Project report on LCA: ANTIBIOTICS AND HOME FURNITURE.

1)WHAT IS LCA? And its aims.-vipin

Life cycle assessment is a process of examining all the stages of life cycle of
any product. each stages material, energy input and output along with the
associated environmental impact are monitored/tracked.
Thereby a LCA of any product is aimed at bringing down the detrimental
impact on the environment by making right policy decisions about each stage,
be it the procurement of raw materials, realisation/manufacturing, usage or
post shell life disposal.

2)ANTIBIOTICS = anti+biotic!? [earlier :antibiosis]vipin

As the very name suggests these are something which are primarily used
against bacterial infections. the term was first given by Dr Selman waksman
in 1942 to describe any substance produced by a living microorganism which
deters the growth of other microorganisms.( SA Waksman (1947). "What Is an Antibiotic or an Antibiotic Substance?".
Mycologia 39 (5): 565569. doi:10.2307/3755196. JSTOR 3755196. PMID 20264541 )
Antibiotics are a type of antimicrobials which aim to either deter
the growth of bacteria or to kill it. Some antibiotics also work against fungi and
other protozoans. However they dont work against viruses, is also an
established fact.
Before the early 20th century, treatments for infections were based primarily
on traditional medicine. Mixtures with antimicrobial properties that were
used in treatments of infections were described over 2000 years ago in
various societies.(Lindblad WJ (2008). "Considerations for Determining if a Natural Product Is an Effective Wound-Healing Agent". International Journal of
Lower Extremity Wounds 7 (2): 7581. doi:10.1177/1534734608316028. PMID 18483011)
however with advancement of science and research in biotechnology
and other associated fields we have been able to synthesise artificial
compounds equivalent to natural antibiotic substances since 1907, when Paul
Ehrlich manufactured synthetic antibacterial salvarsan.(Lindblad WJ (2008). "Considerations for
Determining if a Natural Product Is an Effective Wound-Healing Agent". International Journal of Lower Extremity Wounds 7 (2): 7581. doi:10.1177/1534734608316028. PMID

)The time period from 1945 to 1970 is generally considered as the

golden period of discovery as most classes of antibiotics which we have now
were discovered then. After then research into finding newer classes has
18483011

more or less been half hearted and stagnated, due to commercial reasons
and others.
so currently the term antibiotics,loosely, includes all the natural ,semisynthetic
or synthetic compounds which prohibit or kill the bacterial growth.
3)Life cycle of Antibiotics -vipin

fig: a general life cycle diagram showing various stages of a product (src:
pininterest.com)

{src: http://www.webpal.org/SAFE/aaarecovery/7_medicine/Medicine%20%20antibiotics/Medicine%20Making%20Antibiotics.pdf}

Raw materials and utilities for antibiotics vipin

the most significant raw materials are the organisms themselves. , energy
and carbon resource along with other nutrients essential for faster rate of
growth of the organisms is provided by the growth media.Also some fixed
precursors for the particular antibiotic (for example phenyl acetic acid for
penicillin) are required for production.
apart from this large amount of chilled cooling water is required for controlling
the large amount of heat produced during the fermentation process.
MANUFACTURING vipin
the figure on the previous page shows the typical production scheme of
antibiotics.
the process in general is electricity intensive as large amounts of electricity is
used for transferring oxygen in aerobic fermentation and for production of the
cooling water.
one important point to be noted during manufacturing is that antibiotics can
be destroyed or rendered useless by some other microorganisms. So we
need to maintain a sterile environment to avoid contamination.
{lack of info. over the net about the exact figures is the reason behind missing
energy consumption n other tables}
some worthwhile points -girdhari
.environmental pollution is caused due bio excreata to a limited scale but on
large scale environmental pollution is caused due to the emission from drug
manufacturing as a source of much higher environmental discharges that, in
some cases, greatly exceed toxic threshold concentrations
2.There were scattered, early indications of discharges from manufacturing
being a source of active pharmaceutical ingredients (APIs) in the environment
[16],
3.The discovery of oestrogens in sewage effluents as a cause of the
feminization of fish in the late 1990s sparked an exponentially increased
interest in pharmaceuticals in the environment
4.The pharmaceutical industry argued that significant discharge of APIs from
manufacturing is unlikely based on several lines of reasoning, including that
the extremely high value of drugs would prevent their release for purely
economic reasons .but this assumption was later demonstrated to be

