Critically Important Antimicrobials (CIA)

The findings of a new survey by the National Centre for Disease Control (NCDC) underscored the need for properly monitoring critically important antimicrobials to mitigate AMR.

CIAs – They represent a class of antimicrobials.

Categorised by – World Health Organisation (WHO).

3 groups – Based on their importance to human medicine and the urgency to preserve their effectiveness in treating infectious diseases.
HPCIAs – Highest priority critically important antimicrobials constitute a subcategory within CIAs, signifying antimicrobials of the highest priority in preserving their effectiveness.
Limitation – It is limited to antibacterial drugs of which most are also used in veterinary medicine and on how much and what kind of antibiotics are used in food animals and crops.

Key findings – 3^rd generation cephalosporins tops in overall antibiotic prescriptions with Ceftriaxone as top in this class.

Aminoglycosides is 2^nd highest in overall antibiotic prescription where amikacin is the most commonly prescribed antibiotic.

3^rd generation cephalosporins are categorised as the highest priority critically important antimicrobials (HPCIA) by WHO.

Other CIAs were belonging to the classes of carbapenems, penicillins, fluoroquinolones, glycopeptides and macrolides.

Recommendations – Antimicrobial consumption tracking efforts, like seen for human consumption, should be considered for use of antibiotics in India’s food animal production sector.

Significance of listing – It assists in managing antimicrobial resistance, ensuring that all, especially CIA are used prudently both in human and veterinary medicine.

Report by Centre for Science and Environment in 2021

It highlighted the use of CIAs in food-producing animals in India.
Findings – The 3^rd generation cephalosporins, were found in the Indian dairy sector and aminoglycosides were reported in the Indian poultry sector.
Use of antibiotics – To prevent, control or treat diseases.
Recommendations – Hospitals should adopt standard treatment guidelines and to have well-defined antibiotic policies in place.
It further highlights the need for conducting point prevalence surveys periodically in hospitals to monitor changes in antibiotic usage with time.

Recent data from the Antimicrobial Resistance Research and Surveillance Network of the ICMR as well as National Antimicrobial Surveillance Network (NARS-Net) of NCDC also showed a trend of increasing resistance towards CIAs, including 3^rd generation cephalosporins and aminoglycosides.

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