E-DRUG: Pharmaceutical Waste & antimicrobial resistance- the need for global action
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Dear e-druggers,
There is an interesting correspondence from The Lancet Infectious
Diseases on " Pharmaceutical waste and antimicrobial resistance*"**, *which
might be of interest to you. Please see the link to the full paper:
http://www.sciencedirect.com/science/article/pii/S1473309917302682
Ahmad A, Patel I, Khan MU, Babar ZU
Pharmaceutical waste and antimicrobial resistance. Lancet Infect Dis.
<https://www.ncbi.nlm.nih.gov/pubmed/28555576>
2017 Jun;17(6):578-579. doi:
10.1016/S1473-3099(17)30268-2.
On Sept 21, 2016, the United Nations called a meeting on antimicrobial
resistance with policymakers to address antimicrobial resistance
comprehensively and multisectorally.1
An estimated 700 000 people around the world die each year from drug-resistant
strains of common bacterial infections, tuberculosis, and malaria,2
and total global deaths caused by antibiotic-resistant infections are estimated
to reach 10 million per year by 2050, with economic losses exceeding US$100
trillion.
Thus, the recent discovery of drug resistant bacteria at several
pharmaceutical manufacturing sites in three Indian cities - Hyderabad, New
Delhi, and Chennai - is concerning. Of 34 sites tested, 16 were found to be
harbouring bacteria resistant to antibiotics.3
At four of these sites, resistance to three major classes of antibiotics was
detected, including carbapenems. The pharmaceutical companies involved
export antibiotics to several countries including high-income nations such
as the UK, USA, and France.3
In India, regulations for the release of pharmaceutical waste into rivers
or the environment are minimal.4 Waste fluid containing active pharma-ceutical ingredients from antibiotic manufacturing plants is released into the surrounding soil and water, and this process perhaps favours the selection of resistant organisms.3
Moreover, sewage treatment plants in India, which are supposed to purify water, are
in poor shape, in need of constant repairs, and used beyond their limits.5
Upon purification by these sewage water plants, water can still be contaminated
with antibiotic-resistant bacteria that can pose a serious threat to public
health.4
We suggest that regulations should be imposed on pharmaceutical
manufacturing units operating in India, which are contributing to the
spread of antimicrobial resistance.3
India is a major producer of generic medications and active pharmaceutical
ingredients (APIs). Lenient regulations can affect India's relationships
with high-income countries in Europe and North America, which are the major
importers of the country's medications and APIs. Indian practitioners run
several antimicrobial stewardship programmes to combat antimicrobial
resistance and their efforts are undermined by the questionable practices
of the pharmaceutical manufacturing units.3
Public availability of information about the origin of APIs and evidence of
good manufacturing practice compliance of the manufactured APIs imported by
the European Union and the USA can improve transparency. WHO good
manufacturing practice guidelines for workplace safety, environmental
protection, pollution prevention, and adoption of cleaner production
technology should be adopted and enforced consistently for all the
countries that are responsible for antimicrobial resistance.
Many thanks,
Best Regards
Akram Ahmad
Editor-in-chief:
Journal of Pharmacy Practice and Community Medicine (www.jppcm.org)
Akram Ahmad, PharmD, BPharm
Department of Clinical Pharmacy,
UCSI University, Kuala Lumpur, Malaysia
Akram Ahmad <akrampharma67@gmail.com>