Ending antimicobial resistance is the lynchpin to #endTB as well as health security

Shobha Shukla *

 Ending antimicobial resistance is the lynchpin to #endTB as well as health security

While reaffirming their commitment to end TB by 2030, the draft Political Declaration in the fight against tuberculosis by governments at the first UN High-Level Meeting on TB (#UNHLM to #endTB) acknowledges that "TB, including its drug-resistant forms, is a critical challenge and the leading infectious disease cause of death, the most common form of antimicrobial resistance (AMR) globally."

Dr Tedros Adhanom Ghebreyesus, WHO's Director General, calls AMR a global health emergency that will seriously jeopardize progress in modern medicine. It is creating superbugs that are making it impossible to treat many previously curable diseases, including TB. While the call for accelerating research and development for new treatments is rightly getting more attention, we are also losing on the efficacy of existing drugs with more and more disease causing microorganisms becoming resistant to them.

AMR already contributes to an estimated 700,000 deaths a year globally, and the the figure could rise to 10 million deaths a year and $100 trillion in lost global productivity by 2050 if nothing is done to stop its spread.

What is AMR?

Dr Manica Balasegaram, of Global Antibiotic Research and Develpment Partnership (GARDP) explains that AMR happens when micro-organisms - like bacteria, virus, fungi, other parasites - undergo genetic changes making them resistant to the medicines that they responded to earlier. This is an evolutionary change but the process can be accelerated due to overuse and misuse of drugs in human, animal and agricultural use, as well as due to lack of infection control.

Key actions to stem AMR

In an interview given to CNS (Citizen News Service), Dr Soumya Swaminathan, Deputy Director General for Programmes at the World Health Organization (WHO) and a globally recognised researcher on TB and HIV, underlined the importance of infection control in all healthcare settings so that all healthcare personnel follow standard guidelines for the use of antibiotics.

"Stop irrational veterinary and agricultural use of antibiotics as crop promoters or for prevention of disease and use them only for treatment where needed. Also, antibiotics listed under reserved category in WHO's classification of antibiotics should be reserved for humans and not used for animals. It is also important to have systems in place for production and disposal facilities of antibiotics so that they do not contaminate water and soil and do not spread the resistant mutations to bacteria which are in the environment", she said.

What is India doing to stem AMR?

Dr Kamini Walia, a Senior Scientist at the Indian Council of Medical Research (ICMR) who is currently leading the setting up of Antimicrobial Surveillance Network in India, pointed out that ICMR started its antimicrobial resistance initiative in 2012 as no nationwide data on AMR was available in the country. Its AMR surveillance network focused on six pathogenic groups that were causing a large number of drug resistant infections in the hospitals and in the communities.

ICMR has 20 hospitals in its network and uses data gathered from these hospitals to guide treatment interventions. ICMR has also brought out hospital infection control policy as well as treatment guidelines which is based on ICMR data. She said that, “Our data shows that antibiotic pressure is driving a lot of drug resistance that one sees in India’s hospitals. So to reduce antimicrobial resistance, overuse of antibiotics needs to be controlled, along with reducing hospital infections, because it is the large denominator of hospital acquired infections which are giving actually rise to drug resistant infections”.

Drug resistance/ AMR in TB

The growing threat of AMR to anti-TB medicines (more commonly referred to as drug resistance) is undermining efforts to eliminate the disease by 2030. Explained Dr Soumya Swaminathan that drug resistance in TB is of two kinds. One is primary drug resistance, which one gets due to direct transmission from a drug resistant TB patient. The other is acquired drug resistance (secondary drug resistance) which occurs when a patient of drug-sensitive TB is either on treatment with the wrong combination of drugs or does not take the right doses timely.

"TB bacteria are capable of developing mutation just like other bacteria if they are exposed to the drugs in the wrong dosage and/or for insufficient time. So it is very important to use them in the correct dosage (with the right companion drugs) for the correct time duration in which they need to be given", she said.

Addressing AMR in TB

Dr Mario Raviglione, former Director of WHO's Global TB Programme, blames mono-therapy to be the main reason for TB becoming resistant to drugs. He cautions that TB bacteria should never be treated by a single drug, but by a combination of 3-4 highly effective drugs. Hence it is essential to know the resistance profile of the bacteria before starting treatment. Another mistake is adding just one extra drug to a regimen that is already failing, as there is a very high likelihood of the TB becoming resistant to that new drug also, cautions Dr Raviglione.

