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Pandemic of Antimicrobial resistance - Unraveling the potential of Ayurveda

2024; Medknow; Volume: 7; Issue: 1 Linguagem: Inglês

10.4103/jacr.jacr_58_24

2667-0607

Tanuja Manoj Nesari,

Drug-Induced Hepatotoxicity and Protection

INTRODUCTION The medical advancements made so far are under constant threat from a subdued pandemic of Antimicrobial Resistance (AMR), which is one of the most urgent and emerging public health issues facing the world today. AMR is a global threat to human health and creates a hindrance to the development and advancement of the health sector, further, requiring multi-sectoral efforts, so that the sustainable development goals can be accomplished. AMR is the result of bacteria, viruses, fungi, and parasites changing over time to the point that they become resistant to antibiotics, which makes infections more difficult to cure and raises the risk of disease spread, serious illness, and death. This resistance makes antimicrobial medications, including antibiotics, ineffective and makes treating illnesses more challenging or impossible.[1] According to the factsheets of the World Health Organization (WHO), AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.[2] At the regional level, eastern sub-Saharan Africa has the highest all-age death rate attributable to resistance at 27.3 deaths, while Australasia has the lowest, at 6.5 deaths per 100,000. Lower respiratory infections accounted for more than 1.5 million deaths associated with resistance in 2019, making them the most common infectious syndrome.[3] AMR is found in people, animals, food, plants, and the environment (air, soil, and water) and the driving factors for the rising burden of AMR include misuse and overuse of antibiotics; inadequate access to clean water, sanitation, and hygiene; inadequate infection and disease prevention and control in health-care facilities; inadequate access to high-quality, affordable medications, vaccines, and diagnostics; lack of awareness and knowledge; and lack of legislative enforcement.[1] The consumption of antibiotics is still high both among humans and animals and in terms of human health, average sales of all classes of antibiotics have increased by almost 2% since 2000 despite the efforts by policy-makers. AMR levels in nations, such as Greece, India, and Turkey, are still extremely high and by the year 2035, it is anticipated that more than 40% of infections in these nations brought on by the 12 antibiotic-superbug combinations examined by the Organization for Economic Co-operation and Development's would be resistant to antibiotics.[4] According to the World Bank estimates, in addition to death and disability, AMR has significant economic costs, with an annual US$ 1 trillion in additional health-care costs by the year 2050 and US$ 1 trillion to US$ 3.4 trillion gross domestic product losses per year by 2030.[5] PROPOSED STRATEGIES AND ACTION PLANS To tackle the issue of AMR, at the 68th World Health Assembly in May 2015, the nations adopted the Global Action Plan on AMR (GAP-AMR) and committed to addressing the AMR worldwide by implementing multisectoral national action plans that utilize a "One Health" approach. The Global Action Plan (GAP) lays out five strategic goals: (1) to improve awareness and understanding of AMR; (2) to strengthen knowledge through surveillance and research; (3) to reduce the incidence of infection; (4) to optimize the use of antimicrobial agents; and (5) to ensure sustainable investment in countering AMR.[6] Further, the WHO Global AMR and Use Surveillance System was launched in 2015 to foster AMR surveillance and inform strategies to contain AMR, along with its extending role in surveillance of antimicrobial consumption and invasive fungal infections, serving as a One Health surveillance model relevant to human health.[7] It is a continuous evolution to enhance the quality and representativeness of data to inform the AMR burden accurately, assisting in the development of global, regional, and national strategies to contain AMR, improving the quality of patient care, and strengthening health systems globally. In India, the strategic objectives of the National Action Plan on AMR are aligned with the GAP based on national needs and priorities, and with the other five priorities of GAP-AMR, India has a sixth priority that is India-specific dealing with India's leadership on AMR – including international, national, and subnational collaborations on AMR for strengthening India's leadership on AMR.[8] India is referred to as "the AMR capital of the world," with the growing problem of the emergence of multi-drug-resistant organisms, and the condition being worsened by various factors such as poverty, illiteracy, overcrowding, malnutrition, inaccessibility to healthcare, self-prescription of antimicrobial medicines, and unoptimized use of broad-spectrum high-end antimicrobials with easy availability of over-the-counter drugs further contributes to the growing burden of AMR in the nation.[9] Thus, the issue of AMR needs to be handled and addressed immediately so that the world can embark on the ambitious journey of sustainable development and the efforts toward improving the health of all can be successfully achieved. THE POTENTIAL OF AYURVEDA: AN INTEGRATIVE SOLUTION The emergence of AMR is not only limited to humans but is continuously impacting agriculture and animals. In such a scenario, the strategy for the development of a newer generation of antibiotics is sought, however, the development of new antibiotics has not kept pace with the occurrence of resistance in antibiotics. Under such circumstances, it is desirable to devote substantial resources to the search and development of antibiotic substitutes. Considering the prevailing situation, traditional medicines present a multitude of intriguing opportunities to address AMR, as the mainstay of the alternative health-care system includes herbs, botanicals, phytomedicines, and nutritional strategies that exhibit a wide range of biological activity and can be effectively used for managing a wide range of infections.