India cited as antibiotic mega-user ground zero in new report

India tops the world in the number of antibiotic medications used annually, leading to renewed concerns of a surge in antibiotic resistance, according to a report released by the Washington-based Center for Disease Dynamics, Economics & Policy (CDDEP).

CDDEP director and report co-author R. Laxminarayan

India sees 57% of its infections caused by Klebsiella pneumoniae, a dangerous superbug found in hospitals found to be resistant to a last-resort drug in 2014. That number is an uptick from 29%, the Indian Express and Economic Times said, citing the report which said that India takes 13 billion antibiotic pills annually, more the 10 billion in China and 7 billion in the United States.

CDDEP said it was the first such global map of antibiotic resistance and documents "alarming rates of bacteria resistant to last-resort antibiotics that can lead to life-threatening infections across the world" through its ResistanceMap, an interactive online tool that allows users to track the latest global trends in drug resistance in 39 countries, and antibiotic use in 69 countries.

In June, a news report from China said the Pearl River flows with residues of three dozen types of common antibiotics widely consumed, citing a Chinese Academy of Sciences-sponsored study. The study suggests that overuse by humans and animals is the main driver causing densely populated areas to see high concentrations of antibiotic residue.

The study, reported in the South China Morning Post, cited work led by Ying Guangguo of the Guangzhou Institute of Geochemistry under the Chinese Academy of Sciences. It focused on 36 of the most common antibiotics, according to the SCMP, such as amoxicillin and florfenicol, noting that use of the antibiotics on the mainland reached 92,700 metric tons in 2013 with nearly 60%, or 53,800 tons, entering the environment in the form of urine and excrement after various wastewater treatment.

The World Health Organization estimates that China consumes almost half the world's antibiotics, with the mainland the world's largest manufacturer at 162,000 tons of more than 200 varieties in 2013. Many of them are exported as active pharmaceutical ingredients for humans and animals, SCMP said, citing the researchers.

In addition, in India, high concentrations of antibiotics were found in waterways near heavily populated areas downstream of effluent from drug manufacturing plants in the southern part of the country in 2011, according to Nature.

The overuse of antibiotics in China is well known, but R. Laxminarayan, CDDEP director and report co-author, said efforts lag to halt the practice of oversubscribing.

"Rampant rise in antibiotic use poses a major threat to public health, especially when there's no oversight on appropriate prescribing," he was quoted as saying by the Indian Express.

- here's the release
- here's a story from Indian Express
- and one from the Economic Times