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|Year : 2013 | Volume
| Issue : 1 | Page : 71--73
The Chennai declaration: A roadmap to tackle the challenge of antimicrobial resistance
A Ghafur1, D Mathai2, A Muruganathan3, JA Jayalal4, R Kant5, D Chaudhary6, K Prabhash7, OC Abraham8, R Gopalakrishnan9, V Ramasubramanian10, SN Shah11, R Pardeshi12, A Huilgol13, A Kapil14, JPS Gill15, S Singh16, HS Rissam17, S Todi18, BM Hegde19, P Parikh20,
1 Coordinator, Road map meeting and Antibiotic Stewardship Committee Chairperson, Clinical infectious Diseases Society (CIDS)
2 President CIDS
3 President Elect API
4 Indian Medical Association(IMA)
5 President, Association of Surgeons of India
6 Indian Society of Critical Care Medicine (ISCCM)
7 Indian Society of Medical and Paediatric Oncology (ISMPO)
8 Secretary CIDS
9 Organising Secretary CIDSCSON
10 Organising Chairman, CIDSCON
11 Editor, JAPI
12 Federation of Obstetric and Gynaecological Societies of India (FOGSI)
13 President, Indian Society of Organ Transplantation (ISOT)
14 Indian Association of Medical Microbiologists (IAMM)
15 Director,School of Public Health and Zoonoses, GADVASU
16 Chairman, Research committee ,NABH
17 Member, Board of Governors, Medical Council of India
18 Panel member of Ministry of Health expert committee STG on Critical Care
19 Former Vice Chancellor, Manipal Academy of Higher Education
20 Convenor, Indian Cooperative Oncology Network (ICON)
Coordinator, Road map meeting and Antibiotic Stewardship Committee Chairperson, Clinical infectious Diseases Society (CIDS)
|How to cite this article:|
Ghafur A, Mathai D, Muruganathan A, Jayalal J A, Kant R, Chaudhary D, Prabhash K, Abraham O C, Gopalakrishnan R, Ramasubramanian V, Shah S N, Pardeshi R, Huilgol A, Kapil A, Gill J, Singh S, Rissam H S, Todi S, Hegde B M, Parikh P. The Chennai declaration: A roadmap to tackle the challenge of antimicrobial resistance.Indian J Cancer 2013;50:71-73
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Ghafur A, Mathai D, Muruganathan A, Jayalal J A, Kant R, Chaudhary D, Prabhash K, Abraham O C, Gopalakrishnan R, Ramasubramanian V, Shah S N, Pardeshi R, Huilgol A, Kapil A, Gill J, Singh S, Rissam H S, Todi S, Hegde B M, Parikh P. The Chennai declaration: A roadmap to tackle the challenge of antimicrobial resistance. Indian J Cancer [serial online] 2013 [cited 2019 Dec 11 ];50:71-73
Available from: http://www.indianjcancer.com/text.asp?2013/50/1/71/104065
Development of the Roadmap
"A Roadmap to Tackle the Challenge of Antimicrobial Resistance" - A Joint meeting of Medical Societies in India was organized as a preconference symposium of the 2 nd Annual Conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24 August. This was the first-ever meeting of medical societies in India on the issue of tackling resistance, with a plan to formulate a roadmap to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of the World Health Organization, the National Accreditation Board for Hospitals and Healthcare Providers (NABH), the Medical Council of India (MCI), the Drugs Controller General of India (DCGI), and the Indian Council of Medical Research (ICMR) along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health-care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health-care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and a range of opinions to guide the formation of the roadmap. The ethos of the meeting was clearly not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance.
Aim of the Roadmap Meeting and the Chennai Declaration
The aim of the Roadmap Meeting and the Chennai Declaration was to initiate efforts to formulate a national policy to control the rising trend of antimicrobial resistance, after consultation with all relevant stakeholders, and take all possible measures to implement the strategy.
