By Joanna Sugden, Wall Street Journal, April 23

India has lost the war against the toughest forms of antibiotic resistance, largely because of poor sanitation, unregulated use of antibiotics and an absence of drug resistance monitoring, according to the man who discovered a type of drug resistance in bacteria in New Delhi.

“All these factors add to why it’s going to be so difficult to deal with or even tackle

[resistance], you won’t solve it, it’s over,” said Tim Walsh, professor of medical microbiology at Cardiff University in Wales.

In 2010, Mr. Walsh discovered an enzyme that made disease-causing bacteria resistant to antibiotics.  He named the enzyme “New Delhi Metallo 1” (NDM-1) and claims he was banned from working in India after the discovery.

Bacteria carrying the NDM-1 enzyme are highly resistant to the most powerful group of antibiotics, known as carbopenems, making infections caused by them extremely difficult to treat.

They can also transfer their resilience to other bacteria, including those that cause infections. “The rapidity and frequency of that transfer is something that we have never seen before in antibiotic resistance,” Mr. Walsh said.

He estimates that up to 200 million Indians carry NDM-1 on the benign bacteria in their intestines. But a lack of research and scarcity of data make it difficult to gauge in terms of its transfer to disease causing bacteria.

“We’ve failed to understand how NDM-1 spreads in the community,” Mr. Walsh said, adding that there is also very little understanding about the risks associated with being infected by a bacteria carrying NDM-1.

“We’ve failed to understand what dominant clones are in hospital and we’ve failed to understand the risk post surgical infections,” he said.

In almost three years since he published his research in the Lancet medical journal, Mr. Walsh says that India has failed to respond to the “urgent” need to regulate the sale and use of antibiotics, track the incidence of resistance or improve sanitation.

Antibiotics are for sale without prescription in pharmacies in India and there are no national guidelines for clinicians on their use in hospitals. Bacterial diseases develop resistance to treatment with antibiotics when the drugs are wrongly used to treat viral infections or when a full course of drugs isn’t completed.

Resistance makes infectious diseases more difficult or impossible to treat. Even simple urinary tract infections when caused by an NDM-1 carrying bacteria cannot be eradicated with antibiotics, Mr. Walsh said.

When he published his findings in 2010 Walsh says his name “became mud” in political and scientific circles in India.

“I named the gene after the capital of India which they [the government] weren’t too thrilled about,” he said. It is normal scientific practice to name genes after the cities in which they are found, he added.

“We were banned from India and India had a massive clamp down on sending [biological] strains out,” Mr. Walsh said.  “Indians were banned from working with me, or anybody in Europe the whole thing was a systematic campaign to control research into antibiotic resistance in India.”

Neither the Ministry of Health nor the Central Drugs Standard Control Organization responded to requests for comment.

Mr. Walsh says he received hate mail and was accused of working for the British secret service after he published further research in 2011 showing that NDM-1 existed in samples of tap water and pools of water in New Delhi streets.

The scientist is now working on samples from Pakistan in order to study the impact of NDM-1 on bacteria. “In Pakistan the people want to work with us, and unlike India are completely transparent and open about their health problems,” he said.

He added that the countries had vastly different economic capabilities for tackling the problem of resistance. “Whilst Pakistan can’t do anything about it economically, India can… But it chooses to do nothing,” he said.

[Full Story at Wall Street Journal: India Realtime]