[10] Since the initial waves of the COVID-19 pandemic, a severe impact on countries worldwide has been witnessed. As there was no specific therapy available and the disease has high rates of infection, virulence, and case fatality, it has put even the most advanced health-care systems in the world to the test. Owing to the growing number of mortalities and fatalities across the nation, traditional systems of medicines including Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy, and Traditional Chinese medicine have been utilized and proved their potential given their efficacy and strong evidence-based practices in the fight against the pandemic of COVID-19. Screening of plants and botanicals is currently being done at a greater pace worldwide so that they can be established as an effective source of alternative to antimicrobial medicines. A plethora of studies have been conducted in this regard and have suggested that the active compounds present in these botanical sources are rich in several compounds such as quinones, phenols, alkaloids, flavonoids, terpenoids, essential oils, tannins, lignans, glucosinolates, and certain secondary metabolites attributed to their antimicrobial properties, at the same time, the peptides that make up plant defense systems have also emerged as a promising source of antimicrobial agents as their function and structure are comparable to human antimicrobial peptides and these metabolites may offer a viable and efficient approach to breaking down microbial resistance.[11] With a holistic perspective, Ayurveda views and acknowledges human beings as a whole within a broad ecological spectrum and emphasizes that disease and ill health are caused by imbalances in the individual's entire ecological system rather than by pathogenic evolution and causative agents. The Prakriti (~somatic constitution), Vaya (~age), environment, occupation, food, and lifestyle of an individual have a collaborative impact on their health, which necessitates an ideal course of change in their nutrition, behavior, and living style and a strong adherence to the holistic concepts of healthy living described in Ayurveda which includes following the guidelines and adhering to the principles of Dinacharya (~daily regimen), Ritucharya (~seasonal regimen), Sadvritta (~good conduct and behavior), Vajikarana (~aphrodisiac or virility treatment), Rasayana (~rejuvenation and revitalization therapy), and Aachara rasayana (~customary law, codes, conducts, and behavior which prevents the psychosomatic ailments). The emerging concept of health promotion is gaining traction, and initiatives are being made to increase public knowledge of health-related issues so that people may identify the facilities that are accessible for care, understand preventive measures, and recognize their own health needs. This promotes health education on the core principles of Ayurveda, such as Dinacharya, Ritucharya, and Achara rasayana, among others, as a preventive approach and greatly lessens the burden of pathogen-related diseases and microbe-related incidents in the general population. These concepts of preventive approaches make the basic cores of the concept of immunomodulation which has been practiced by Ayurvedic practitioners since ages. The large spectrum of "Vyadhi-kshamatwa" has been a central and integrative part of Ayurveda classics which focuses on the strategies and preventive approach for enhancing "Immunity" instead of directly working on immediately neutralizing the disease-causing pathogens. This concept entails the strategies to strengthen the body's natural resistance to the disease-causing agent or microbes, at the same time, enhancing the innate immune capacities, such as innate immunity and acquired immunity in terms of Oja, Sahajabala, etc. Rasayana enhances both physical strength and immunity are now being recognized as a potential agent for the modulation of immunological response and could provide an alternative to enhance impaired immune responsiveness. There is a vivid and codified description of microorganisms/pathogens/microbes, either pathogenic or nonpathogenic in the classical texts of Ayurveda, which are believed to be the cause of numerous diseases as they infiltrate the body and cause a variety of microbes and infectious diseases named under the category of Krimi and Krimi rogas. Ayurveda advocates four methods to destroy microorganisms, namely refraining, disentangling, removing, and fumigating.[12] Apart from these, various antagonists and antimicrobial drug agents have also been mentioned in the classics to destroy the infectious agents and microbes under the category of Mahakashaya (~group of ten drugs) to halt the prevailing infection. Ayurveda advocates the approach toward attaining Swasthya or health as an interlinked concept of Loka and Purusha addressing the linkages of human health with the ecosystem as a whole. The GAP-AMR utilizes a "One Health" approach and this could be successfully achieved with the Ayurveda concepts of holistic integration of addressing the health issues among humans, animals, plants, and the ecosystem. The inescapably rising of new, resistant bacterial strains among animals has been raising concerns among various ecologists. For ages, ethnoveterinary medicine or Pashu Ayurveda has been practiced efficiently among the traditional practitioners but this age-old knowledge is fading in the contemporary world. However, the adoption and practice of this traditional veterinary expertise can address the current problem of AMR among cattle species and animals. Animal, human, and environmental health are closely related as they all share the same environment and resources. Since almost 60% of viruses that cause diseases in humans originate from animals, preserving the health of animals is important, and necessitates the "One Health approach" as one solution to tackle this global burden of AMR.[13] The rising issue of AMR requires a deeper understanding and realization of the probable futuristic impact on the ecosystem and a significant amalgamation of strategies toward wider adoption of the fundamental principles of Ayurveda in health promotion and preventive strategies at the global scale. This requires raising public awareness and increasing the use of botanical, Ayurveda therapies as alternatives for diseases and ailments as well as to mitigate the side effects of antibacterial medication. Furthermore, more vigorous steps and initiatives toward enhancing research and development in the sector development of phyto-based compounds and herbal drugs for generating evidence and assessing the synergistic impact of chemicals derived from plants in conjunction with conventional antimicrobials to combat clinically significant bacteria and explore the role of these phytomedicines as future drugs against AMR is utmost required. With a higher return on investment than implementation costs, scaling up investments in One Health packages which are inclusive of Ayurveda concepts against AMR is feasible and profitable at the same time. The fight against the pandemic of COVID-19 is toward its end, a new era of pandemic of AMR has already arrived. The battle against COVID-19 has been efficiently and effectively fought with the integrative approach of conventional and Ayurveda systems of medicines, similar integrative strategies, and One Health-based policy action is required to combat this scaling concern of AMR.