Message from Co-ordinator’s desk
“A roadmap to tackle the challenge of antimicrobial resistance”, was the first ever joint meeting of medical societies in India addressing antibiotic resistance, held in Chennai in August 2012. The high antimicrobial resistance rate in the country and the inspiration received from the on-going international efforts prompted Indian doctors to organise the Chennai meeting. Considering the large number of medical societies in India, ensuring participation of all major societies, as well as representatives from of governmental bodies such as the office of Drugs Controller General of India, Medical Council of India, National Accreditation Board of Hospitals, Indian Council of Medical Research, was a major achievement. The efforts resulted in a strategy of Indian medical societies and policy makers to combat the serious menace of antimicrobial resistance in the country.1,2Shortly after the meeting, representatives of major societies joined together to compile a consensus document on tackling antimicrobial resistance.
“The Chennai Declaration” named after the city where the meeting took place, is the consensus evolved out of the meeting and co-authored by representatives of various medical societies. The document is based on realistic goals and objectives, with a deep understanding of the background Indian scenario. Over the last decade or two, the Indian health-care infrastructure underwent significant changes. While possessing many world-class corporate hospitals and institutes, the facilities available in many villages and remote areas are still vastly inadequate. Medication including antibiotics may be purchased over the counter and/or are prescribed by practitioners from alternative medical branches and healers. Formulating and implementing an antimicrobialstewardship program in one of the largest countries, with an enormously heterogenic and diverse health-care system, is indeed a huge challenge. Strict control on over
the counter sale (OTC) as well as in hospital antibioticusage should be the first steps of the policy. Whether such a policy is implementable on the Indian subcontinent is an issue that warrants serious debate. The lack of (qualified) doctors in many remote places possibly makes the complete ban of OTC antibiotics throughout the country obsolete. Consequently, a targeted strategy of absolute control in densely populated areas, where qualified doctors will be available, and a more liberal approach in remote places, with monitoring of a selected list of oral antibiotics, should be more feasible.1,2
India needs an ‘implementable policy’ and not a ‘perfect policy’ was the slogan and the motto of the Declaration. Concrete recommendations followed, including a plan of action with clear and practical suggestions, to be carried out by all stakeholders. There were calls to the Indian Ministry of Health to formulate a national policy, the Drugs Controller’s office to urgently implement recommendations on over-the-counter and in-hospital antibiotic usage, the Medical Council of India to reform training on infectious diseases and antibiotic usage, medical societies to launch joint action to realise the recommendations, media to spread the message on sensible antibiotic usage, the WHO to take an active initiative in co-ordinating tackling resistance activities in various continents and, last but not least, doctors as individuals to carry out their responsibility to prescribe rationally and sensibly.3,6
Chennai declaration has already been studied by the Indian Ministry of Health and decided to incorporate all major recommendations in the new antibiotic policy being prepared by the Ministry.Other countries in the Indian subcontinent and many in other continents share more or less similar resistance statistics and prescription habits as that of India. The ‘Chennai Declaration’ should serve as an inspiration to medical communities of these countries to initiate an action plan and to communicate with various stakeholders with perseverance to get the recommendations implemented.3,6
Let us unite or perish!
Dr Abdul Ghafur MD MRCP FRCPath
Coordinator, Chennai Declaration
drghafur@hotmail.com
1.GhafurA,MathaiD,MuruganathanA,JayalalJA, KantR, ChaudharyD,etal. ‘The Chennai Declaration’: recommendations of ‘A roadmap to tackle the challenge of antimicrobial resistance’—a joint meeting of medical societies of India. Indian Journal of Cancer 2013 [Epub ahead of print]
http://www.indianjcancer.com/ preprintarticle.asp?id=104065 [cited 25.01.13].
2. Voss and Ghafur: “The Chennai declaration” – Indian doctors’ fight against antimicrobial resistance. Antimicrobial Resistance and Infection Control 2013 2:7.
3.A. Ghafur . ‘The Chennai Declaration’: An Indian perspective on the antimicrobial resistance challenge.
Journal of Global Antimicrobial Resistance 1 (2013) 5–6
4.Hopkins S. Improving antimicrobial stewardship and surveillance: the Chennai Declaration. BMJ 2013;346:f591.
5.Goossens H. The Chennai declaration on antimicrobial resistance in India. The Lancet Infectious Diseases 2013;13:105–6.
6. Mitka M. Indian public health leaders move to reduce antimicrobial resistance. JAMA 2013;309(6):531–2.