incorrect.A summary of studies that have reported API discharges from

manufacturing sites is presented in table 1.
5.In 2007, the first in a series of papers was published showing very high
emissions of pharmaceuticals from drug manufacturers in Patancheru, near
Hyderabad, India [11,17,20]. This area is an important hub for the world's
production of bulk drugs and features a very large number of industries
congregated in a limited area. The concentrations in the effluent from a
treatment plant receiving wastewater from about 90 manufacturing units
were, for some pharmaceuticals, greater than those found in the blood of
patients taking medicine. The concentration of ciprofloxacin, which is a broadspectrum antibiotic, was as high as 31 mg l-1 [11], which is approximately one
million times greater than the levels that are regularly found in treated
municipal sewage effluents [28] and toxic to a range of organisms. The
estimated total release of ciprofloxacin for 1 day was 44 kg, which is
equivalent to Sweden's entire consumption over 5 days, or, expressed in
another manner, sufficient to treat everyone in a city with 44 000 inhabitants.
These discharges have led to pollution of river sediment [20], surface, ground
and drinking water [17] to unprecedented levels, and a recent report also
demonstrated contamination of irrigated soils
6.Indian drinking water Cetirizine (antihistaminic), Ciprofloxacin (antibiotic),
Enoxacin (antibiotic), Terbinafin (antimycotic), and Citalopram (antidepressant
drug) were found. Up to 14 different pharmaceuticals have been found in the
drinking water of big cities around the world. There also exist publications
reporting the presence of cancer drugs in surface water in some countries.

Now coming to the product use.-vipin

antibiotics have become integral part of modern medicine. Clubbed with
vaccination processes antibiotics have helped curb and bring under control
the diseases and bacterial infections like tuberculosis, syphilis, salmonella etc
which earlier were considered fatal.
with passage of time due to mastery of human race over the means of large
scale cheap production of antibiotics, the use of antibiotics isnt just confined
to humans. Now a days we are seeing the detrimental and potentially
catastrophic aftereffects of large scale non human use of antibiotics.
not just this, we also have witnessed human misuse of antibiotics intentional
or accidental.(to be discussed later)

antibiotics have long been, across the world, an instrumental part of meat
producing animals feed. In such animals like poultry they are used for mainly
three reasons:
therapeutic ie treatment of infected
prophylactic implies prevention of those at the risk
and growth promotion for enhancing rate of growth and feed efficiency.
Across these three the third accounts for the most antibiotic consumption in
India as well as other countries.
Such unsustainable use of antibiotics for not just animals but also plants(will
be covered subsequently) and crops has led to the trending phenomenonal
problem of ANTINIOTIC RESISTANCE!!

4) Current situation regarding over the counter sale-by girdhari

=>Resistance to antibiotics is becoming a serious threat for India because of
popular habit to pop pills at will. Even the World Health Organization (WHO)
recently warned that the world is staring at a post-antibiotic era, when
common infections will no longer have a cure.
WHO director general Dr Margaret Chan had said, "The world is on the brink
of losing these miracle cures."
=>A recent study by the Centre for Disease Dynamics, Economics and Policy,
Washington DC, said there has been a six-fold increase in the number of
antibiotics being popped by Indians.
=>Regulating over the counter sale of antibiotics was one of the key
recommendations of the Chennai Declaration, besides the need for
monitoring antibiotics usage in hospitals, stepping up infection control,
regulation of antibiotics in veterinary practice, setting up a National Antibiotic
Resistance Monitoring Network, and facilitating clinical research for
preventive strategies.
Dr Abdul Ghafur, coordinator, Chennai Declaration and a consultant in
infectious diseases and clinical microbiology at Apollo Specialty Hospital,
Chennai told India Medical Times, The new amendment would certainly
reduce indiscriminate buying of over the counter antibiotics for simple
problems to tuberculosis. First of all, most prescriptions for the drugs are
unnecessary, they are increasing the number of infections that become

resistant to antibiotics. Moreover, people dont complete the course and

hence the numbers of antimicrobial resistance are increasing. There is a
public health threat from infections that are resistant to multiple antibiotics
and there is an urgent need to develop new treatments, which is one of the
major issues raised in Chennai Declaration.
He said, This is one of the boldest steps taken by the Ministry of Health and
Family Welfare and I have worked with them on the same issue for one and a
half year. Undoubtedly, the Chennai Declaration speeded up the process.
This is just a start as bringing many drugs under the net at the same time was
not feasible. We are expecting that more drugs would be listed in this
category where prescription by the doctor would be a prerequisite.

5)So what is IS ANTIBIOTIC RESISTANCE (AR)??-vipin

It basically refers to the loss of effectiveness of current medicines(antibiotics)
against the microbes as the microbes
1) mutate or
2) due to horizontal gene transfer, ie the
microbes acquires the genetic information from other microbes to develop
resistance. .
Although AR is a natural phenomenon, but it is accelerated because of the
higher antibiotics usage!!
Without urgent, coordinated action by many stakeholders, the world is headed for a
post- antibiotic era, in which common infections and minor injuries which have
been treatable for decades can once again kill, says Dr Keiji Fukuda, WHOs
Assistant Director-General for Health Security.
(src: WHO ANTIBITIC SURVEILLANCE REPORT 2014 http://www.who.int/
drugresistance/documents/surveillancereport/en/)

the figure shows the complete life cycle along with the steps during which
antibiotic stewardship can be shown!!
(for ref and credit for this awesome graph : http://www.epa.gov/esd/bios/
daughton/drug-lifecycle.pdf)

