiscriminate use of antibiotics in the country is resulting in the emergence of bacteria that are resistant to drugs. There is a risk of drugs losing effectiveness against pathogens known to cause potentially fatal bacterial diseases like pneumonia, cholera and tuberculosis.
Since carbapenems are the last resort against the CRE, resistance in these germs is worrying globally as antibiotics are a shared resource and their inefficacy has implications for everyone’s health.
Why the overuse
Residing
The Chief Minister approached the Centre several times, requesting the Prime Minister and Finance Minister for a moratorium on the repayment of interests, but received no response. After the TMC withdrew support to UPA 2, the Centre’s “animosity” towards the state had become apparent, Mamata alleged.