| What does the acronym AMRITH represent? | Antimicrobial Resistance Intervention for Total Health | He highlighted a number of success stories including functional AMR committees in all 14 districts and 190 blocks, AMR surveillance network (KARS-NET) with 40 laboratories across the state, dispensing antibiotics in blue coloured covers, antibiotic smart hospitals, Programme for Return Of Unused Drugs (PROUD), monitoring of antibiotic prescriptions according to AWaRe classification, antibiotic literate Kerala campaign, Operation AMRITH (Antimicrobial Resistance Intervention for Total Health), etc. Best practices for optimizing AMU in Madhya Pradesh Dr Sagar Khadanga (Associate Prof. | 441 | definition | 0.980 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | He highlighted a number of success stories including functional AMR committees in all 14 districts and 190 blocks, AMR surveillance network (KARS-NET) with 40 laboratories across the state, dispensing antibiotics in blue coloured covers, antibiotic smart hospitals, Programme for Return Of Unused Drugs (PROUD), monitoring of antibiotic prescriptions according to AWaRe classification, antibiotic literate Kerala campaign, Operation AMRITH (Antimicrobial Resistance Intervention for Total Health), etc. | 10 | page=10,block=1 | 0.700 | valid |
| What is the result of not having disposal systems for unused and expired drugs? | improper disposal along with household waste leading to environmental contamination which is a potential risk for emergence of AMR | Since the Red line campaign has not had the impact that was anticipated, ensuring a single colour for antimicrobial packaging such as blue may make the messaging simple and more effective. Absence of disposal systems for unused and expired drugs leads to improper disposal along with household waste leading to environmental contamination which is a potential risk for emergence of AMR. It is important to establish drug take-back initiatives such as the PROUD program in Kerala, with standard protocols for handling, collection and disposal of drugs. | 255 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Absence of disposal systems for unused and expired drugs leads to improper disposal along with household waste leading to environmental contamination which is a potential risk for emergence of AMR. | 17 | page=17,block=1 | 0.800 | valid |
| What are the consequences of antimicrobial misuse besides contributing to resistance? | higher costs and poor patient outcomes | Background Containment of antimicrobial resistance (AMR) is a global and national priority. The National Action Plan on AMR (NAP-AMR) identifies optimizing antimicrobial use in all sectors, including human health as a strategic priority. Misuse of antimicrobials not only promotes the development of AMR but also leads to higher costs and poor patient outcomes. Antimicrobial use (AMU) and AMR are impacted by a number of factors, including prescription practices, patient behaviour, antimicrobial manufacturing, distribution/sales, promotion of AMU and disposal of antimicrobials. optimizing AMU needs coordinated actions by various stakeholders. | 322 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Misuse of antimicrobials not only promotes the development of AMR but also leads to higher costs and poor patient outcomes. | 5 | page=5,block=1 | 0.700 | valid |
| What challenges were discussed regarding the dispensing of antimicrobials by pharmacists? | pharmacists’ dispensing antimicrobials without a doctor’s prescription | Group work 1 – Regulating availability/access of antimicrobials Discussed the current status, challenges and solutions on implementing Schedule H and H1 to optimise antimicrobial use and need for new/revised regulations; patient demand and pharmacists’ dispensing antimicrobials without a doctor’s prescription; telemedicine and e- prescriptions; prescription of antimicrobials by traditional medicine practitioners; monitoring the manufacture, distribution and sale of antimicrobials; licensing/manufacture of antimicrobials; effluents from pharmaceutical industry; and approval of fixed dose combinations. Following were the key suggestions and recommendations across four core themes – regulations, prescriptions, manufacture and effluents/disposal. | 240 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Group work 1 – Regulating availability/access of antimicrobials Discussed the current status, challenges and solutions on implementing Schedule H and H1 to optimise antimicrobial use and need for new/revised regulations; patient demand and pharmacists’ dispensing antimicrobials without a doctor’s prescription; telemedicine and e- prescriptions; prescription of antimicrobials by traditional medicine practitioners; monitoring the manufacture, distribution and sale of antimicrobials; licensing/manufacture of antimicrobials; effluents from pharmaceutical industry; and approval of fixed dose |
| What did Dr Paul say about how AMR could affect India's economy? | potential impact of AMR on the country’s economy | Professor Dr Atul Goel spoke about the possibility of return of the pre-penicillin era where untreatable infections would become leading cause of death and emphasized the key role of drug regulators in controlling the sale of antibiotics. He emphasized that it is the responsibility of dispenser to have a receive-back mechanism for unused/expired antimicrobials. Given the rampant over-the- counter sale of antibiotics he highlighted the need to have strong visuals in pharmacies to prevent over-the-counter sale of antibiotics without prescription. Dr Paul in his keynote address outlined the potential of AMR in affecting India’s achievements towards Sustainable Development Goals and hampering the health system’s response to new challenges including future threats. He also discussed the potential impact of AMR on the country’s economy. | 793 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | He also discussed the potential impact of AMR on the country’s economy. | 7 | page=7,block=1 | 0.700 | valid |
