A study conducted by Princeton University says that there has been a 36% rise in antibiotic use in all countries over the last 10 years – except in India, which has seen a rise of 62% and is now the largest consumer of antibiotics in the world.
If these antibiotics were simply being taken by Indian people, then a public campaign and regulations for doctors could stop it. But 70% of these antibiotics are being fed to sick chickens, which are then fed to Indians. This is an extremely dangerous situation.
When one is consistently exposed to an antibiotic over a period of time, the body develops a resistance to it. If the person has been eating it in chicken frequently, then when he really falls sick, the antibiotic he takes will have no effect on him. What his body now has is the “superbug”, an infection that cannot be removed by an antibiotic. A person can die of a common cold and cough.
It is predicted that in a few years antibiotic resistant bacteria will have killed one crore people around the world and 47 lakh individuals will be from Asia. In India most antibiotics have stopped working on people. New antibiotics are needed to provide a cure, but new ones are not easy to discover. Only two new antibiotics have been approved for use in the past 10 years, and one of these – ceftaroline – has already started facing the problem of resistance in the first year of its use.
Doctors are falling back on antibiotics that were used and discarded fifty years ago, because they may have cured one problem but they created another. Now the medical community is going to “last resort” drugs - drugs that would otherwise not be recommended are now being seen as viable alternatives, as people have not yet developed resistance to them. One such antibiotic is colistin. Colistin, or polymyxin E, is an antibiotic produced by certain strains of the bacteria Paenibacillus polymyxa. Colistin is very effective against most Gram-negative bacilli. But it is no angel.
Colistin was introduced in the market in 1959 but was abandoned in the early 1980s due to undesirable effects, such as kidney failure and neurological toxicity. Respiratory arrest has also been seen after intramuscular administration of colistin. It can lead to temporary neurological disturbances such as numbness, tingling of the extremities, itching of the skin, dizziness, and slurring of speech.
Colistin is referred to as a ‘last mile drug’, to be used very judi-ciously only on patients in extremely critical conditions. There is nothing more powerful available at the moment to fight infection. Extreme care must be also taken so people don’t develop resistance to this antibiotic, leaving us with no available alternative.
Unfortunately, that is exactly what is happening. Studies done in Indian hospitals in Delhi and Pune have shown that 5% of patients admitted after outbreaks of severe bacterial infection are resistant to colistin. How have they developed this resistance? A recent example from China can help to demonstrate:
In 2015, Timothy Walsh, Professor of Medical Microbiology at Cardiff University and his team discovered a colistin-resistant gene in Chinese pigs. This discovery created panic in the global medical community, as this gene (mcr-1) was capable of creating widespread untreatable infections. It was found that rampant use of colistin in Chinese livestock farming had caused the spread of mcr-1. Shockingly, the gene was found in bacteria from animals and humans in more than 30 countries where Chinese pigs had been exported for consumption.
This is what has happened in India as well. When colistin fell out of favour for human use in the 1980s, the companies manufacturing it started selling it to piggeries in China and poultries in India. Colistin was banned for animal use in the West, so the companies targeted Asia, and tonnes of colistin were shipped to India, Vietnam, South Korea and Russia every year for veterinary use.
Five pharmaceutical companies in India are openly advertising products containing colistin as a growth promoter for animals. Two companies are manufacturing colistin locally. We are importing over 150 tonnes of it every year.
Indian poultry farms are using colistin and going completely unchecked. Why? Because they keep their chickens so badly in small battery cages – as reported in the Law Commission report on poultries – that they need antibiotics to prevent them from dying before they can be killed. And, as the chickens become resistant to gentle antibiotics, the poultry owners are using more and more dangerous drugs to keep them alive. It is also used to promote the faster growth of chickens so they can be killed sooner, increasing profits. Poultries are increasing the number of chickens they ram into the same space, to make more money. As sickness and resistance increases in the flock, more and more antibiotics are being used. Already Indians are indirectly ingesting the largest amount of antibiotics. This is predicted to increase 5 times by 2030. Owing to the risky nature of colistin itself, combined with its indiscriminate use by the poultry industry, we are heading for a disaster.
Not just chicken (and pig) eaters are now found with colistin resistant genes, colistin finds a number of ways to reach us. Colistin resistant bacteria transfer through the air from these farms and through workers at these poultries. Flies, that sit on the faeces of chicken, carry the bacteria with them for long distances. Colistin in the faeces spreads into the soil and surrounding water bodies, thus seeping into agricultural produce, grown in the area, as well as the water supply.
None of you are complaining, so government takes no action. No raids are done on poultries. No companies selling banned drugs are shut down. Three Ministries are responsible for this huge disaster that is already upon us : the Ministry for Animal Husbandry whose inspectors are corrupt and lazy and treat poultries as a second source of income, the Health Ministry who is doing nothing to check colistin use and the Environment Ministry which does nothing anyway.
So, colistin is hitting you in two ways : its regular use destroys the kidneys and makes your body toxic. So you have symptoms you cannot explain: skin that itches and fainting spells which are incorrectly attributed to anaemia. And when you fall sick, you cannot use colistin because you are immune to its beneficial effects. This puts a large part of our population at direct risk, as it rules out the use of the only antibiotic left in the doctor’s armoury.
With a population density like ours, even one person catching an antibiotic-resistant infection can lead to an epidemic. We are on the cusp of a public health disaster. The slow way is to generate awareness among consumers about the dangers of colistin. But what can they do? The government needs to act.
Poultry farms need to be ordered to immediately stop the use of colistin and all other antibiotics in their production systems. China has banned colistin use. In fact, England’s chief medical officer has called for a worldwide ban on the use of every antibiotic as a growth promoter in poultry. Antibiotics as growth promoters were banned in the E.U. in 2006, and made illegal in the U.S. in 2017. India has refused to do it, since profit making is more important than public interest.