AMR Voices: Superbugs and COVID in India

19 Jan 2021

The Covid-19 virus has impacted every aspect of life; social distancing measures have become the norm, entire cities, regions and nations have experienced government lockdowns with little warning, and international travel has ceased overnight.

At such a time, the suggestion that viruses could be a source of hope for the future of AMR may at first seem contentious, but Pranav Johri’s story of recovery thanks to phage therapy is remarkable. In the face of four separate drug-resistant bacterial infections, his treatment was only possible thanks to open skies and unrestricted travel. What seemed a given in free society months ago is now a logistical ordeal.

In 2016, Pranav developed chronic bacterial prostatitis, an inflammation of the prostate gland typically caused by a bacterial infection. Diagnostic testing revealed a multi-bacterial infection, including methicillin resistant Staphylococcus aureus (MRSA), Staphylococcus haemolyticus, Enterococcus faecalis and Streptococcus mitis.

These four strains that caused the prostate infection were all resistant to the classes of antibiotics that are available to treat prostate infection – macrolides, tetracyclines and fluoroquinolones.

“I think the general public does not realise the threat that AMR poses, and its potential to cause morbidity and mortality. Not just the general public, even some medical practitioners seem reluctant to accept the problem of AMR, with some wanting to deny the scale of the problem and others being defensive about it. AMR is a problem that goes beyond any specific doctor or hospital or city or even country, it is a problem at a global scale like Covid-19 and requires a multi-pronged response similar to Covid-19.”

Fortunately, Pranav was able to overcome his resistant infection with three courses of pioneering bacteriophage therapy, a method that uses viruses to attack specific bacteria. His third and last round of phage therapy finished in May 2018, and since then he has been free of infection and symptoms. However the Covid-19 pandemic has focused his thoughts on how different his situation may have been had he contracted the infection this year.

Facing the prospect of a resistant infection, with his doctors unable to provide adequate pharmacological solutions, Pranav was forced to take things into his own hands and research alternatives. He discovered the work of the Eliava Institute in the Republic of Georgia, US. He travelled from his home in New Delhi to Tbilisi for phage therapy treatments, sometimes for weeks at a time. It has been a long and difficult road to recovery.

Pranav Johri from India stands smiling at the camera in a black suit jacket and white shirt - he has recovered from antibiotic resistance with phage therapy

The implications of COVID-19

It is no secret that the Covid-19 pandemic has seen a shut-down in global travel, with many countries banning entry from abroad, requiring strict quarantines from travellers, and of course the collapse of many airlines. For many people, international travel for healthcare treatment has been essential in their recovery, something that the pandemic has rendered near-impossible.

Having experienced a drug-resistant infection and gone to great lengths to seek specialised experimental treatment, Pranav is wary of Covid-19, knowing the adverse impact it would have on his immunity, which would increase the possibility of a secondary bacterial infection occurring. He has taken many precautions to protect himself – avoiding crowded spaces, maintaining social distancing, and always wearing a mask.

What is phage therapy?

Bacteria are found everywhere in our biosphere, but nature has a way of preventing bacterial overgrowth and keeping them under control. It does so with the help of ‘bacteriophages’. Bacteriophages, or simply ‘phages’, are naturally occurring viruses that infect and feed on bacteria. They do not harm any organisms other than bacteria. They are found everywhere – in the air, in water, soil, food, even inside our bodies, and any other environment that allows bacteria to grow in it. Phage therapy is the use of phages to cure bacterial infections in human hosts.

With the present Covid-19 pandemic creating a greater public awareness of infectious disease and the need to prevent its spread, Pranav hopes it will create public pressure for governments to take greater action, particularly against antimicrobial resistant infections.

“The most important step would be to start accepting the scale of the problem and putting it into the public domain. When people start realising that the problem of drug-resistant infections will soon claim more lives every year than Covid-19 may end up claiming in 2020, then they will begin to see the scale and danger that it poses.”

He would like to see increased regulation of access to antibiotics. In India, an influencing factor in the increase of resistant infections is the ability to buy antibiotics over the counter without the need for a prescription. This has resulted in self-medication with inappropriate drugs that have contributed to the rise of resistant infections in the country.

As Pranav’s experience highlights, for some infections, the antibiotics we have available in the fight against some resistant strains are already ineffective. The challenge of antimicrobial resistance will only be overcome if it is fought on many fronts and innovation continues apace;

“The next step I would like to see is faster adoption of alternative treatments for AMR infections, like phage therapy. Medical regulators need to recognise the fact that antibiotics are not a treatment option in an increasing number of cases of infection due to the rise of AMR, and alternative treatment options like phage therapy need to be fast-tracked.”

Pranav is helping to spearhead the need for greater innovation. Thanks to his experience and treatment in Georgia, he and his wife established Vitalis Phage Therapy in India to bring phage therapy treatment to people facing the grim prospect of infections that antibiotics cannot treat.

“Infections caused by antibiotic resistant bacteria pose a similar threat to our lives as Covid-19. The impact of the virus on every aspect of our life should be the alarm-bell alerting everyone to the terrible impact lethal microorganisms can have. Media has played a vital role in creating awareness on Covid-19 among people and should be encouraged to play the same role with spreading awareness of AMR and the steps we can take to slow down its impact. I hope that governments, medical regulators, doctors and the medical community overall will now look at AMR with a renewed sense of urgency.”

AMR VOICES

AMR Voices

Between July and November 2020, the Longitude Prize reached out to contacts around the world to connect with people living with – or who have experienced – drug-resistant infections, to better understand how the Covid-19 pandemic is shaping their lives. The team also spoke to medical professionals, doctors and pharmacists, to capture their perspectives. Combined, the stories shared in this report provide the reader with a first-hand look at how the antimicrobial resistance (AMR) and Covid-19 agendas meet and what people living with resistant infections or have overcome them think needs to be done. We will be sharing this as a series for the next few months. You can find all the stories published thus far here.

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