Increasing antimicrobial resistance is a serious global and regional challenge. There is an urgent need to initiate measures to tackle the scenario and join international efforts to control this menace.The Indian Ministry of Health (MOH) will need to take urgent initiatives to formulate a national policy to control the rising trend of antimicrobial resistance, after consultation with all relevant stakeholders and then take all possible measures to implement the policy.The DCGI will need to formulate and implement a policy on rationalizing the usage of antibiotics in the country, both in hospitals and over the counters, after consultation with stakeholders and experts in the field.The state Departments of Health (DOHs) will need to take initiatives to improve infection-control standards and facilities in hospitals and encourage the implementation of regional antibiotic policies and the pending formulation and publication of a national policy. Once a national policy is formulated, wholehearted support for this policy by the state DOH is needed for its implementation.The MCI will need to make the necessary changes in the curriculum so as to include a structured training on usage of antibiotics and infection control at the undergraduate and postgraduate level.An Infection Control Team (ICT) must be made mandatory in all hospitals. Regulatory authorities and accreditation agencies [NABH, International Organization for Standardization (ISO)] must insist on a functioning ICT, during the process of licensing and accreditation.The state DOHs should take initiatives in organizing regional and state infection-control committees to supervise the functioning of the hospital ICT.A national task force should be set up to guide and supervise the regional and state infection-control committees.The NABH is required to insist on strict implementation of hospital antibiotic and infection-control policy, during accreditation and reaccreditation processes of hospitals. Hospitals not in compliance with the policy should not be given accreditation.The ICMR should broaden the Antimicrobial Resistance Surveillance Network , incorporating hospitals from both the government and private sector. The ICMR will need to provide funds for research on antimicrobial resistance, drug development, and vaccines.The Indian division of the World Health Organization should step up interaction with the government on issues related to drug resistance, antibiotic policy, and infection control.There is an urgent need to standardize microbiology laboratories in India. Hospitals must have a good-quality microbiology laboratory or should be willing to outsource specimens, in the absence of a standardized laboratory.Medical societies need to take an active interest in initiating infection-control and antibiotic stewardship awareness activities among the society members, utilizing the extensive network of local branches of all societies.Medical journals should make deliberate attempts to educate readers on issues related to infection control and national antibiotic policy.Electronic and print mass media should take initiatives on public awareness campaigns on the dangers of the misuse of antibiotics.Nongovernmental organizations (NGOs)-national and international-have played a pivotal role in disseminating public information and funding research in diseases like cancer and cardiac diseases. They should take the initiative to tackle antibiotic resistance issue with the same vigor.There is a need to evaluate the extent and to regulate the usage of antibiotics in veterinary practice.
India needs 'an implementable antibiotic policy' and NOT 'a perfect policy'
A strict and perfect antibiotic policy is always the ideal, just like having a perfect police and law and order system. However, asking for a complete and strict antibiotic policy in a country where there is currently no functioning antibiotic policy at all may not be an intelligent or immediately viable option without the political will to make such a drastic change. A multidisciplinary committee of eminent experts should explore the options available to us. For example, should we:
Adopt a strict antibiotic policy, with absolute and strict control on the use of antibiotics in the community and in hospitals, against a background of the enforcement of good standards of infection control in hospitals?ORIntroduce step-by-step regulation of antibiotic usage, concentrating on higher end antibiotics first and then slowly extending the list to second- and first-line antibiotics?
Where does the roadmap head?
The "Roadmap Meeting" decisions- the "Chennai declaration" will be submitted to all sectors of the relevant governmental and nongovernmental bodies, medical societies, and all major stakeholders.
The roadmap should form the template for regional and local framework for combating antimicrobial resistance. Progress in the implementation of the roadmap will be assessed annually by a joint committee during the annual conference of one of the participating medical societies. A roadmap committee of medical societies will communicate with all stakeholders to collect data on the progress.
The Central Task Force can categorize the recommendations into major and minor on a priority basis, and assess the progress of implementation and compliance by all stakeholders.
The roadmap will be a dynamic process, subject to further adaptation with time, experience, and maturity.
Serious concern about the rising trend of antimicrobial resistance in the country has prompted medical societies to hold the joint Roadmap Meeting to seek practical, implementable solutions to the problem. We have considered the Indian scenario at ground level before making the recommendations. We believe that if we have the will and resolve, targets of the Chennai Declaration can very easily be achieved.
Note: This is an abridged version. The full text of the Chennai Declaration is available online from the Indian Journal of Cancer website www.indianjcancer.com
The opinions expressed in the Chennai Declaration are those of the authors. The opinions do not reflect, in any way, those of the institutions to which the authors are affiliated. The authors express their gratitude to the governmental bodies like DCGI, MCI, NABH, ICMR, and the World Health Organization for participation in the Roadmap Meeting, but the opinions expressed in the Chennai Declaration do not in any way belong to these organizations. The authors also acknowledge the international representatives for participating in the meeting and sharing their experience.