The document discusses antimicrobial resistance (AMR) in India, including current challenges and strategies to address it. It provides an overview of AMR globally and in India, describing increasing resistance levels in many pathogens. It also outlines India's national policies and programs related to AMR containment, surveillance networks, and challenges such as inadequate community stewardship. Key mitigation strategies discussed are improving prescribing through antimicrobial stewardship programs in both hospitals and communities.

1. ANTI-MICROBIAL RESISTANCE:
CURRENT SCENARIO, FUTURE CHALLENGES AND
MITIGATING STRATEGIES IN INDIAN CONTEXT
Presenter- Dr. Yukti Bhandari, Senior Resident
Moderator- Dr. Vivek Sagar, Associate Professor
Department of Community Medicine and School of Public
Health, PGIMER, Chandigarh

2. Contents
• What is AMR?
• Current Global Scenario
• Indian Scenario
• Various challenges faced
• Mitigation strategies in place in India
• Discussion on new innovations

3. What is AMR?
Antimicrobial Resistance (AMR) occurs when
bacteria, viruses, fungi and parasites change over
time and no longer respond to medicines making
infections harder to treat and increasing the risk of
disease spread, severe illness and death.
Antimicrobial Resistance. Fact Sheet. World Health Organisation.

4. • The direct consequences of infection with
resistant microorganisms can be severe,
including
• longer illnesses and prolonged stays in hospital
• increased mortality
• loss of protection for patients undergoing
operations and other medical procedures
• increased costs
Global Action Plan on Antimicrobial Resistance, World Health

5. How does AMR Develop?

6. Spread of AMR

9. Detection of AMR
Phenotypic methods Genotypic methods
Relates only to the concentration of an
antimicrobial that inhibits bacterial growth in
vitro.
Provides the opportunity for accelerated
cultures, and may even be performed directly on
the clinical specimens.
They provide no indication of the mechanisms of
resistance which may disseminate to other
bacterial species.
These methods help assess the genetic makeup,
identify antimicrobial resistance genes and
understand the mechanism of resistance.
Time taken – 36-72 hours Time taken – 30 minutes - 8 hours
For eg. broth microdilution, disk diffusion,
gradient tests, agar dilution and breakpoint tests
etc.
For eg. Whole Genome Sequencing (WGS),
Nucleic acid amplification test, Polymerase Chain
Reaction (PCR), Fluorescent in-situ hybridisation
(FISH) etc.
Vasala A, Hytönen VP, Laitinen OH. Modern tools for rapid diagnostics of antimicrobial
resistance. Frontiers in Cellular and Infection Microbiology. 2020 Jul 15;10:308.

10. Global
Scenario
• WHO has declared AMR as one of the top 10 global
public health threats facing humanity.
• Misuse and overuse of antimicrobials are the main
drivers in the development of drug-resistant
pathogens.
• AMR has become a major threat to the treatment of
not only common bacterial infections, but also to
the treatment of -
• Fungal infections like Candida
• Parasitic diseases like malaria
• Viral diseases like HIV
• Important public health threats like Tuberculosis
Anti-microbial resistance, WHO Fact Sheet

11. Global Antimicrobial Resistance and Use Surveillance System
(GLASS)
• Launched by the World Health Organization (WHO) in 2015 to
support the strengthening of the antimicrobial resistance (AMR)
evidence base, the Global Antimicrobial Resistance and Use
Surveillance System (GLASS) is the first system that enables
harmonized global reporting of official national AMR and
antimicrobial consumption (AMC) data.

