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Drug-resistant infections most prevalent in intensive care units
Antibiotics are hailed as medical saviors.
But they increasingly face a wily adversary: bacteria that mutate, adapt and outsmart the very drugs designed to defeat them and cure the infections they cause.
These antibiotic-resistant “superbugs” directly caused 1.14 million deaths worldwide in 2021, according to The Lancet, a medical journal. Antibiotics – considered the first line of defense against serious infections – did not work in most of these cases.
India is among the countries hardest hit by “antimicrobial resistance”. In 2019 alone, antibiotic-resistant infections caused around 300,000 deaths. They alone are responsible for the deaths of nearly 60,000 newborns each year.
But there is some hope on the horizon. A number of promising new locally developed drugs show potential to combat antibiotic-resistant pathogens. They also offer a revolutionary solution to preserve last resort treatments.
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Pseudomonas aeruginosa, a drug-resistant bacteria, is a major concern for doctors
Enmetazobactam, developed by Chennai-based Orchid Pharma, is the first antimicrobial invented in India to be approved by the US Food and Drug Administration (FDA). This injectable medication treats serious conditions such as urinary tract infections (UTIs), pneumonia, and blood infections by targeting the bacteria's defense mechanisms rather than the bacteria itself.
Bacteria often produce enzymes, such as beta-lactamase, to destroy antibiotics. Enmetazobactam binds tightly to these enzymes, neutralizing them and allowing the antibiotic to effectively kill the bacteria.
To put it simply, the drug immobilizes the bacteria's “weapon” without easily triggering resistance. This also preserves the effectiveness of other antibiotics, including carbapenems, which are a reliable “last line of defense.”
Trials conducted in 19 countries – the drug has been approved by global regulators – on more than 1,000 patients have shown its effectiveness. “The drug showed remarkable potency against these bacteria that have evolved over the years. It is administered by intravenous (IV) infusion in hospitals, particularly for critically ill patients, and is not available over the counter,” Dr Maneesh Paul, the drug's lead co-inventor, told the BBC .
Mumbai-based Wockhardt is testing a new antibiotic, called Zaynich, to treat serious drug-resistant infections. Developed over 25 years, the drug is currently in phase 3 trials and is expected to be launched next year.
Dr. Habib Khorakiwala, founding chairman of Wockhardt, described Zaynich as a “revolutionary, first-of-its-kind new antibiotic designed to fight all major superbugs.” It was administered on compassionate grounds to 30 critically ill patients in India who did not respond to any other antibiotics. Amazingly, all survived. “It would make India proud,” Dr Khorakiwala said.
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Mumbai-based Wockhardt is testing promising new antibiotics that will work on drug-resistant bacteria
Also in Phase 3 is Wockhardt's Nafithromycin, trademarked as MIQNAF, a three-day oral treatment for hospital-acquired bacterial pneumonia with a 97% success rate. Existing treatments for the disease have resistance of up to 60%. Its trials are expected to end next year and once approved, the company says it could be launched commercially by the end of next year.
Bugworks Research, a 30-member biopharmaceutical company based in Bangalore, has partnered with the Global Antibiotic Research and Development Partnership (GARDP), a non-profit organization based in Geneva, to develop a new class of antibiotics intended for the treatment of serious drug-resistant infections. Currently in the early stages of phase 1 trials, the drug is ready for commercialization in five to eight years.
“Antibiotics are becoming less and less effective, but the large sums of money are being spent on drugs for cancer, diabetes and other diseases, not antibiotics,” Anand Anandkumar, CEO of Bugworks, told the BBC. “There is little innovation because antibiotics are kept as a last resort option. Big pharma is not focused on antibiotic resistance. We have been funded by different organizations, but less than 10% of our funding comes from India.”
But this must change. A 2023 drug resistance surveillance report by the Indian Council of Medical Research (ICMR), which analyzed nearly 100,000 bacterial cultures from 21 specialty care hospitals in India, found worrying trends in terms of antibiotic resistance.
E.coli (Escherichia coli), commonly found in the intestines of humans and animals after consumption of contaminated food, was the most frequently isolated pathogen.
This was followed by Klebsiella pneumoniae, which can cause pneumonia and also infect the blood, cuts in the skin and lining of the brain to cause meningitis. The emergence of a multidrug-resistant pathogen called Acinetobacter baumannii, which attacks the lungs of patients placed on respiratory support in intensive care units, has grown closer.
The investigation found that the effectiveness of antibiotics against E. coli had consistently declined sharply, while Klebsiella pneumoniae showed an alarming increase in drug resistance. Doctors have found that some of the leading antibiotics are less than 15% effective in treating infections caused by these pathogens. Most worrying was the growing resistance to carbapenems, an essential antibiotic of last resort.
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Doctors say urgent need to reform India's antibiotic prescribing practices
“It's like playing whack-a-mole with bacteria. They evolve at an incredibly fast rate and we're always catching up. You get rid of one, another appears. We need more innovation and learning from past mistakes,” Dr Manica Balasegaram, executive director of GARDP, told the BBC.
It is no surprise that GARDP is focusing on India. It is collaborating with Hyderabad-based Aurigene Pharmaceutical Services to produce zoliflodacin, a novel oral antibiotic for gonorrhea, a sexually transmitted disease that shows increasing resistance to antibiotics. GARDP has also partnered with Japanese pharmaceutical company Shionogi to distribute cefiderocol – a breakthrough antibiotic approved by the FDA for the treatment of serious infections such as urinary tract infections and hospital-acquired pneumonia – in 135 countries, with production plans in India.
But that's only part of the story. Doctors say India's drug prescribing practices urgently need to be reformed. The widespread use of broad-spectrum antibiotics – they target many types of bacteria but can kill good bacteria, cause side effects and increase antibiotic resistance – fuels drug resistance by encouraging the emergence of resistant bacterial mutants to medications.
According to doctors, priority should instead be given to narrow-spectrum antibiotics. But hospitals often lack antibiograms – guidelines for antibiotics based on microbiology – forcing doctors to prescribe “broadly and indiscriminately.”
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Crowded Indian hospitals are hotbeds of infections
“I'm really excited that we have these new drugs. But what's also important is that we create mechanisms so that they're not misused like we did before with (which were once also) blockbuster drugs. Inappropriate and irresponsible use will compromise the longevity of these new drugs,” warns Dr Kamini Walia, scientist at ICMR.
The rapid mutation of bacteria, which can evolve within hours, highlights the urgency of a holistic approach. This includes reducing infections through better water, sanitation and hygiene, better vaccination, strengthening infection control policies in hospitals, training doctors and discouraging patient self-medication. “Addressing antimicrobial resistance is a complex, multifaceted challenge linked to health care equity and systemic accountability,” says Dr. Walia.
The message is clear: without urgent action, we risk finding ourselves in a future where even relatively minor infections could become untreatable.
