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Operation AMRITH (Antimicrobial Resistance Intervention for Total Health)

Why is it in the news?

  • The Kerala Drug Control Department launched Operation AMRITH as a strategic intervention to tackle the growing concern of antimicrobial resistance (AMR) by preventing the overuse of antibiotics in the state.


  • The initiative stems from the regulatory framework introduced by the Indian government in 2011, known as the H1 rule, which aimed to regulate the over-the-counter (OTC) sales of antibiotics.
  • Initially, the H1 rule restricted the sale of all antibiotics without a prescription, recognizing the need to curb the indiscriminate use of these drugs.
  • However, in 2013, the rule underwent an amendment, allowing the OTC sale of first-line antibiotics while restricting access to second- and third-line antibiotics without a prescription.
  • Operation AMRITH seeks to reinforce the original intent of the H1 rule by mandating that individuals obtain a doctor’s prescription for acquiring any class of antibiotics, thereby curbing the misuse and overuse of these medications.
Antimicrobial Resistance (AMR)

·       AMR is a global health threat that occurs when microorganisms such as bacteria, viruses, fungi, and parasites develop resistance to antimicrobial drugs.

·       This resistance renders these drugs ineffective in treating infections, leading to prolonged illnesses, increased risk of disease transmission, severe complications, and even death.

·       Statistics indicate that nearly 700,000 people succumb to AMR-related infections annually, with projections estimating a staggering increase to as many as 10 million deaths by 2050 if urgent measures are not implemented to address this issue.

 Causes for Antimicrobial Resistance

·       Overuse and Misuse of Antibiotics: One of the primary drivers of AMR is the excessive and inappropriate use of antibiotics in both humans and animals. This includes obtaining antibiotics without a prescription, not completing the full course of prescribed antibiotics, and using antibiotics for non-bacterial infections.

·       Inadequate Dosage and Duration: Incorrect usage of antibiotics, such as taking them in incorrect dosages or for shorter durations than recommended, can lead to incomplete eradication of targeted microorganisms, enabling surviving bacteria to develop resistance.

·       Self-Medication: Self-prescription and usage of antibiotics without proper medical guidance contribute significantly to the misuse of these drugs.

·       Antibiotics Consumption in Food-Animals: The practice of using antibiotics as growth promoters in food animals and poultry further exacerbates the development of AMR, as it allows for the transmission of resistant bacteria through the food chain.

·       Unavailability of Laboratory Facilities: Limited access to accurate infection diagnosis due to inadequate laboratory facilities results in unnecessary antibiotic prescriptions, contributing to the emergence of AMR.

 Challenges Posed by AMR

·       Threat to Public Health: AMR poses a significant threat to the successful treatment of infectious diseases, organ transplantation, cancer chemotherapy, and major surgeries.

·       Increased Healthcare Costs: The emergence of AMR results in heightened healthcare costs, especially concerning the use of high-order drugs or second-line expensive antibiotics, which can push treatment expenses beyond the reach of many individuals.

·       Environmental Contamination: Poor sanitation practices lead to the contamination of water bodies with antibiotic residues and antibiotic-resistant organisms, further perpetuating the cycle of AMR.


Global Efforts against Antimicrobial Resistance

·       Global Action Plan on Antimicrobial Resistance (GAP): Nations worldwide have committed to the GAP framework, which emphasizes the development and implementation of multisectoral national action plans to address AMR.

·       World Antimicrobial Awareness Week (WAAW): A global campaign aimed at raising awareness about AMR and its implications on a worldwide scale.

·       Global Antimicrobial Resistance and Use Surveillance System (GLASS): Launched by the World Health Organization (WHO) in 2015, GLASS aims to fill knowledge gaps and inform strategies related to AMR.

·       Global Antibiotic Research and Development Partnership (GARDP): A collaborative initiative between WHO and the Drugs for Neglected Diseases Initiative (DNDi), GARDP promotes research and development efforts to address AMR by fostering public-private partnerships.

·       Country-Wise Initiatives: Various nations have implemented initiatives such as the $1 billion AMR Action Fund, patient education campaigns, regulatory reforms, and livestock management strategies to combat AMR effectively.

Measures Taken in India

·       National Action Plan on Antimicrobial Resistance (NAP-AMR): India has adopted a One Health approach through the NAP-AMR, which involves various stakeholders from different ministries and departments.

·       Establishment of AMR Surveillance Network: The Indian Council of Medical Research (ICMR) has set up the AMR surveillance and research network (AMRSN) to monitor trends and patterns of drug-resistant infections in the country.

·       India’s Red Line Campaign: A proactive initiative to mark prescription-only antibiotics with a red line, aimed at discouraging their over-the-counter sale.

·       Guidelines by FSSAI: The Food Safety and Standards Authority of India (FSSAI) has set guidelines to limit the use of antibiotics in food products to mitigate the risk of AMR.

·       Inclusion in National Health Policy: Antimicrobial resistance has been recognized as a key healthcare issue in India’s National Health Policy, 2017, which prioritizes the development of guidelines for antibiotic use and surveillance measures.

·       National Antibiotic Consumption Network (NAC-NET): A network established to compile data on antibiotic consumption in health facilities and facilitate informed decision-making regarding antibiotic usage.


·       Addressing AMR requires a comprehensive approach that encompasses improvements in public health infrastructure, sanitation facilities, and governance.

·       While enforcing regulations on over-the-counter antibiotic sales is a significant step, combating AMR necessitates multifaceted strategies, including reforms in physicians’ prescribing practices and mandatory reporting of healthcare-associated infection rates in hospitals.

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