12. GLASS enrolment map as on 30 April 2021
Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report, 2022

13. AMR and
Sustainable
Development
Goals
• In 2020, two new AMR indicators were included in
the monitoring framework of the SDGs linked to the
health target 3.d (“strengthen the capacity of all
countries, in particular developing countries, for
early warning, risk reduction and management of
national and global health risks”).
• These indicators monitor proportion of bloodstream
infections (BSIs) due to:
• Escherichia coli resistant to 3rd generation
cephalosporins
• Methicillin-resistant Staphylococcus
aureus (MRSA)

14. ResistanceMap: Antibiotic resistance. Sourced from GLASS 2019.

15. All-age rate of deaths attributable to and associated
with bacterial antimicrobial resistance by GBD region
2019
Murray CJ, Ikuta KS, Sharara F,
Swetschinski L, Aguilar GR, Gray A
et al. Global burden of bacterial
antimicrobial resistance in 2019: a
systematic analysis. The Lancet.
2022 Feb 12;399(10325):629-55.
1·27 million deaths
47,600 DALYs

16. Global Action Plan on Anti-Microbial Resistance
In May 2015, World Health Assembly adopted a global action
plan on antimicrobial resistance, which outlines five objectives:
To improve awareness and understanding of antimicrobial resistance
through effective communication, education and training
To strengthen the knowledge and evidence base through
surveillance and research
To reduce the incidence of infection through effective sanitation,
hygiene and infection prevention measures
To optimize the use of antimicrobial medicines in human and animal
health
To develop the economic case for sustainable investment that takes
account of the needs of all countries and to increase investment in new
medicines, diagnostic tools, vaccines and other interventions.

17. Indian Scenario
Antibiotic % Resistance (with 95% C.I.)
Aminopenicillins 87% (83-90%)
Fluroquinolones 86% (85-87%)
Cephalosporins 3rd Gen 83% (82-84%)
Amoxicillin-clavulanate 60% (51-69%)
Carbapenems 41% (38-44%)
Piperacillin-tazobactam 28% (26-30%)
Aminoglycosides 17% (15-19%)
Data from GLASS. ResistanceMap. https://resistancemap.onehealthtrust.org/AntibioticResistance.php
AMR in Human Beings:
Resistance of E. coli to Antimicrobials in India
More than 70% isolates of Klebsiella pneumoniae and Acinetobacter baumannii and 50% of
Pseudomonas aeruginosa were also resistant to fluoroquinolones and third generation
cephalosporins.

18. Indian
Scenario
AMR in Animals and Food:
• 48% of Gram-negative bacilli detected in cow and buffalo
milk were extended-spectrum β-lactamases (ESBL)
producers (West Bengal) and 47.5 per cent were resistant
to oxytetracycline (Gujarat).
• Vibrio cholera and V. parahaemolyticus, isolated from the
retail markets of shrimps, shellfish and crabs in Kerala
were 100 per cent resistant to ampicillin, while resistance
to ceftazidime ranged from 67 to 96 per cent.
• In the poultry industry, presence of ESBL producers vary
from 9.4% in Odisha to 33.5% in Madhya Pradesh to 87%
in Punjab.
• Salmonella species in broilers varied from 3.3% in Uttar
Pradesh to 23.7% in Bihar with 100% isolates being
resistant to ciprofloxacin, gentamicin and tetracycline in
Bihar and West Bengal.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.

19. Indian
Scenario
AMR in the Environment
• The groundwater and surface water that are used for
drinking and recreational purposes have been reported
with 17% of E. coli, resistant to third generation
cephalosporin, in central India, 7% in Kashmir, 50% in
Sikkim and 100% in Hyderabad.
• The rate of isolation of E. coli resistant to third generation
cephalosporin at water treatment plants was 25, 70 and
95% when the inlet to the plant was domestic water
alone, domestic waste along with hospital effluent and
hospital effluent alone, respectively.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.

