The antibiotic crisis in India is part of a larger global issue concerning antimicrobial resistance (AMR). The World Health Organization’s July 2026 assessment highlighted that approximately one in six laboratory-confirmed bacterial infections worldwide is resistant to antibiotic treatment. In the WHO South-East Asia Region, which encompasses India, the rates of resistance are notably higher. Surveillance data from the WHO indicates that resistance has escalated in over 40 per cent of monitored pathogen-antibiotic combinations between 2018 and 2023, with an annual increase averaging between 5 to 15 per cent.

This alarming trend prompted the World Health Assembly to adopt a new Global Action Plan on AMR for the period 2026 to 2036, framing AMR not just as a medical issue but as a multifaceted threat impacting human health, animals, food systems, and the environment.

India’s Specific Challenges with Antibiotic Resistance

The situation in India is particularly concerning, as revealed by the Indian Council of Medical Research’s 2024 surveillance data. E. coli emerged as the most frequently isolated pathogen, followed by Klebsiella pneumoniae and others. The susceptibility of E. coli to imipenem dropped from around 81 per cent in 2017 to 58 per cent in 2024. For Klebsiella pneumoniae, susceptibility levels were alarmingly low, at approximately 31 per cent for imipenem and 35 per cent for meropenem in 2024. Although these figures stem from tertiary hospitals and may not represent all community infections, they indicate a troubling trend in resistance.

Antibiotics are crucial for modern medical procedures, including organ transplants and surgeries. The WHO has consistently warned that the absence of effective antibiotics increases the risks associated with routine medical interventions. In low- and middle-income countries, about 11 per cent of surgical patients develop infections during surgery, highlighting the urgent need for improved infection prevention measures alongside medical advancements.

India’s healthcare financing often prioritises visible treatments over preventive measures. Investments in infection control, such as hand hygiene and sterilisation, are frequently viewed as administrative costs rather than essential clinical interventions. This misalignment in funding can exacerbate the AMR crisis.

Need for Comprehensive Infection Prevention Strategies

Effective AMR policy must begin before antibiotics are prescribed. An intensive care unit lacking essential infection-control practices will likely lead to infections that necessitate antibiotic treatment. The WHO’s infection-prevention framework emphasises the importance of staffing, surveillance, training, and equipment in ensuring safe healthcare.

Despite the lessons learned from the COVID-19 pandemic regarding infection control, antibiotic overuse remains prevalent. The pandemic underscored the need for rapid diagnostics to prevent unnecessary antibiotic prescriptions, as uncertainty often drives clinicians to prescribe antibiotics even when they are not warranted.

Furthermore, stewardship programmes must ensure that patients receive timely antibiotics without compromising their effectiveness. Millions of patients still require appropriate antibiotics, and improving access to these medications could save countless lives. However, the focus must remain on using the right antibiotics for the right patients to prevent further resistance.

Regulatory and Environmental Considerations

The quality of antibiotics is another critical factor in the AMR discussion. Substandard medications can lead to inadequate treatment and increased resistance. WHO estimates that at least one in ten medicines in low- and middle-income countries is substandard or falsified. India has faced challenges regarding drug quality, as highlighted by past incidents of contaminated cough syrups.

Effective drug regulation requires adequate oversight and manpower. An expert committee has recommended increasing the number of drug inspectors to ensure compliance with safety standards. Additionally, AMR does not solely originate from healthcare settings; it is also influenced by environmental factors, including pharmaceutical waste and agricultural practices.

India’s National Action Plan on AMR 2.0 addresses these issues by recognising the need for regulatory action across various sectors. A coordinated approach involving healthcare, agriculture, and environmental management is essential to combat AMR effectively.

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