Question
- (a) Describe the concept of one health with regards to antimicrobial stewarship 2 mark(s)
- (b) List three classes of antibiotics with one example for each class 3 mark(s)
- (c) Name three mechanisms of antibiotic resistance in bacteria with one example for each 3 mark(s)
- (d) Briefly discuss national action plan for prevention of antimicrobial resistance 2 mark(s)
Answer
(a) “One Health” concept with regard to antimicrobial stewardship: One Health is an integrated, collaborative approach recognizing that human health, animal health, and environmental health are interconnected — applied to antimicrobial resistance (AMR), it recognizes that resistant organisms and resistance genes can spread between humans, animals (including livestock/food animals), and the environment (soil, water). Effective antimicrobial stewardship therefore requires coordinated action across all three sectors — rational antibiotic use and prescribing practices in human medicine, judicious/regulated antibiotic use in veterinary medicine and animal husbandry (e.g., restricting growth-promoter use in livestock), and environmental controls to limit the spread of resistant organisms/genes through waste, water, and agricultural runoff.
(b) Three classes of antibiotics with one example each:
- β-lactams — e.g., Amoxicillin (penicillin class).
- Aminoglycosides — e.g., Gentamicin.
- Fluoroquinolones — e.g., Ciprofloxacin.
(c) Three mechanisms of antibiotic resistance with one example each:
- Enzymatic drug inactivation — e.g., β-lactamase production hydrolyzing penicillin/cephalosporins (e.g., in E. coli).
- Target site modification — e.g., altered penicillin-binding protein (PBP2a) conferring methicillin resistance in MRSA.
- Efflux pump-mediated resistance — e.g., tetracycline efflux (Tet proteins) reducing intracellular drug accumulation.
(d) National Action Plan for prevention of antimicrobial resistance (India, NAP-AMR): launched by the Government of India, structured around six strategic priorities, broadly: (1) improving awareness and understanding of AMR through effective communication, education, and training; (2) strengthening surveillance of antimicrobial resistance and antimicrobial usage; (3) reducing the incidence of infection through effective infection prevention and control; (4) optimizing the use of antimicrobial agents (antimicrobial stewardship) in health, animal, and food sectors; (5) promoting investment for AMR activities, research, and innovation (including new antibiotics/diagnostics); and (6) strengthening India’s leadership on AMR through international, national, and sub-national collaboration — reflecting the One Health approach described above, with participation from the human health, animal husbandry, agriculture, and environment sectors.