20. Development of AMR related policies in India
2010
• Establishment of
National Task Force on
AMR Containment
2011
• Situation Analysis of
AMR
• National Policy on
AMR Containment
• Jaipur Declaration on
AMR containment
• National Programme
on AMR Containment
(12th FYP)
2012
• National Program on
Antimicrobial
Stewardship,
Prevention of Infection
and Control (ASPIC) by
ICMR
2013
• National AMR
Surveillance Network
by NCDC and ICMR

21. Timeline and Development of AMR in India
2014
• Inclusion of antibiotics in
Schedule H1 category to
avoid non-prescription sales
of antibiotics
2016
• Launch of the Red Line
Campaign on Antibiotics to
create awareness regarding
rational usage of antibiotics
• National Treatment
Guidelines for Antimicrobial
Use in Infectious Diseases
by NCDC
2017
• National Action Plan for
Containment of AMR
• Delhi Declaration on AMR
• The Food Safety and
Standards (Contaminants,
Toxins and Residues)
Regulations in food animals

22. Timeline and Development of AMR in India
2018
• Kerala Antimicrobial
Resistance Strategi Action
Plan
2019
• Treatment guidelines for
Antimicrobial Use in
Common Syndromes by
ICMR
• Madhya Pradesh State
Action Plan for
Containment of
Antimicrobial Resistance
2020
• National Guidelines for
Infection Prevention and
Control in Healthcare
Facilities
• State Action Plan to
combat Antimicrobial
Resistance in Delhi
2021
• Standard Operating
Procedures for National
Programme on
Antimicrobial Resistance
Containment
• Launch of One Health
Consortium

23. National
Programme
on AMR
Containment
(2012-2017)
Objectives of this programme were:
• Establish a laboratory-based AMR surveillance
system in the country to generate quality data on
antimicrobial resistance
• Carry out surveillance of antimicrobial usage in
different health care settings
• Strengthen infection control practices and promote
rational use of antimicrobials through Antimicrobial
stewardship activities
• Generate awareness amongst health care providers
and community on antimicrobial resistance and
rational use of antimicrobials.
National Centre for Disease Control, 2012

24. National Health Policy 2017
The problem of anti-microbial resistance calls for a -
• Rapid standardization of guidelines regarding antibiotic use
• Limiting the use of antibiotics as Over-the-Counter medication
• Banning or restricting the use of antibiotics as growth promoters
in animal livestock.
Pharmacovigilance including prescription audit inclusive of
antibiotic usage, in the hospital and community, is a must in order
to enforce change in existing practices.
The policy also includes AMR as one of areas where the private
sector could play an active role in through use of the corporate
social responsibility platform.

25. National Action Plan on Antimicrobial Resistance
(NAP-AMR) 2017 – 2021
The following are the specific objectives of the NAP-AMR:
1.Define the strategic priorities, key actions, outputs,
responsibilities, and indicative timeline and budget to slow
the emergence of AMR in India and strengthen the
organizational & management structures to ensure intra- &
inter-sectoral coordination with a One Health approach;
2.Combat AMR in India through better understanding and
awareness of AMR, strengthened surveillance, prevention
of emergence and spread of resistant bacteria through
infection prevention and control, optimised use of
antibiotics in all sectors, and enhanced investments for AMR
activities, research and innovations;
3.Enable monitoring and evaluation (M&E) of the NAP-AMR
implementation based on the M&E framework.

27. STATE ACTION PLAN FOR CONTAINMENT OF ANTIMICROBIAL RESISTANCE

28. National Programme on
Antimicrobial Resistance
Containment
• This guidance document defines standards for
antimicrobial susceptibility testing, data
collection and reporting processes for sites
participating in the AMRSN co-ordinated by the
NCDC.
• It provides guidelines to ensure consistent AST
procedures and systematic AMR surveillance data
reporting from sites across the network.

29. India's Antimicrobial Resistance Surveillance &
Research Initiative
India’s Antimicrobial Resistance Surveillance & Research Initiative https://iamrsn.icmr.org.in/index.php/about
The Indian Council of Medical Research (ICMR) has been
supporting research on antimicrobial resistance through
the Antimicrobial Resistance Research & Surveillance
Network (AMRSN) since 2013.
Data collected from the network is used to track resistance
trends and to better understand mechanisms of resistance
in the key priority pathogens using genomics and whole
genome sequencing (WGS).
The data collected from the network has enabled
compilation of drug resistance data on six pathogenic
groups on antimicrobial resistance from the country.

