# 5021
A couple of stories this morning on NDM-1.
In what unfortunately may end up being a case of closing the barn door after the horse got out, India yesterday announced stricter regulations on the over-the-counter sale of antibiotics to the public.
This move comes in response to recent reports of a new form of antibiotic resistance (see NDM-1 Surveillance) strongly associated with medical tourism out of India and Pakistan.
Actually, the first response from Indian officials was outrage that this emerging pathogen was named after New Delhi, along with a few ham-handed attempts to `spin’ the news.
This move to restrict the sale of antibiotics comes more than two months later.
NDM-1 or New Delhi metallo-ß-lactamase-1 made headlines in the wake of the release of a Lancet study back in August called:
Since then, sporadic NDM-1 cases have been identified in countries around the world, with the vast majority of them having had some medical procedure or treatment in India or Pakistan.
But I digress . . . here is the first report, from DNA (Daily News & Analysis).
Superbug fallout: Antibiotics ‘on counter sale’ ceased
Published: Saturday, Oct 30, 2010, 9:00 IST
By Akanksha Bafna | Place: Mumbai | Agency: DNAThe drug controller general of India (DCGI) on Friday introduced new rules to buy antibiotics. According to the revised rules, a patient will need two copies of a prescription - one which will be in the chemist's custody.
Admittedly, India required prescriptions for the purchase of antibiotics before yesterday, but a lack of enforcement meant that this was regarded more as a suggestion than a rule.
Indian and Pakistani pharmacies are also prominently featured in online ads hawking the sale of a variety of meds – including antibiotics – without the need for prescriptions.
While these new regulations supposedly add `teeth’ to the law, the unregulated sale of antibiotics has been a lucrative business in India for some time.
It remains to be seen how successfully these new rules will be enforced and how effective they will be in curbing the unregulated sale and use of antibiotics.
From The Hindu, we get a report on a recent independent investigation conducted by Channel 4 News in the UK, where science correspondent Tom Clarke – with the aid of NDM-1 researcher Professor Timothy Walsh – tested sewage in more than 120 locations across Delhi for the NDM-1 resistant bacteria.
The resistant gene was detected in nearly 10% of the samples.
“It suggests NDM is spread all over Delhi and people are carrying (these bacteria) as part of their normal flora,” Professor Walsh was quoted as saying.
First the article in the Hindu, followed by a link to the Channel 4 News investigative report.
News channel claims superbug could be widespread in India
Aarti Dhar
A British television channel has claimed that the New Delhi metallo-B- lactamese (NDM-1) bacteria could be widespread in Indian cities.
The Channel 4 News story, with more detail, including reports of political interference in the Lancet research:
Drug Resistant Superbug Threatens UK Hospitals
Thursday 28 October 2010
Tom Clarke Science Correspondent
Efforts to contain a new strain of superbug threatening the NHS and other health authorities around the world may almost be unachievable, exclusive research by Channel 4 News reveals.
Unlike a flu pandemic – which can spread very quickly – antibiotic resistance moves at a more glacial pace. MRSA, after all, was first identified in the early 1960s in the UK, but didn’t really become a huge public health problem for a couple of decades.
Today, with global travel and medical `tourism’ far more common, resistant organisms have more opportunities to spread - and so while it may still take awhile – newly emerging resistant bacteria are likely to spread faster than we’ve seen in the past.
All of which makes NDM-1 an important long-term story to watch.
Like many health bloggers, I’ve written a number of times on this emerging mutated gene. A few of my previous efforts include:
NDM-1: A New Acronym To Memorize
Public Health Agencies On NDM-1
Arguably, some of the best coverage has come from our favorite `scary disease girl’ Maryn McKenna editor of the Superbug blog.
And if you’ve not already read Maryn’s 2nd book, Superbug: The Fatal Menace of MRSA, I would invite you to do so.
Superbug (MRSA) Book
Although published before the identification of the NDM-1 threat, this book remains a chilling and informative look at the growing problem of emerging antimicrobial resistance.
My review of it may be read here.
Highly recommended.
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