‘Compassionate Use’ Of Medicine Helps Resistant Bacteria
The travails of a Nepall national who flew to Lucknow to undergo a tummy tuck has all the makings of a medical thriller death status to revival from near to the “compassionate use” of an antibiotic that is still under due trial. The antibiotic is not a drug made abroad, but one developed in an Aurangabad laboratory by an Indian pharmaceutical company.
“Our drug, WCK5222, wh ich is at present undergoing clinical trials in some European nations, was mentioned by the World Health Organisation as a promising antibiotic under research,” said chief scientific officer Mahesh Patel of Wockhardt Research Centre in Aurangabad.
In early August, a couple of days after the tuck, the 50year-old Nepali woman developed a fever that soon worsened into a lung infection. A few days later, her liver and kidneys too were affected. Sepsis rapidly set in and she was put on ventilator support, with the culprit identified as a gram-negative bacteria called Pseudomonas Gram negative bacteria are aeruginosa. resistant to multiple drugs and in her case, the Pseudomonas A bacteria was resistant to all antibiotics, expect colistin. Three weeks later, it became resistant to colistin too, meaning there was no drug available to treat the patient who had by then been transferred from a local hospital to Medanta Lucknow.
India, where antibiotics are often self-prescribed or by chemists, has been witnessing alarming levels of antibiotic or antimicrobial resistance. The Indian Council for Medical Research (ICMR)’s fifth de tailed report on antimicrobial resistance (AMR) trends and patterns showed that many ICU patients no longer benefit from carbapenem, a powerful antibiotic used to treat pneumonia and septicemia.
Resistance level is increasing by 5% to 10% every year for broad-spectrum antimicrobials, mainly due to discriminate use leading to resistance later one. “India has high rates of multi-drug resistance among enterobacterales and gram-negative nonfermenters like Acinetobacter baumanii and Pseudomonas aeruginosa. New treatment options are urgently needed for such multi or extremely drug-resistant pathogens,” said ICMR’s senior scientist Kamini Walia, who coordinates antimicrobial resistance and diagnostics initiatives across the country.
UP TO 10% RISE IN DRUG RESISTANCE A YEAR
WHAT IS AMR
Antimicrobials could be antibiotics, antivirals, antifungals and antiparasitics
Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites evolve over time to such an extent that regular medicines have no effect on them
Main cause: Misuse and overuse of antimicrobials
Drug-resistant infections are harder to treat; can cause disability, prolonged illness, hospitalisations and increased costs
World Health Organisation says AMR is among the top 10 global public health threats
AMR IN INDIA
India has been referred to as ‘the AMR capital of the world
More than 70% isolates of superbugs Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii and nearly half of all Pseudomonas aeruginosa were resistant to medicines called fluoroquinolones and cephalosporins
Increasing rates of carbapenem resistance to the tune of 71% in A baumannii led to frequent use of colistin as the last-resort antimicrobial
The resistance to colistin has also emerged in India
BURDEN OF AMR IN THE WORLD
7,00,000 people die due to antimicrobial resistance every year
Another 10 million are projected to die from it by 2050 AMR kills more people than cancer and road traffic accidents combined
By 2050, AMR would decrease gross domestic product (GDP) by 2%-3.5% with a fall in livestock by 3%-8%, costing US$100 trillion to the world
ICMR REPORT’S FINDINGS
Indian Council for Medical Research’s (ICMR) latest AMR surveillance report shows rising resistance to all known antibiotics
The report looked at 95,728 culture positive isolates between January 1 and December 31, 2021
Fortunately for the Nepali national, critical care specialist at Medanta Lucknow Dr. Dilip Dubey remembered reading about WCK5222 in research papers and called up Wockhardt. He was told that only families could request for the drug on compassionate grounds and that too after seeking permission from the Drugs Controller General of India (DCGI). The family immediately wrote to the DCGI and got an approval within the next 48 hours, the doctor said.
A 10-day course of WCK5222 was given free of cost to the patient. “Although we gave the medicine for 10 days, she was free of the bacteria by Day 5,” said Dr. Dubey The patient was discharged on September 12, and came in for five follow-up visits to Medanta Lucknow. A couple of weeks back, she got the medical nod to return to Nepal.
The next step is starting clinical trials in India. “For WCK5222, we have special USFDA approvals and plan to start studies in India soon,” said Wockhardt researchers Mahesh Patel and Sachin Bhagwat.
Work on WCK5222 began in 2012 with 130 scientists working on it. A Phase 1 trial of 200 patients was conducted in the US that revealed that the drug is safe for use in humans. The company has received requests from other parts of the world as well as four requests from India. “But we didn’t get enough time to process the paperwork,” he said. The drug has already got 25-30 publications.