30. Annual Report, Anti-microbial Resistance Research and Surveillance Network, 2021

31. Antimicrobial
Resistance
Research &
Surveillance
Network
Under AMRSN, there are nodal centres (NCs) for each
pathogenic group in four tertiary care hospitals from the
country.
• Enterobacterales causing sepsis (PGIMER, Chandigarh)
• Fungal pathogens (PGIMER, Chandigarh)
• Gram-positives: staphylococci and enterococci,
(JIPMER, Puducherry)
• Typhoidal Salmonella (AIIMS New Delhi)
• Diarrhoeagenic bacterial organisms (CMC Vellore)
• Streptococcus pneumoniae (CMC Vellore)
• Gram-negative non-fermenters (CMC Vellore)
Annual Report, Anti-microbial Resistance Research and Surveillance Network, 2021

32. NARS-NET
• Under the National Programme on AMR
Containment, National AMR Surveillance
Network has been established which is a
network of state medical college
laboratories from across the country for
generating AMR surveillance data through
a sentinel surveillance system.
• MoHFW identified NCDC in July 2017 as
the National coordinating centre for AMR
surveillance.

33. Challenges in
AMR
Surveillance
Network in India
Not representative of entire country; Reflection of tertiary care settings and
not the general community
High antibiotic use in the community and inadequate implementation of
measures to curb sale of over-the-counter antimicrobials; Prior antibiotic
exposure data difficult to capture
Continued training support for the staff in order to undertake quality
antimicrobial susceptibility testing (AST) and surveillance
Funding to sustain the quality data over a long period
Limited access to clinical pharmacists
Physician immunity to changes regarding stewardship policies
Data sharing and private sector involvement
Walia K, Madhumathi J, Veeraraghavan B, Chakrabarti A, Kapil A, Ray P, Singh H,
Sistla S, Ohri VC. Establishing Antimicrobial Resistance Surveillance & Research
Network in India: Journey so far. Indian J Med Res. 2019 Feb;149(2):164-179. doi:
10.4103/ijmr.IJMR_226_18. PMID: 31219080; PMCID: PMC6563732.

34. Antimicrobial
prescribing
facts: The 30%
Rule
30% of all hospitalized in-patient at any given
time receive antibiotics.
Over 30% of antibiotics are prescribed
inappropriately in the community.
Up to 30% of all surgical prophylaxis is
inappropriate.
30% of hospital pharmacy costs are due to
antimicrobial use.
10-30% of antimicrobial cost can be saved by
antimicrobial stewardship programs.
Antimicrobial Stewardship Program Guidelines. ICMR

35. Antimicrobial
Stewardship
• Coordinated interventions
designed to improve and
measure the appropriate use
of antimicrobial agents by
promoting the selection of
the optimal antimicrobial
drug regimen including
dosing, duration of therapy,
and route of administration.
Antimicrobial Stewardship Program Guidelines. ICMR

36. Components
of
Antimicrobial
Stewardship
Program
Antimicrobial Stewardship Program Guidelines. ICMR

37. Antimicrobial
Stewardship in
Community Settings
• Antimicrobial stewardship in community settings is
required to help out health care practitioners which
are often compelled to treat empirically and to prevent
use of unregulated drugs approved in the community
and to prevent self medication and antibiotics on over
the counter.
• The core elements of AMSP in primary care OPDs and
community settings includes:
• Accountability for optimizing antibiotic prescription
• Use of evidence based diagnostic criteria and
treatment recommendation
• Self-evaluate antibiotic prescribing practices
• Use effective communication strategy to educate
patients.
Antimicrobial Stewardship Program Guidelines. ICMR

38. Standard Operating Procedures from ICMR
• External Quality Assessment
Scheme (EQAS)
• Bacteriology
• Mycology
• Veterinary practices
• Rational Prescribing guidelines
• Hospital Infection Control
guidelines

