A laudable initiative by Apollo to combat the rising threat of AMR

Apollo Hospitals, an Indian multinational healthcare group headquartered in Chennai, has recently launched national Antimicrobial Stewardship Programme (Apollo ASP) to promote rational use of antibiotics in the country. The program will sensitize the care providers on antimicrobial resistance (AMR), an issue leading to a public health problem and is today one of humanity's top ten global public health threats. It will be the largest program of its kind in the country to promote the rational use of antibiotics to combat the rising burden of AMR, also known as drug resistance, in the community.

Through this programme, Apollo, one of Asia's biggest integrated healthcare services provider, aims to optimize the use of antibiotics, turn the tide on AMR, and ensure continued effective treatment of infections for future generations. According to the company's top management, Apollo ASP is being launched across the group to improve antimicrobial use and patient outcomes. Apollo ASP will also support the government of India's National Action Plan on the containment of Antimicrobial Resistance (NAP-AMR) and Indian Council for Medical Research (ICMR)'s AMR Surveillance and Research Network (AMRSN) to control AMR by empowering doctors to use antibiotics judiciously. Apollo has launched this programme as its recent data of over 300 thousand bacterial isolates since 2019 across 20 different locations in India has shown a considerable increase in community-acquired antimicrobial resistance which warrants immediate measures to stop this emerging trend. Integrating these insights into clinical decision-making would foster a culture of rational antibiotic use and save lives.

Regular audits and benchmarking of best practices, surveillance and monitoring of metrics for antibiotic consumption and the patient outcome will form an integral part of Apollo ASP. The program will be backed by a digital backbone that will ensure efficiency, and accuracy and allow an analysis of data for decision-making. The ASP will be integrated with Apollo's electronic medical records platform - Medmantra to facilitate automated alerts. Education and training of doctors, pharmacists and other healthcare staff will include comprehensive case-based modules.

AMR occurs when bacteria, viruses, fungi, and parasites mutate over time and are no longer affected by medicines against them.

This makes treating infections caused by them harder to treat and increases the risk of disease spread, severe illness and death. Since the discovery of penicillin in 1928, antibiotics have significantly improved global health. They have been a cornerstone of modern medicine, including cancer chemotherapy and advanced surgical procedures. But decades of overuse and misuse of antibiotics have accelerated the emergence and spread of resistant microbes.

Infections caused by drug-resistant organisms lead to prolonged duration of hospitalization and increased mortality, causing a huge financial burden to the affected persons, and healthcare systems, and hindering the goals of sustainable development. Antibiotic resistance has led to the emergence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis, the bacteria that is responsible for tuberculosis. Antibiotic-resistant strains have emerged among both Gram-positive and Gram-negative bacteria that cause commonly seen infections such as Staphylococcus aureus, Enterococcus species, Pseudomonas aeruginosa, Acinetobacter species, Escherichia coli, Klebsiella pneumonia, and Neisseria gonorrhoeae.

Today, drug resistance is one of the top ten global public health threats faced by humanity and can have a major impact on modern healthcare. Besides, the cost of AMR to national economies and their health systems is significant as it results in prolonged hospital stays and the need for more intensive care. Challenges in India to combat the huge burden of AMR are manifold considering a sustained annual rise of 5-10 per cent resistance to broad-spectrum antimicrobials. The first steps have already been taken with the formation of a National Advisory Committee to drive consensus on the way forward and roll out modules for training.

There can be no two opinions about the fact that AMR is a major public health concern in India. The emergence of resistance is not only limited to the older and more frequently used classes of drugs but there has also been a rapid increase in resistance to the newer and more expensive drugs, like carbapenems. Available data indicates to rising rates of AMR, across multiple pathogens of clinical importance, at the national scale. The launch of a national program like the national antimicrobial stewardship program by the Apollo Group to promote rational use of antibiotics is definitely a laudable initiative which others can emulate.

(The author is a freelance journalist with varied experience in different fields)