5) CASE STUDY!!! vipin

recently Pollution monitoring lab, PML of CSE New Delhi conducted some
tests regarding antibiotic presence in chicken samples in and around Delhi.
the test results were shockingly positive.
40% of the chickens were tested positive s one or more antibiotic presence.
more on this can be seen on the CSEs website under food safety and toxins
tab or one can refer to our groups slides :)
(http://www.cseindia.org/content/latest-study-cse%E2%80%99s-pollutionmonitoring-lab-finds-antibiotic-residues-chicken)
6)FEW OTHER INSTANCES (example from our Delhi again)-vipin
The Curious case of NDM-1
NDM-1 stands for New delhi metallo-beta-lactamase-1. It is a antibiotic
resistance gene found in some strains of few bacteria as of now.
it is resistant to nearly all antibiotics including carbapenem antibiotics, which
are antibiotics of last resort. (src: http://www.medicalnewstoday.com/articles/
197616.php)

GARP-India(global antibiotic resistance partnership) research estimates that

of the approximately 190, 000 neonatal deaths in India each year due to
sepsis, a bacterial infection that overwhelms the bloodstream, over 30 per
cent are attributable to antibiotic resistance.
(http://www.thehindu.com/sci-tech/health/policy-and-issues/antibioticresistance-in-india-high-survey/article2512475.ece)
7) Drug laws in India-by girdhari

1.Drug Controller General of India (DCGI) Dr G N Singh had written to the Union
health minister to notify a new schedule H1 in the Drugs and Cosmetics
Rules.Drugs that Indians are becoming resistant to or can become resistant to are
being put under schedule H1.these drugs cannot be sold without prescription.
2.The drugs to come under H1 includes Moxifloxacin, Meropenem , Imipenem,
Ertapenem, Doripenem, Colistin, Linezolid , Cefpirome, Gentamicin, Amikacin,
Pencillin, Oxacilin, Zolpidem, Cefalexin, Norfloxacin , Cefaclor, Cefdinir,
Tigecycline , Tobramycin, Tramadol and Vancomycin.
3.To check the indiscriminate use of antibiotics, anti-tuberculosis and some other
drugs in the country, the union health ministry has notified amendments to the
Drugs and Cosmetics Act, 1940 under which a new provision Schedule H1 has
been included to curb over the counter (OTC) sale of certain antibiotics and antituberculosis drugs from March 1, 2014.
Forty-six drugs, comprising mainly third and fourth generation antibiotics, have
been placed under this restricted category and the sale of these drugs could only
be done on furnishing an appropriate prescription letter of a doctor. Also, the seller
has to retain a copy of the prescription letter and maintain a separate register that
records the name of the buyer and the doctor who prescribed the medicine along
with other necessary details.
To spread awareness, a mandatory warning has to be printed in a red box on the
label of listed drugs and any violation of the new rule can result in prosecution,
states the notification, which was issued on August 30.
Dr Madhukar Pai, associate professor at McGill University and associate director,
McGill International TB Centre, in an exclusive conversation with India Medical
Times said, This Government of India order and the Chennai Declaration are
important to raise awareness about the rampant abuse of antibiotics, including antiTB drugs, in India, especially over the counter use.
4.Dr A Muruganathan, president, Association of Physicians of India, told IMT,
Personally, I believe it should not be only about certain antibiotics and anti-TB
drugs for which a prescription letter should be mandatory. No drug in India should
be sold without a doctors advice. Also, the seller should ask for fresh prescription
letter if there is a gap between the patient buying over the counter medicine and the
date on which the doctor recommended. Like in other countries, India should take
sincere steps to stop the practice of over the counter sale of antibiotics as it leads
to growing antimicrobial resistance.
5.WHAT THE NEW SCHEDULE H1 NORM MEANS
FOR RETAILERS

* Will require more time and add to work in the form of record keeping
* Will slow down dispensing process
* Will have address of patient so can recall medicines in case of problems in a
particular batch or spurious drug
* Loss of Over The Counter (OTC) sale
FOR DOCTORS
* Will need to be extremely judicious while prescribing these medicines
* It will help minimize resistance in patients
* Patients will come for repeat prescriptions for chronic diseases
FOR PATIENTS
* Will have to buy medicines in lumpsum for at least a month
* Patients cannot buy medicine OTC in case of emergency
* Patients who cannot go to doctors often but are on certain medicines lifelong will
have to shell out more money on doctor visits

7)way ahead
Now the Case study revelations along with the findings of the
antibiotics report by WHO together clubbed with the precautionary
principle can easily be used to bring out some long needed stringent
laws to stop over the counter sale(without prescription) of antibiotics,
also to put a stop to antibiotics in animal feed as growth promoters.