39. Factors behind acceleration of AMR in India
• Huge burden of infectious diseases
• Poor sanitation, poor implementation of infection control practices
• Close animal-human interface
• Lack of infectious disease specialists
• Lack of diagnostics
• Absence/non-adherence to standard treatment guidelines
• Irrational self-administration or prescription
• Drugs available without prescription
• Poor quality of drugs
Advancing Antimicrobial Stewardship. ICMR

40. AMR in HIV
To minimize the emergence and transmission of drug resistant HIV, WHO recommends that
ART and pre-exposure prophylaxis (PrEP) programmes be accompanied by measures to
monitor the quality of ART and PrEP delivery and the routine surveillance of HIV drug
resistance.
Nevirapine (NVP) or efavirenz (EFV)-based regimens were the most frequent ART regimens
initiated in 16 of 20 countries reporting survey findings to WHO (2014–2020). In 21 of 30
surveys reported, pretreatment drug resistance to NVP or EFV in populations initiating first-
line ART exceeded 10%.
The high levels of observed pretreatment drug resistance to NVP or EFV emphasize the
need to fast-track the transition to the integrase strand-transfer inhibitor dolutegravir
(DTG)-based first-line regimens in accordance with WHO recommendations
HIV Drug Resistance Report 2021

41. AMR in Malaria
Chloroquine-resistant P. falciparum first developed independently in three to
four areas in Southeast Asia, Oceania, and South America in the late 1950s
and early 1960s.
P. falciparum has also developed resistance to nearly all of the other
currently available antimalarial drugs, such as sulfadoxine pyrimethamine,
mefloquine, halofantrine, and quinine.
Most recently, resistance to the artemisinin and non-artemisinin
components of artemisinin-based combination therapy has emerged in parts
of Southeast Asia, impacting the efficacy of this vital antimalarial class.
Drug Resistance in the Malaria-Endemic World. CDC. 2018

42. AMR in Tuberculosis
Global Tuberculosis Report, 2022. WHO.

43. AMR in Tuberculosis
• The first national anti-tuberculosis drug
resistance survey (NDRS) revealed that 28% of TB
patients were resistant to any drugs (22% among
new and 36.82% among previously treated).
• MDR-TB was 6.19% among all TB patients with
2.84% among new and 11.60% (CI 10.21–13.15%)
among previously treated TB patients.
• In 2021, 48,232 MDR/RR-TB patients were
diagnosed.
• 8,455 Pre-XDR-TB, 376 XDR-TB and 13,724 H
mono/poly patients were diagnosed.

44. Mitigation Strategies
Uchil RR, Kohli GS, Katekhaye VM, Swami OC. Strategies to combat
antimicrobial resistance. J Clin Diagn Res. 2014 Jul;8(7):ME01-4.

45. Role of Surveillance in AMR
• Cornerstone for assessing
the spread of AMR.
• Inform local, national and
global strategies.
• Inform infection prevention
and control responses.
• Monitor the impact of
local, national and global
strategies.
WHO. Initiatives. GLASS. WHO. Initiatives. GLASS

46. WHO AWaRe Tool
• The AWaRe Classification of antibiotics was developed in 2017 by the
WHO Expert Committee on Selection and Use of Essential Medicines
as a tool to support antibiotic stewardship efforts at local, national
and global levels.
• Antibiotics are classified into three groups, Access, Watch and
Reserve, taking into account the impact of different antibiotics and
antibiotic classes on antimicrobial resistance, to emphasize the
importance of their appropriate use.
• It is a useful tool for monitoring antibiotic consumption, defining
targets and monitoring the effects of stewardship policies that aim to
optimize antibiotic use and curb antimicrobial resistance.
2021 AWaRe Classification. https://www.who.int/publications/i/item/2021-aware-classification

47. 2021 AWaRe Classification Tool

49. Steps of rational
antimicrobial use
• Making a clinical diagnosis
• Limiting empiric antimicrobial therapy
• Know your bugs
• Choose appropriate antimicrobial
• De-escalation/Modification
• Identify clinical situations where antimicrobial use
needs to be stopped
• Reduce duration of therapy
• Optimize pharmacodynamics and
pharmacokinetics

