In London, the British Asian community faces nearly double the proportion of antibiotic-resistant infections compared to the white UK population, according to cross-bench peer Baroness Murphy. Speaking in the House of Lords during a debate on biosecurity and infectious diseases, she highlighted the global impact of antibiotic resistance, attributing it to travellers from abroad. Currently, Asian and Asian British ethnic groups exhibit a 35% proportion of antibiotic-resistant infections, contrasting with the 19% observed in white British ethnic groups. Baroness Murphy suggested this disparity may result from antibiotic overuse in parts of Asia. She emphasised the significance of international travel in transmitting antibiotic-resistant strains, referencing a study on enterobacteria causing dysentery in India and Pakistan. The study revealed the spread of subtypes throughout the UK due to global travel. The Hospital for Tropical Diseases in London reported 92 travellers from South Asia and Nigeria with enteric fever, of which 30% were multiple drug resistant.
The debate delved into the broader issues of pathogens and pests spreading to the UK through global factors such as globalization, climate change, and international travel. Concerns were raised about inadequate biosecurity measures at international borders. The indiscriminate use of antibiotics in animals in parts of South and Southeast Asia was identified as another serious risk. Baroness Hayman added a dimension to the discussion, pointing out the potentially catastrophic air quality in Indian cities during extreme heat events. The conversation highlighted the intricate relationship between global health challenges, international travel, and the need for robust biosecurity measures.
Not uncommon for British Asians to return with life-threatening sepsis following trips to India and the subcontinent
Speaking to the newsweekly, Professor Indranil Chakravorty MBE, Consultant Physician, St George's University Hospital London told us, “South Asians are a large part of the migratory communities in Britain and face a rising trend of acquisition of antibiotic-resistant bacteria, due to several contributory factors. It is not uncommon for British Asians to return with life-threatening sepsis following trips to India and the subcontinent. Antibiotic Resistance is a global phenomenon in many countries due equally to indiscriminate use in livestock rearing, leaking into the water supply as it is due to overuse. Antibiotics are life-saving, yet indiscriminate or unregulated use can contribute to increased mortality.”
Dr Chakravarty further said, “Among Asian countries, India accounts for the highest consumption of antibiotics in the world and is second only to China with the highest prevalence of antibiotic resistance. Globally, antibiotic resistance is leading to the emergence of superbugs such as ones with the gene named the New Delhi Metallo-beta lactamase-1 isolated in India in 2008. The number of deaths related to antibiotic resistance is rising, as India and other low and middle-income countries rise the ranks. The close ties that many S Asians maintain with their home countries include frequent travel, family contact and taking advantage of easily available antibiotics without prescription.”
According to him, the poor access to doctors or healthcare facilities in much of rural India leads to a dependence on pharmacies with easy availability of combination drugs, and poor governance or secure supply chains. India is the largest manufacturer of generic drugs including affordable antibiotics supplying to much of the world, yet the lack of a robust regime of quality assurance, and greed amongst manufacturers leads to lower grades/ doses which in turn fuels resistance. There is also a practice amongst prescribers to accept financial incentives for prescribing.
“Economic challenges often reduce availability and many people are not able to complete courses. This is a common reason for the prevalence of multi-drug resistance in Tuberculosis in India and other LMICs. Even in patients where economic deprivation or lack of education is not an issue, there is a culture or belief that antibiotics are harmful, and make one weaker and therefore it is common to have inappropriately lower doses or not complete the course as recommended.
“What can South Asians do? My advice would be to only take antibiotics when it is clinically appropriate, preferably after obtaining a sample for culture, when prescribed by a doctor and to complete the course as prescribed. As doctors, we have a huge responsibility to educate our communities, prescribe in generic terms, and resist industry practice of incentives.”
Antibiotics don’t work against viruses
GP Dr Aaliya Goyal, Nationally Elected RCGP Council Member, Vice Chair RCGP Midland Faculty and Occupational Health Doctor told us, “Antibiotic resistance is an important, and increasing, public health challenge. The public can work together with health and care staff to use antibiotics responsibly so that they will continue to work to treat infections and help save lives when they are needed. Antibiotics don’t work against viruses, so insisting on antibiotics for a cold or the flu, for example, won’t help and may reduce the chance of them working in future. Healthcare professionals can advise whether antibiotics are likely to be of benefit. If they are prescribed, make sure you take them as directed and complete the course so that the infection is treated completely.”
