Why in news?
India is facing a growing threat from antimicrobial resistance (AMR) driven by widespread antibiotic overuse. In 2021, an estimated 2.67 lakh deaths were linked to AMR.
Key data point to alarmingly high resistance levels — including evidence that 83% of Indians carry drug-resistant bacteria — alongside major treatment gaps and widespread antibiotic misuse, rendering routine infections harder to treat and threatening the foundations of modern medicine.
Experts warn that the global antibiotic pipeline is nearly dry, with few genuinely new drugs in development, putting modern medicine at serious risk.
What’s in Today’s Article?
- Antimicrobial Resistance in India: A Growing but Largely Invisible Crisis
- Behaviour Drives Antibiotic Overuse in India
- A Drying Antibiotic Pipeline
- Role of Antibiotic Stewardship
- Role of Livestock, Environment and Humans
- Data Gaps Limit the Full Picture
- Exploring Alternative Therapies
Antimicrobial Resistance in India: A Growing but Largely Invisible Crisis
- AMR is emerging as a silent pandemic in India, intensifying both within hospitals and in the community.
- High antibiotic use in hospitals creates strong pressure on bacteria to evolve resistance through genetic mutations, which then spread rapidly via resistance genes, fuelled by antibiotic misuse.
- Patients often enter hospitals for unrelated conditions such as heart or kidney disease but acquire drug-resistant infections during treatment, sometimes with fatal outcomes.
- This hidden pathway makes AMR difficult to quantify accurately. Reliable global estimates only began emerging in 2021, and even now, comprehensive data remains limited.
- Beyond hospitals, common community infections such as typhoid, diarrhoea and pneumonia are increasingly becoming drug-resistant.
- Given that India accounts for about 18% of the world’s population, roughly one-fifth of global infections are estimated to occur in the country, underscoring the scale of the challenge despite the absence of precise national figures.
Behaviour Drives Antibiotic Overuse in India
- Antibiotic misuse in India is largely behavioural. Many people take antibiotics for common ailments like coughs, colds or diarrhoea without confirming whether the infection is bacterial.
- Antibiotics are often taken on pharmacists’ advice or prescribed prophylactically by doctors, reinforcing habitual overuse. This behaviour needs urgent correction.
A Drying Antibiotic Pipeline
- Although a few antibiotics have been approved in recent decades, almost none belong to new drug classes or use novel mechanisms.
- With no strong replacements in sight, continued misuse risks exhausting the effectiveness of existing drugs.
- Treating Routine Infections Is Getting Harder
- Drug-resistant infections now require stronger, last-resort antibiotics.
- Even community infections like UTIs and typhoid are becoming harder to treat due to repeated inappropriate antibiotic use.
- Resistance to fluoroquinolones in Salmonella typhi is rising, while overuse of ceftriaxone and azithromycin risks rendering them ineffective.
- However, resistance can reverse when drugs are withdrawn, as seen with older typhoid medicines regaining effectiveness.
Role of Antibiotic Stewardship
- Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.
- Stewardship programmes are more effective than sudden bans. Kerala’s antimicrobial stewardship programme, launched in 2015, focused on rational prescribing and awareness.
- Only after nearly a decade did the state ban over-the-counter sales, with reasonable success. Responsible use requires public understanding, not just regulation.
Role of Livestock, Environment and Humans
- High resistance levels in humans are largely driven by human antibiotic use, not livestock.
- Studies by ICMR found significant overlap of resistance genes between human and hospital environments, but minimal overlap with animals.
- A key concern is antibiotic residues in food, which persist in the gut microbiome and act as a reservoir for resistance.
Data Gaps Limit the Full Picture
- India’s AMR data mainly comes from 25 tertiary hospitals under the ICMR network, where resistance rates are higher due to prior hospitalisation and antibiotic exposure.
- This limits nationwide representation. Wider surveillance, similar to Japan’s system covering around 2,000 hospitals, is needed.
Exploring Alternative Therapies
- Phage therapy, which uses bacteria-eating viruses, shows promise for infections like UTIs but requires precise matching and often virus combinations.
- Resistance can develop even here. Monoclonal antibodies are another emerging option, though still in early stages of development.