50. Strategies to improve Antimicrobial Use
Front-end strategies:
• Antimicrobials are made available through an approval process (formulary
restriction and preauthorization)
• Shows immediate reduction in use and expenditure of restricted antibiotics
Back-end strategies:
• Antimicrobials are reviewed after antimicrobial therapy has been initiated
(prospective audit and feedback)
• Timely de-escalation of antibiotics
• Reduction in inappropriate use
Principles of Antimicrobial Prescribing. CMC Vellore & WHO

51. Strategies to improve Antimicrobial Use
Advantages Disadvantages
Pre-
authorization
• Reduces empiric initiation of
inappropriate Antimicrobials
• Encourages early and frequent review
of culture data
• Reduces costs
• May delay therapy
• Loss of prescriber
autonomy
• Impacts only restricted
agents
Prospective
Audit &
Feedback
• Visibility of the stewardship is increased
• More data is available and hence
uptake is better
• Educative and collaborative effort
which could address de-escalation and
duration of therapy
• Prescriber autonomy is maintained
• Labor intensive
• Compliance voluntary and
prescriber reluctance to
change if patient better
Principles of Antimicrobial Prescribing. CMC Vellore & WHO

52. Antimicrobial Stewardship in PGIMER
Shafiq N, Kumar MP, Kumar G, Rohilla R,Saha S, Gautam V, Agarwal R, Ray P, Singh G, Muralidharan J,Arora P. Antimicrobial Stewardship Program of
PostgraduateInstitute of Medical Education and Research, Chandigarh:Running Fast to catch the Missed Bus. J Postgrad Med EduRes 2017;51(3):123-127

53. Infection Prevention
and Control
Guidelines

54. Way forward

55. Priority 1 -
Stepping up
leadership for
the AMR
response
WHO Strategic Priorities on AMR. 2022

56. Priority 2 – Driving public health
impact in every country to address
AMR
• National AMR action plans in 148
countries
• Practical guidance and tools to
member countries
• Annual World Antimicrobial
Awareness Week (18-24 November)
– the theme for 2022 was
“Preventing Antimicrobial
Resistance Together”.
WHO Strategic Priorities on AMR. 2022

57. Strategic Priorities
Priority 3 – Research and Development for better access to quality AMR
prevention and care
• Development of priority bacterial and fungal pathogen lists
• List of Critically Important Antimicrobials for Human Medicine
Priority 4 – Monitoring AMR burden and global AMR response
• GLASS
• Tripartite AMR Country Self Assessment Survey (TrACCS)
WHO Strategic Priorities on AMR. 2022

58. Antimicrobial Resistance: A complex multi-factorial problem requiring orchestrated
interdisciplinary response. From the Australian Academy of Science Report. 2017

59. One Health Consortium
• The Department of Biotechnology under the Ministry of Science and Technology, has
launched the country’s first One Health consortium.
• This Consortium consists of 27 organisations from human, veterinary and related
environmental fields.
• It envisages carrying out surveillance of important bacterial, viral and parasitic infections
of zoonotic and transboundary pathogens in India.
• It also looks into the use of existing diagnostic tests and the development of additional
methodologies for the surveillance and understanding the spread of emerging diseases.
• There exists a need to make mitigation of AMR as one of the priorities of the One Health
Consortium.
Press Information Bureau, Ministry of Science and Technology, GoI, Dec 2021

60. TrACCS Country Report 2022 - India
Tracking AMR Country Self Assessment Survey (TrACSS) 2022 Country Report

61. Innovations
Kumar M, Sarma DK, Shubham S, Kumawat M, Verma
V, Nina PB, Jp D, Kumar S, Singh B, Tiwari RR. Futuristic
non-antibiotic therapies to combat antibiotic
resistance: A review. Frontiers in microbiology. 2021
Jan 26;12:609459.

