Emergence of multidrug resistant pneumococci in India

Editor—The World Health Organization warns of the emergence of superbugs, according to a news article by Kmietowicz.¹

I have been a consulting paediatrician in Bijnor, a small district in western Uttar Pradesh, India, since 1992. During the past 10 months I have treated seven cases of drug resistant pneumoccocal meningitis. The patients were aged between 2 and 14 years, and all of them were resistant not only to penicillin but also to commonly used third generation cephalosporins—namely, cefotaxime and ceftriaxone. The diagnosis was based on the results of Gram staining and culture sensitivity reports in cerebrospinal fluid. All of the children were given vancomycin, after which only three children showed an improvement and two died. Three children were left with severe neurological problems and were lost to follow up.

This report highlights the emergence of drug resistant serious pneumococcal infections in the community, a phenomenon hitherto unknown in India. Reports of penicillin resistant pneumococci have been numerous from developed countries, but such resistance has not been a problem in the Indian subcontinent. The arrival of resistant pneumococci was, however, long overdue here, given the degree of inadvertent and irrational use of third generation cephalosporins and other newer antimicrobials in certain trivial infections that ideally required none—for example, viral bronchitis, infections of the upper respiratory tract, diarrhoea, and viral croups. In a country where quacks are able to prescribe allopathic medicines, antibiotics are prescribed at the drop of a hat, most practitioners do not have access to good investigation facilities, and a policy on the use of antibiotics is almost totally lacking, it is rather surprising that conventional antibiotics were still holding sway over a micro-organism that had become resistant to most of them elsewhere in the world.