A study conducted by Princeton University reports a 36 per cent rise in antibiotic use globally in the last 10 years – except in India, which shows a rise of 62 per cent and is now the largest consumer of antibiotics in the world.
If these antibiotics were being consumed directly by people, a public campaign could curtail it. But 70 per cent of these are fed to chickens that are then fed to Indians. This is an extremely dangerous situation.
When one is consistently exposed to an antibiotic, the body develops resistance to it. If a person has been eating affected chicken frequently, then when he really falls sick, antibiotics will have no effect on him. Thus his body now has the superbug that cannot be removed by an antibiotic.
It is predicted that in a few years antibiotic resistant bacteria will have killed 1 crore people globally and 47 lakh from Asia. In India most antibiotics have stopped working on people, thus new antibiotics are needed, but they are not easy to discover. Only two new antibiotics have been approved in the past 10 years, and one of these – ceftaroline – has already started facing resistance.
Doctors now resort to antibiotics that were used fifty years ago as “last resort” drugs – drugs that would otherwise not be recommended are now viable alternatives, as people have not yet developed resistance to them. One such antibiotic is colistin or polymyxin E, 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 judiciously 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 in Indian hospitals in Delhi and Pune have shown that 5 per cent of patients admitted after outbreaks of severe bacterial infection are resistant to colistin. A recent example from China can help demonstrate this: 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 has happened in India as well. When colistin fell out of favour for human use in the 1980s, the companies manufacturing sold 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 openly advertise products containing colistin as a growth promoter for animals. Two companies manufacture colistin locally. We are importing over 150 tonnes of it every year.
The unchecked use of colistin in Indian poultry farms is rampant because they keep their chickens in small battery cages. As reported in the Law Commission report on poultries, 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 cram 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 through chicken (and pig), 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.
No one is complaining, so government takes no action. No raids are done on poultries. No companies selling banned drugs are shut down. 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. Poultry farms need to immediately ban 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 EU in 2006, and made illegal in the US in 2017. India has refused to do it, since profit making is more important than public interest.