62. Application of Synthetic Antimicrobials in AMR

63. Artificial Intelligence in AMR
• Development of synthetic antimicrobial peptides using AI
• A class of small host defense peptides, found in all classes of biological species.
• AI guided discovery and development of new antibiotics
• Discovery of new and structurally different antibiotics from the ones already known using AI.
• Assisting in appropriate antibiotic prescription
• Appropriate therapy selection, dose, and correct administration route
• Prediction of antibiotic resistance
• ML techniques to predict early AMR or the probability of a microbial agent becoming resistant
• Prediction of severity of infection
• Machine/deep learning tools for infectious pathology recognition and appropriate management
Rabaan AA, Alhumaid S, Mutair AA, Garout M, Abulhamayel Y, Halwani MA et al. Application of Artificial
Intelligence in Combating High Antimicrobial Resistance Rates. Antibiotics (Basel). 2022 Jun 8;11(6):784.

64. Future directions for India
Promoting further research on the drivers of AMR with due importance to components other than
antimicrobial use for human health alone.
Framing of antibiotic stewardship plans for healthcare settings to monitor and ensure judicious use of
antimicrobials, including all tiers of healthcare - primary health centres, secondary and tertiary hospitals.
Strict vigilance and control over sale of antimicrobial agents.
Prescription audit to bring down the over the counter (OTC) sale.
Disciplinary control over the functioning of hospital effluent plants with periodic assessment and
reporting of antimicrobial residue in the discharge.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.

65. Future directions for India
Regulation of wastewater discharges from pharmaceutical companies with regular monitoring
of antimicrobial residues in them along with provision of legislative support to punish offenders
Framing and implementing rules and regulations for the use of antimicrobial agents in food
animals including farmed seafood
Improving agricultural practices by ensuring use of environment-friendly manure and fertilizers
Educating the masses at the community level regarding AMR and formulating educational
bodies/non-governmental organizations for continued dissipation of information.
Taneja N, Sharma M. Antimicrobial resistance in the environment: The Indian scenario. Indian J Med Res.
2019 Feb;149(2):119-128. doi: 10.4103/ijmr.IJMR_331_18. PMID: 31219076; PMCID: PMC6563737.

66. AMR and GoI Initiatives
• ICMR has initiated antibiotic stewardship program (AMSP) on a pilot project basis in 20 tertiary care
hospitals across India to control misuse and overuse of antibiotics in hospital wards and ICUs.
• DCGI has banned 40 fixed dose combinations (FDCs) which were found inappropriate.
• ICMR worked in collaboration with Indian Council of Agriculture Research, Department of Animal
Husbandry, Dairy and Fisheries and the DCGI to ban use of Colistin as growth promoter in animal
feed in poultry.
• Various IEC activities like public conclave, poster and quiz competitions have been conducted by
National Centre for Disease Control (NCDC) in schools, colleges and Health melas to create
awareness about AMR, its containment & prevention and judicial use of antibiotics among the
common public.
• To raise awareness among the community and the health care providers, communication material
includes posters, videos and radio jingles has been developed with emphasis on prevention of
irrational use of antibiotics during viral-illnesses and also on infection prevention through hand
hygiene to prevent spread of infections.
Press Information Bureau. MOHFW. GoI. 5 Aug 2022

68. AMR and
PGIMER
• WHO-AGISAR Monitoring the Antimicrobial Resistance Profile of Bacterial
Food-borne Pathogens in Humans, Food Animals and Retail Meat in India.
• 2017-21 ICMR-AIIMS-CDC India Collaborative Project: Capacity Building and
Strengthening of Hospital Infection Control to detect and prevent
antimicrobial resistance in India
• 2019 PHFI Project: Antimicrobial resistance and zoonotic transmission in
enteric bacteria at human and animal interface in an intensive food
production geographic area
• Nodal centre for surveillance of Enterbacterales causing sepsis & fungal
pathogens.

69. THANK YOU