Acquired drug resistance is now being addressed through the recent WHO guidelines which require that every presumptive TB patient must get upfront molecular diagnostic test for drug resistance done, so that the he/she can be given the right combination of drugs. Soumya insists that not only should patients have the right diagnosis and appropriate treatment but they should also be supported by way of counselling, peer support, nutritional support to be able to complete their treatment.

Dr Mario Raviglione airs similar sentiments: “To prevent drug resistant TB we need to do good basic practice in TB care and control; provide the best possible treatment to a TB patient using the recommended drug regimen based upon the results of drug susceptibility test done upfront, and follow the patient closely through the long journey of treatment.”

Cautious use of new TB drugs: Bedaquiline and Delamanid

After 40 years, the TB world has hailed the arrival of 2 new drugs Bedaquiline and Delamanid. They hold a great potential to improve cure in TB patients, especially in those with drug resistant TB. South Africa has already introduced Bedaquiline upfront for all drug-resistant TB patients. But one needs to tread with caution to prevent their irrational use.

WHO has come out with specific guidelines for judicious use of these drugs. Dr Soumya Swaminathan cautions that, “While on one hand we need to safeguard these drugs to make sure that they are effective at least for the next couple of decades, at the same time they should not be so restrictive that people who need them are not getting them”.

Bedaquiline use in India

No wonder, India is treading carefully for the rational use of Bedaquiline. For Dr KS Sachdeva, Head of India’s national TB programme and Deputy Director General, Ministry of Health and Family Welfare, Government of India: it is very important to know at what point in a patient’s journey towards TB cure, should Bedaquiline be introduced.

He shared with CNS (Citizen News Service that Bedaquiline was approved for use in India’s national TB control programme three years ago on a pilot basis. Subsequently after completing the training of the healthcare providers Bedaquiline based treatment regimen has been scaled up nationally and is being offered to patients under conditional access through the public sector to ensure that there is no misuse of the drug.

“We have an entry criteria for its use and also to rule out certain pre-conditions before the patient becomes eligible to get that drug. Within India’s TB programme, only those drug-resistant TB patients who are intolerant to the conventional drugs, or who have an additional drug resistance to an injectable or the oral drug quinolone, are being offered this drug. Currently 1800 patients are on Bedaquiline based treatment and it is being scaled up in a holistic and systematic manner through a duly approved national algorithm. Patients have to be made comfortable in its use and be very vigilant with the side effects”, he said.

World leaders commit to ambitious targets at #UNGA

World leaders meeting at the 73rd UN General Assembly have committed to ensure that 40 million people with TB receive the care they need by 2022. While powerful new drugs, and simpler treatment regimens, especially for drug-resistant TB, will go a long way in making the fight against TB easier, let us not forget to put proper safeguards in place to ensure that TB bacteria does not become resistant to them in future.

* Shobha Shukla, CNS (Citizen News Service) wrote this article for
The writer is is the Managing Editor of CNS (Citizen News Service). Follow her on Twitter @Shobha1Shukla or @CNS_Health or visit
This article was posted on 06 October, 2018 .

* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.

