India's National Action Plan for antimicrobial resistance – An overview of the context, status, and way ahead

Abstract

Antimicrobial resistance (AMR) is a multifaceted complex problem with momentous consequences for individuals as well as health-care systems. Understanding the gravity of the problem, the World Health Assembly has adopted the Global Action Plan on AMR in the year 2015 as a part of the tripartite collaboration with World Health Organization, Food and Agricultural Organization, and World Organization for Animal Health. India's National Action Plan (NAP) for AMR was released in April 2017 by the Union Ministry of Health and Family Welfare. The objectives of the NAP include improving awareness, enhancing surveillance measures, strengthening infection prevention and control, research and development, promoting investments, and collaborative activities to control AMR. On the basis of the NAP, various states have begun the process of initiating their State Action Plans. The aim of this article is to highlight some of the main components of the NAP and to make family physicians, general practitioners, and other stakeholders aware of the issue of AMR and its factors and what can be done. The article also discusses some of the challenges in implementation of NAP such as varied perceptions about antibiotic use and AMR among key stakeholders, inappropriate antibiotic use owing to a number of reasons, lack of diagnostic facilities, widespread use of antibiotics in various sectors, environmental contamination because of pharmaceutical industry, agricultural and hospital waste, gaps in infection prevention and control, and difficulty in enforcing regulations. Similar to other low-middle income countries (LMICs), lack of sufficient finances remains a major challenge in NAP implementation in India as well. Overall, a strong political will, inter-sectoral co-ordination between public and private sectors and comprehensive strengthening of the healthcare systems are necessary to achieve the desired forward momentum.

A review of animal health and drug use practices in India, and their possible link to antimicrobial resistance

“…Ghafur et al [8] provided options for implementation of such bans, including a more liberal one where a few drugs are considered at the start of the intervention. The Indian NAP (for AMR) is a well-designed and comprehensive initiative, however, its implementation is slow mostly due to funding limitation; health is under state governments (which manage many other programs and may not afford to support newer initiatives) [125].…”

Antibiotic abuse during endodontic treatment: A contributing factor to antibiotic resistance

“…[64] This 5-year NAP (2017–2021) outlines the priorities and implementation strategies for curbing Antimicrobial resistance in India. [65] The government can adopt computerized decision support systems that are designed to improve antibiotic use by providing treatment recommendations to clinicians at the time of prescribing. Implementation of this system has been associated with reduced use of broad-spectrum antibiotics, improved antibiotic selection and dosing, fewer prescribing errors, antibiotic cost, and reduced antibiotic resistance.…”

Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study

“…India had made its National Action Plan for curtailing AMR (NAPAMR) in 2017 in line with the global action plan for combating AMR. [ 12 13 ] As a next step, the states were required to develop their state action plans. State of Haryana, which has a population of 28 million, is initiating the same exercise.…”