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|Year : 2014 | Volume
| Issue : 1 | Page : 1--2
Chennai Declaration: An initiative our country could be proud of!
Consultant in Infectious Diseases and Clinical Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India
Consultant in Infectious Diseases and Clinical Microbiology, Apollo Hospital, Chennai, Tamil Nadu
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Ghafur A. Chennai Declaration: An initiative our country could be proud of!.Indian J Med Microbiol 2014;32:1-2
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Ghafur A. Chennai Declaration: An initiative our country could be proud of!. Indian J Med Microbiol [serial online] 2014 [cited 2019 Nov 13 ];32:1-2
Available from: http://www.ijmm.org/text.asp?2014/32/1/1/124284
"Ask and it will be given to you; seek and you will find; knock and the door will be opened to you."-
Matthew 7:7-8, Holy Bible
"Chennai declaration" is a document and initiative by medical societies in India, to tackle the challenge of antimicrobial resistance from an Indian perspective. This Indian initiative is now highly applauded by International Medical Community and Policy makers.
It is indeed true that India lagged behind other developed countries, in her efforts to rationalise antibiotic usage. Heavy burden of tropical diseases, heterogeneity in the standard of health care institutions, large population, socio-economic disparity, sanitation issues in many parts of the country, inadequate awareness about the antibiotics resistance issue, inadequate training on rational antibiotic usage in undergraduate and post-graduate curriculum, extreme laboratory orientation of the Microbiology curriculum, lack of nationwide antibiotic resistance surveillance network and inadequate infection control facilities in many hospitals are important contributing factors to the high antimicrobial resistance rate in our country. There were no organised efforts to tackle the resistance problem at least until the Roadmap meeting of medical societies and the "Chennai declaration."
Indian Association of Medical Microbiologists actively participated in the "Roadmap meeting" and preparation of the declaration. Road map meeting was held in August 2012 in Chennai. Organisers ensured dynamic participation of representatives of all major medical societies, representatives of Governmental and semi governmental bodies such as Drugs Controller General of India office, National Accreditation Board of Hospitals, Indian Council of Medical Research, Medical Council of India and World Health Organization.  Representatives of various stakeholders prepared the Chennai declaration document. The declaration provided a practical and implementable strategy to tackle the challenge of antimicrobial resistance in our country, giving due consideration to the background of Indian scenario. Since the publication of the declaration in December 2012, more than a dozen highly reputed international journals have written reviews on the document. This is a significant achievement in academic medical field. It may be difficult to recall any other recent document in any field of medicine receiving such an acclaim at global level. Many national and international conferences discussed the Chennai declaration document with great importance. As a result of Chennai declaration efforts, medical community and Indian authorities have become more receptive about the resistance problem. They have foregone their inhibitions and are open to discussion. International academic community has changed the approach towards India and other developing countries by being sympathetic and not critical. In the annual report, Chief Medical Officer of UK advised British Government to support Chennai declaration initiative, to be implemented in all commonwealth countries.  Reputed colleges and societies such as Royal College of Physicians of Edinburgh, European society of Clinical Microbiology and Infectious Diseases and Australian Infectious Diseases society have endorsed or supported the declaration. What makes Chennai declaration different from other similar documents on the subject is, it is part of a major initiative to control antibiotic resistance and not just a review document.
National antibiotic policy, published in 2011, though still available on the website, was publicly withheld by the health Minister, immediately after its publication.  Complete ban on over-the-counter (OTC) sale of antibiotics and the decision to restrict usage of third line antibiotics only to tertiary care hospitals; created widespread protest and led to early demise of the policy. Chennai declaration team submitted a detailed document incorporating declaration recommendations and various components of the previously withheld antibiotic policy, making necessary changes. Ministry of health organised a meeting of task force members of the 2011 policy along with senior ministry officials, to study the document submitted by the Chennai declaration team. The meeting discussed both documents in detail and the Ministry is preparing a new national antibiotics policy. Chennai declaration efforts were instrumental in convincing the Ministry to hold multiple meetings towards the resurrection of the previously published and with held policy. The amended policy will be published soon.
A national antibiotics policy will mostly have recommendations and not rules. Rationalising in hospital antibiotic use by law will be extremely difficult, though hospital accreditation agencies can monitor the compliance to the recommendations. The most important step Health Ministry could undertake was publishing a rule to rationalise OTC sale of antibiotics. Schedule H1, a group of drugs requiring prescription of a registered medical practitioner to be sold OTC, was first published in 2011. All antibiotics were included in this category. As mentioned earlier, this was immediately withheld, due to serious political repercussions. Roadmap meeting and Chennai declaration recommendations helped the Ministry to come out of the dead lock by recommending a step-by-step strategy of restricting second and third-line antibiotics to start with. The modified H1 list published by the Ministry has 24 antibiotics and 11 anti-tuberculosis drugs.  These drugs will not be dispensed OTC without prescription. Pharmacies will have to retain details of the prescription in a register for 3 years.
Indian Council of Medical Research has decided to expand the surveillance network by incorporating more hospitals. Let us hope India will have nationwide data on antibiotics resistance in near future. National accreditation board of hospitals and other accreditation agencies should take initiatives to make sure that hospitals follow declaration recommendations on antibiotics usage and infection control. Medical societies including IAMM should disseminate the information to regional and local branches. The Medical Council of India will need to make necessary curriculum changes so as to include a structured training on antibiotic usage and infection control at the undergraduate and post-graduate level. An Infection Control Team (ICT) must be made mandatory in all hospitals.
Indian medical community can be proud of the Chennai declaration initiative. The declaration helped our country to hold her head high in front of international community by proving that India is not a mere follower but the leader in tackling antibiotic resistance initiatives.
The impact Chennai declaration created on policy makers, public and the medical community in India and abroad, should serve as an inspiration for similar initiatives in all developing countries.
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