  • Amuktang-Ga Haikho #2 : eRang
  • Exam Centre allocation for HSLC 2019
  • 3rd World Bamboo Workshop #2 : Gallery
  • Cry of a Dying River - 65 :: Poem
  • DIPR facts on Census confuse Pangals
  • Manipur Tourism: Global Mice Congress
  • Coping up with examination stresses
  • On Govt inability to present CAB
  • Breather for the North East
  • Henjunaha #2 :: Funga Wari
  • Sangai Chef: Season 1 : Gallery
  • CAB: Imphal I/W [12 Feb] #2: Gallery
  • Lui-Ngai-Ni -Naga Seed Sowing Fest
  • Inner Line Permit (ILP) Demand :: Timeline
  • Different opinions on CAB 2016
  • Change of B Voc Examination Schedule
  • Nagaland MP will vote against CAB
  • Overshadowing issues by CAB
  • RS adjourned till February 13
  • CAB: Imphal I/W [12 Feb] #1: Gallery
  • CAB: Blockade [7 Feb] #2: Gallery
  • Keisham Priyokumar's short stories? #1
  • Just a beautiful lie :: Poem
  • World Wetlands Day 2019
  • Protests against Union HRD Ministry
  • 'PDA trying to confuse Naga people'
  • The 'ban' of Internet
  • Setting date with February 12, 2019
  • NSCN (I-M) elects new leaders
  • Scientific Knowledge in Manuscript
  • Poppy destruction @CCpur : Gallery
  • Kishorechand Wangkhem's case
  • 70th Indian Republic Day #3 : Gallery
  • Hinduism and Indianess
  • CAB: Maharaj & Xenophobia :: WJ
  • Deciphering a laboratory test report
  • Stop discrimination against women
  • The falls of protracted leader
  • More than hinting CAB will be tabled
  • CAB: Khwairamband [10 Feb] #1: Gallery
  • Gaan-Ngai @Majorkhul #2 : Gallery
  • Human trafficking at Moreh
  • Why meiteis should not be ST #2
  • The Dark Light :: Poem
  • Exclusion of Pvt Teachers from HSLC
  • Pan Meetei met Ex Dy CM
  • NSS special camp 2019 concluded
  • NE to Bangkok flight from March
  • CAB: Khwairamband [9 Feb] : Gallery
  • Thamoise Foidattuna :: e-pao Radio
  • Chingyaisu, Chaklai, Cheksa :: eMing
  • CAB Meira Rally #4 [30 Jan] : Gallery
  • Prof T Kameshwar: Reminiscence
  • Bamboo Cooking Competition: Final Day
  • Tips for healthier skin this winter
  • Sincerity matters
  • Awaiting final pact with NSCN (IM)
  • CAB: Blockade [7 Feb] #1: Gallery
  • 3rd World Bamboo Workshop #1 : Gallery
  • The panic radiated at War-Torn PAD
  • NE- Socio-Economic Development: Book
  • CAB- Consequences in Manipur
  • [ST] Demand for Constitutional Safeguard
  • 'ArP to observe Black Day during PM visit'
  • CAB date with RS on Feb 12 ?
  • Check Post (ICP) @ Moreh : Gallery
  • Tribes India [Exhibition] #2 : Gallery
  • Citizenship Bill, 2016: What to do now #4
  • It's a privilege to be a Rongmei
  • A Saviour Of My Own :: Poem
  • North East Startup Summit 2019
  • Budget : Full, half or quarter ?
  • BJP shows no concern for NE states
  • Mission schools under threat again
  • CAB : Blockade @Tiddim [6 Feb] : Gallery
  • Dolaithabi Barrage: Concealing Facts
  • 70th Indian Republic Day #2 : Gallery
  • Marketing Associates @ PiCiDi Systems
  • CAB, Political Parties and Manipur
  • The Novels Of BM Maisnamba #2
  • Employment in non-Govt sectors in Manipur
  • The board exam festival
  • Naga Peace Process :: News Timeline
  • NE voice on CAB: no worry for the BJP
  • Alienating natives & embracing foreigners
  • Henjunaha #1 :: Funga Wari
  • CAB Gen Strike #2 [31 Jan] : Gallery
  • Demand for ILP :: Articles/Photos...
  • Movement against Citizenship Bill in NE
  • Bamboo Cooking Competition: Day 1 Report
  • A girl with a Bicycle :: Poem
  • Mithun (Sandang) Mela at Machi
  • Disrespect to mother earth
  • Significance of MANPAC
  • Konthoujam Maikel (Painter) :: Profile
  • CAB Meira Rally #3 [30 Jan] : Gallery
  • Business as usual will fail on cancer control
  • Citizenship Bill: Thinking with ethics
  • STDCM reasserts Demand for ST
  • NE Pol parties met Union Home Minister
  • Free Heart Screening at Jiribam & Silchar
  • The ultimate showdown
  • Nepal to SE Asia: Trafficking via Moreh
  • Symbolism in the Tribal Art #2
  • Aribam Syam return Padmashree to Govt
  • Literature review
  • CAB : An Adhesive for Integrity of Manipur
  • Cry of a Dying River - 64 :: Poem
  • Impact of AI and Robotics on Society
