Thursday, December 30, 2010


The current year, just about to be pushed into history, was notable for India in a negative sense. A scientist from Chennai had the unique distinction in co-discovering a super bug which was inappropriately named after the Indian capital city New Delhi. Of course realizing the potential for damage the report can inflict on India's image as a safe haven for medical treatment, this scientist later dissociated from the conclusions of the report. According to the claims made by the group of scientists who made the discovery earlier, India has to be more careful and diligent in preventing large scale epidemic due to spread of pathogens equipped with the super gene which are resistant to most antibiotics known to man. Such a surmise is based on the widespread prevalence of poverty, poor sanitation, poor immunity and non-availability of a viable treatment protocol. According to one of the authors of the original study, India is poised to become the epicenter of NDM-1 epidemic because there are 650 million people with poor sanitation, highly vulnerable to the infection. As per the authors it has been named after Delhi because of the previous precedence of naming new super bugs, four in number since 1998 similarly and they further aver that no ulterior motive should be attributed to their scientific work.

In a strong rebuttal Indian establishment denied that NDM-1 containing super bugs are widely prevalent in India and they can occur all over the world. It is also claimed that such inspired reports are targeted at India's booming $ 2 billion medical tourism because of low cost treatment packages available in world class hospitals here. About half a million people visit India under medical tourism and the the annual growth is estimated at 30%. While questioning the conclusions of the report, it was pointed out that NDM-1 is not confined to India alone and unless global investigations are carried out the real threat of this super bug cannot be predicted. Though a few cases diagnosed outside India confirmed the cause as NDM-1 related, there is no clear proof that the infection really occurred in Indian hospitals. It is also a relevant question as to why there was not even a single case of any Indian affected due to this super bug.

The infamous NDM-1, acronym for New Delhi metallo-beta lactamase is a gene that is responsible for breaking down almost all antibiotics known to day except may be polymyxins and tigecycline and the most powerful antibiotics like beta-lactams, fluoroquinolones and aminoglycosides, the front line defense against gram negative bacteria are ineffective when it comes to NDM-1. According to pathologists even Methicillin Resistant Staphylococcus Aureus (MRSA) is not as dangerous as NDM-1 equipped pathogenic bacteria. Though NDM-1 is known to be present in normally harmless gut bacterial population including E.coli, it becomes dangerous when there is horizontal gene transfer into bacteria like Klebsiella pneumoniae as the latter will not respond to most antibiotics currently being used against pathogens.

The major concern is that the fecal microorganisms containing NDM-1 can occur widely in soil and water and the possibility of evolution of pathogens containing it can be disastrous especially under insanitary environment. That NDM-1 containing pathogens can be resistant to even the most powerful antibiotic Carbapenem probably makes it highly dangerous. What is not known how ever is whether such horizontal gene transfer really takes place, the ideal condition for it and the frequency of such occurrence. The contention by GOI that since the published report in Lancet was financed by the drug industry, the possibility of over stating the danger from this super bug cannot be ruled out. The well orchestrated H1N1 scare last year is sill fresh in our memory and some of the drug companies which developed the vaccine on assured purchase basis by many countries were able to make a kill from the sale of this product. Whether H1N1 virus scare was real or not only time can tell but billions of dollars worth business generated by the alarm cannot be denied.

Whether NDM-1 threat is real or not, it has been able to wake up the health authorities in India to the wide spread and uncontrolled use of antibiotics which seems to have contributed to development of resistance to many antibiotics by some of the pathogens, in spite of the prevalent law that they can be dispensed only with a prescription from a qualified physician. The recent decision to tighten sale of antibiotics may be appropriate if it is strictly implemented. According to new rules, antibiotics can be sold only when the prescription is presented in duplicate, one of which will be kept as a record by the pharmacy.


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