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J Antimicrob Chemother 2013; 68: 1453 – 1454
doi:10.1093/jac/dkt062 Advance Access publication 18 March 2013
The Chennai Declaration: India’s landmark national commitment
to antibiotic stewardship demonstrates that ‘truth alone triumphs’†
A. H. Holmes1* and M. Sharland2
1
Centre for Infection Prevention and Management, Imperial College, London, UK; 2Paediatric Infectious Diseases Research Group,
St Georges University, London, UK
*Corresponding author. Tel: +44-208-383-3248; Fax: +44-208-383-3394; E-mail: [email protected]
†‘Truth alone triumphs’ (‘satyameva jayate’) is a mantra from the ancient Indian scripture Mundaka Upanishad. With the gaining of independence, it
was adopted as the national motto of India. It is inscribed in Devanagari script at the base of the national emblem. The emblem and the words
‘Satyameva Jayate’ are inscribed on one side of all Indian currency.
A joint meeting of the medical societies in India took place in Chennai in August 2012, giving rise to national
recommendations and an action plan to address the challenge of antimicrobial resistance in India. The
‘Chennai Declaration’, published in November 2012, has a pragmatic achievable plan and represents a bold
national commitment to antibiotic stewardship and infection control across India. The global importance of
implementing such an antibiotic policy as a national strategy needs to be recognized and supported
internationally.
Keywords: antimicrobial management, antibiotic policy, national policy, antibiotic usage, antimicrobial resistance, global biosecurity,
infection control
The rise of antimicrobial resistance (AMR), with the rapid dissemination of multiresistant bacteria within and between countries,
is now impacting individual patient care and clinical outcomes
for children and adults. This has serious implications for treatment, infection control and the delivery of healthcare and
means that AMR must now be considered a matter of global biosecurity. It is increasingly important that countries, particularly
those that face the greatest challenges, have clear, transparent
national strategies and action plans in place. In November
2012 an important paper from India was published that represented a significant national step forwards as a landmark commitment to antibiotic stewardship, with international importance
and global implications. This paper was the ‘Chennai Declaration’.1 Although there has been a national antibiotic policy in
India since 2011, the recommendations were considered to be
difficult to implement and there was no clear action plan.2,3
The concerns and frustration arising from the lack of impact of
such a well-intentioned but difficult to implement policy gave
rise to a meeting of Indian medical societies coming together
with Indian national authorities in August 2012 to develop this
‘roadmap’ outlining the urgent actions required.
The final declaration that appeared in November 2012 arose
from the dedication and hard work of multiple medical societies
working together with national authorities to shape a wide
ranging action plan for India. The paper represents an extraordinary example of national commitment from a country that
recognizes the clinical and public health issues of AMR.
Through the publication of this declaration and action plan,
India is providing assurance of national action and a clear demonstration that the country is facing up to this growing national
threat, both authoritatively and responsibly.
It is particularly noteworthy that the declaration comes from
a diverse mix of medical societies, not just those from infectious
diseases and microbiology specialities and a broad range of national authorities. The shared authorship includes the Indian
Medical Association, the Association of Surgeons of India, the
Indian Society of Critical Care Medicine, the Indian Society for
Medical and Paediatric Oncology, the Federation of Obstetric
and Gynaecological Societies of India, the Indian Societies of
Organ Transplantation, the School of Public Health and Zoonoses,
the Research Committee of the National Accreditation Board for
Hospitals, the Medical Council of India, the Ministry of Health
Expert Committee on Critical Care and the Indian Cooperative
Oncology Network. It is not only authorship that is shared, but
overseeing delivery of the action plan will also be shared
across the societies and a review of progress will be featured in
the different individual conferences. The collaborative strength
represented in this shared endeavour is impressive and other
nations can perhaps learn from this model and recognize the importance of ensuring multi-stakeholder engagement in addressing the key issues of antibiotic usage, antibiotic stewardship
and infection control. The role and involvement of oncologists
in drawing up this national action plan was particularly crucial,
and the rapid publication of the manuscript in the Indian
Journal of Cancer was because of the backing within oncology,
# The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
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1453
Leading article
where antibiotic resistance is clinically well recognized and a
genuine threat to patient outcomes.1
The declaration also has a much broader scope stretching
beyond antibiotic stewardship to improve patient care and
patient safety, as it promotes the important role of the infection
control committee and team by mandating that there must be
one in every hospital. The roadmap states that it will be these
infection control committees that should deliver the hospitals
antibiotic stewardship agenda, and this integration of infection
control and antimicrobial stewardship is a critical component
of the action plan. A lack of infection prevention and control
activity and committees in Indian hospitals has been recognized
as a cause for concern.
From a UK perspective, we should consider how we can offer
some practical support to our medical colleagues in India and
share experiences of initiatives and lessons learned. Recent initiatives in the UK and Europe could perhaps provide some useful
tools that may be adapted to both monitor antimicrobial use
and encourage an improved quality of prescribing. The NHS has
just launched a national antimicrobial stewardship programme,
‘Start Smart– Then Focus’, that emphasizes both the absolute requirement for evidence-based local antibiotic prescribing guidelines and also the need for a simple clinical review of all
patients on antibiotics at 48 –72 h to encourage stopping or simplifying the regimen.4,5 Surveillance programmes can also be
simplified and provide excellent opportunities for benchmarking
and quality improvement. In a recent global antibiotic 1 day
point prevalence survey for children, Indian hospitals took part
anonymously with their own local data feedback (www.
arpecproject.eu). The rapid growth in smartphone use can also
be used to support the local dissemination of antibiotic guidelines, decision making, stewardship and surveillance activity.6
Linkage between professional societies allows adaptation of
educational initiatives, especially focusing on the potential risks
and balances of antibiotic use. The development of the role of
pharmacists can also be supported. Professional linkage
between governmental organizations can help with defining
the international research agenda, while recognizing some of
the sensitivities involved.
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The declaration therefore represents a strong collaborative
voice and the authors, medical societies and national bodies
are to be commended for their coordinated commitment and
the production of their consensus recommendations. It now
needs to be considered what incentives are necessary for
sustainability and how other countries can provide positive
reinforcement and tangible support for such an important
national initiative.
Transparency declarations
M. S. is the Chair of the Department of Health Expert Advisory Committee
on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI).
A. H. H. is an expert member of ARHAI.
References
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antimicrobial resistance”—a joint meeting of medical societies of India.
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2 Lack of foresight: Antibiotic policy bites dust. http://www.dailypioneer.
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January 2013, date last accessed).
3 Antibiotic policy put on hold indefinitely. http://ibnlive.in.com/news/
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