  • New MSAD Executive term 2019
  • Rejoinder from Shurhozelie Liezietsu -Feb 3
  • Festival to promote NE trade, tourism
  • Onetwo Okram : Singer- Profile :: eRang
  • CAB : Film Forum Protest : Gallery
  • Cultural: Republic Day #1: Gallery
  • Why Manipuri people oppose CAB? #2
  • Antibiotic Consumption by farm animals
  • The Beauty of the Sunset :: Poem
  • Coordinator of Social Media for Congress
  • Rejoinder to NDPP [Feb 2]
  • Non presentation of CAB at RS is an insult
  • Noting anti-CAB stand of NPP, NPF
  • CAB Gen Strike #1 [31 Jan] : Gallery
  • Match: 4th Women's Polo #3: Gallery
  • Citizenship Bill, 2016: What to do now #3
  • Truth of Manipur is inherent in nature
  • Chola Pass & Chola Range in Sikkim
  • JRF required at IBSD, Imphal
  • NPF disclosure on Citizenship Bill
  • Viral audio which confuse people
  • CAB indication from President
  • Imoinu Erat Thouni #3 : Gallery
  • February Calendar for Year 2019 :: Tools
  • CAB Meira Rally #2 [30 Jan] : Gallery
  • The Novels Of BM Maisnamba #1
  • Screen time, effect on speech & language
  • Trainees Certificate of Lunglei, Mizoram
  • ST: Unfounded fear psychosis being spread
  • Join the people, brother/sisters of state BJP
  • CAB : The rallying point for NE
  • CAB Meira Rally #1 [30 Jan] : Gallery
  • CAB Protest #1 [29 Jan] : Gallery
  • NE Railway's Work & fate of Villages
  • Fellowship Meet of Maring Naga
  • Legal Awareness for Women leaders
  • Flowers for beauty
  • Opposing ST demand of STDCM
  • Gaan-Ngai @Namthanlong : Gallery
  • Why Manipuri people oppose CAB? #1
  • Citizenship Bill, 2016: What to do now #2
  • Oinam Shilla : Society Development Award
  • Let this year be your year
  • Release Journalist Keshore Wangkhem
  • Bill haunt NE today, may haunt BJP tomm
  • Staying away from all parties meet
  • Taking the Street Vendor seriously #2
  • CAB Protest #2 [21 Jan] : Gallery
  • I'm sorry :: Poem
  • Self-development
  • Time to Reshape Reservation Policy
  • Sikandra, where Akbar the Great rests
  • Wise rulers listens kingmakers
  • Understanding National Voters' Day
  • 70th Indian Republic Day #1 : Gallery
  • Agri Fair @ CAU #1 : Gallery
  • MIK (Manipuri in Kolkata) : Gallery
  • Of Manipuri marriages & Swasti Pujas
  • 2nd AMAND Blood Donation Camp at Pune
  • NSUD : on call centre scam at Noida
  • The Banyan :: EI
  • Match: 4th Women's Polo #2: Gallery
  • Why shouldn't Meitei be included in ST
  • Some lessons from Ramayan
  • Republic Day celebrated across North East
  • Mizo Gov addresses RDay in empty ground
  • On the arrest of Gen Sec of RSF
  • International exposure via business
  • Kitchen Ingredients- can be used on skin
  • Republic Day at Loktak Power Station
  • 'A slap in the face for PDA government'
  • No final solution yet in sight !!
  • Combing Operation @Hatta : Gallery
  • Laishram Bombayla : Padma Shri Award
  • Female sex tourism: Sociological study
  • Imphal Declaration: Pan Meetei Convention
  • RPL trainees of Damparengui, Mizoram
  • Is the country listening ?
  • Yet another boycott call of R-Day
  • Maisnam Renuka (Painter) : Profile
  • Thank You Note: Khumukcham Sanjita
  • Gaan-Ngai - festival of Kabui #2
  • Imoinu Erat Thouni #2 : Gallery
  • Rongmei and Kabui are one
  • Rani Khidir : Kalaritu (Laiyekpa) : Profile
  • 11 in line for Congress ticket
  • Gaan-Ngai @Majorkhul #1 : Gallery
  • Eyek Tamba :: Learn Manipuri script
  • Match: 4th Women's Polo #1: Gallery
  • CAB Protest [17 Jan] : Gallery
  • Ranjit Ningthouja : Profile of a playwright
  • Imoinu Erat Thouni #1 : Gallery
  • Dr Thokchom Asha: Teacher Award
  • Purnima Ngangom (Printmaker) :: Profile
  • The Killing Fields 2013-18 : News Timeline
  • New Year picnic at Sekmai #2: Gallery
  • WWII museums in Japan: Gallery
  • Manipuri Calendar for 2019 : Download
  • Featured Front Page Photo 2018 #6: Gallery
  • Irengbam Bedamani - Actress :: eRang
  • List of Restricted Holidays for 2019
  • List of Public Holidays for 2019
  • List of General Holidays for 2019
  • Fabrics of Bangladeshi Manipuri: Download
  • Old Manipuri Movie #1 :: eRang Classic