| What framework are the strategies identified during the consultation expected to be integrated into? | NAP AMR’s implementation and monitoring framework | Monitoring of AMC at the national, state and institution level and monitoring of AMU at institutional level are important. Expansion of the NAC-NET to include more sentinel sites will help to monitor AMC and AMU. Development of digital solutions to monitor antimicrobial prescriptions, AMC and AMU are important next steps. Concerted efforts are needed across departments – including regulators, prescribers and dispensers – at all levels of the health system. The consultation helped identify effective and actionable strategies for key stakeholders. The identified strategies are expected to be included/integrated with the NAP AMR’s implementation and monitoring framework by relevant stakeholders. | 626 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | The identified strategies are expected to be included/integrated with the NAP AMR’s implementation and monitoring framework by relevant stakeholders. | 17 | page=17,block=8 | 0.700 | valid |
| What is a potential consequence of improper disposal of unused and expired drugs? | environmental contamination which is a potential risk for emergence of AMR | Absence of disposal systems for unused and expired drugs leads to improper disposal along with household waste leading to environmental contamination which is a potential risk for emergence of AMR. It is important to establish drug take-back initiatives such as the PROUD program in Kerala, with standard protocols for handling, collection and disposal of drugs. De-blistering of tablets/capsules followed by disposal at common collection points with linkages to biomedical waste treatment establishments, may be useful in implementing this in programme mode. | 122 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Absence of disposal systems for unused and expired drugs leads to improper disposal along with household waste leading to environmental contamination which is a potential risk for emergence of AMR. | 17 | page=17,block=1 | 0.700 | valid |
| What is suggested to expand the monitoring of antimicrobial consumption and use? | Expansion of the NAC-NET to include more sentinel sites | Monitoring of AMC at the national, state and institution level and monitoring of AMU at institutional level are important. Expansion of the NAC-NET to include more sentinel sites will help to monitor AMC and AMU. Development of digital solutions to monitor antimicrobial prescriptions, AMC and AMU are important next steps. Concerted efforts are needed across departments – including regulators, prescribers and dispensers – at all levels of the health system. The consultation helped identify effective and actionable strategies for key stakeholders. The identified strategies are expected to be included/integrated with the NAP AMR’s implementation and monitoring framework by relevant stakeholders. | 123 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Monitoring of AMC at the national, state and institution level and monitoring of AMU at institutional level are important. Expansion of the NAC-NET to include more sentinel sites will help to monitor AMC and AMU. | 17 | page=17,block=8 | 0.700 |
| What is the goal of raising awareness among prescribers, patients, and dispensers? | prevent over-the-counter sale and misuse of antimicrobials | Despite huge improvements, quality of antimicrobials remains a concern, since substandard and falsified antimicrobials may lead to sub-therapeutic dosing which aid the development of AMR. A focused biannual sampling drive will help to monitor the quality of antimicrobials and taking decisive action to eliminate the supply of sub-standard drugs in the market. Raising awareness of prescribers, patients and dispensers is essential to guide behaviour change and prevent over-the-counter sale and misuse of antimicrobials. Strong messages on the packaging of antimicrobials may be helpful in reducing this. Since the Red line campaign has not had the impact that was anticipated, ensuring a single colour for antimicrobial packaging such as blue may make the messaging simple and more effective. | 462 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Raising awareness of prescribers, patients and dispensers is essential to guide behaviour change and prevent over-the-counter sale and misuse of antimicrobials. | 17 | page=17,block=1 |
| What role did Professor Dr Atul Goel emphasize for drug regulators in relation to antibiotics? | the key role of drug regulators in controlling the sale of antibiotics | Professor Dr Atul Goel spoke about the possibility of return of the pre-penicillin era where untreatable infections would become leading cause of death and emphasized the key role of drug regulators in controlling the sale of antibiotics. He emphasized that it is the responsibility of dispenser to have a receive-back mechanism for unused/expired antimicrobials. Given the rampant over-the- counter sale of antibiotics he highlighted the need to have strong visuals in pharmacies to prevent over-the-counter sale of antibiotics without prescription. Dr Paul in his keynote address outlined the potential of AMR in affecting India’s achievements towards Sustainable Development Goals and hampering the health system’s response to new challenges including future threats. He also discussed the potential impact of AMR on the country’s economy. | 167 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr46.pdf | Professor Dr Atul Goel spoke about the possibility of return of the pre-penicillin era where untreatable infections would become leading cause of death and emphasized the key role of drug regulators in controlling the sale of antibiotics. |