The government facility providing vital free care to delhi the biggest threat to modern medicine

Like medical centres across India’s sweltering capital, the Kalawati Saran hospital in north Delhi is bearing the brunt of an outbreak of mosquito-borne disease.

Entire families are camped out in its corridors, alongside stocks of food and water. Women sleep nearly 20 to a room on mats inside the neonatal ward. Outside, a bin overflows with rubbish and a stray dog shuffles up the stairs.

Few people wear masks and even fewer use foot covers, which might keep Delhi’s incorrigible dust from entering treatment rooms.

Hospitals such as Kalawati, a government facility providing vital free care to Delhi’s poorest, are ground zero for antibiotic-resistant superbugs – described at the UN general assembly this week as the biggest threat to modern medicine.Nowhere is the growing global threat of antibiotic resistance as stark as in India, researchers say.

One of the resistance-enabling enzymes that most concerns doctors was discovered to be rampant in Delhi in 2008, and named after the city: NDM-1. It has since spread to 70 countries around the world.

But poor conditions inside some Indian hospitals, cities and villages are only part of the problem. A 2010 study found Indians were the largest consumers of antibiotics in the world, and the Indian Medical Association has estimated that about 50% of prescriptions might be inappropriate or unnecessary.

“Doctors try to be on the cautious side, so they usually prescribe antibiotics for conditions where it is not required,” says Dr Ajay Kumar, a senior specialist in paediatrics at Kalawati Saran.

There are also financial incentives: doctors routinely receive commissions from drug companies for prescribing particular medicines.

Over-prescribing isn’t limited to hospitals. At a pharmacy close to Kalawati Saran, it was possible on Wednesday to buy the antibiotic Nflox-TZ without a prescription – just a vague description of a stomach ache. The pharmacist agreed to sell a single strip – half the full course – for about 69 rupees (80p).

Hundreds of strips and packages of antibiotic were also being sold, seemingly without prescription, from the rows of pharmacy stalls opposite the All India Institute of Medical Sciences (AIIMS), a major hospital in south Delhi.

But cracking down on antibiotic use, or making the drugs more expensive, would have its own toll: more Indians still die for lack of access to the powerful medicines than from their overuse.

Delhi’s newborns often bear the brunt of poor conditions and antibiotic overuse. A landmark study published in the Lancet last week followed 13,530 babies admitted into intensive care units in the city’s three largest hospitals, and found an “alarming degree” of antibiotic resistance.

Nearly 500 babies died from sepsis, many contracting the disease from the bacteria acinetobacter. Of those, 82% simply could not be treated by any known antibiotic.“We are now staring at overwhelming evidence of rampant antibiotic resistance, across all ages, all over the country,” Dr Vinod Paul, the chief of paediatrics at AIIMS, told the Hindu newspaper.

Awareness campaigns have proliferated among India’s medical establishment to persuade doctors to prescribe alternatives. “We don’t use antibiotics indiscriminately, and we closely monitor the common bugs, and which antibiotics would be best to treat it,” says Kumar, from Kalawati Saran.

“We avoid broad-spectrum drugs, and we try to use specific antibiotics for specific conditions. We are more aware, and really very finicky about it.”

However, he added: “Developing countries are the same … There’s nothing unique to this place or this city. The reasons are all the same.”

On Tuesday, all 193 member states of the UN agreed to take the threat of antibiotic resistance as seriously as climate change, and report back in two years about the results.

But superbugs are spreading fast and, in Delhi, are a daily reality. “No doubt about it,” says Kumar. “The resistance is already there.”


https://www.theguardian.com/society/2016/sep/21/delhi-hospitals-fighting-uphill-battle-against-drug-resistant-superbugs