‘Rampant antibiotic overuse, OTC sale fuelling India’s AMR crisis’

Antimicrobial resistance (AMR) is spreading faster than health systems around the world can tackle, with WHO’s Global Antimicrobial Resistance and Use Surveillance System report 2025 saying that nearly one in six bacterial infections no longer responded to standard antibiotics.

In India, drug resistance has surged beyond global averages, with more than 41,000 bloodstream infections, many becoming resistant even to last-line antibiotics.

Lata Mishra speaks to Dr Anitha Mathew, director, internal medicine at Fortis Hospital, Mumbai, about what’s driving this alarming trend and how to curb itHow challenging has it become to treat even routine infections that once responded easily to antibiotics? Which ones have ceased to be effective?India is facing a significantly high AMR rate, and a principal cause is the rampant misuse and overuse of antibiotics — both by healthcare professionals and the public.

Many infections, such as common cold, flu, dengue, and malaria, do not require antibiotics, but they are still frequently prescribed. Then there are self-medicating patients who obtain antibiotics over the counter (OTC) without a valid prescription.

Pharmacies further enable misuse by selling antibiotics without proper checks. In hospital settings, there’s a rise in prevalence of drug-resistant organisms, which makes treating infections like sepsis, urinary tract infections (UTIs), and pneumonia more challenging.

Routine infections that once responded to simple antibiotics are now more difficult to treat, often requiring higher doses or more advanced, last-line antibiotics. Common antibiotics like Amoxicillin, Ciprofloxacin, and even third-generation Cephalosporins, which were once highly effective, are losing efficacy against resistant strains.

Are OTC sales and incomplete courses fuelling resistance in India?These two practices are major drivers of AMR in India. There are many instances of unnecessary antibiotic use.

In a hospital setting, the pressure of treating resistant bugs leads to increased use which, over time, helps the bacteria develop drug resistance. When hospitals do not implement stringent infection control practices, resistant organisms thrive, further complicating treatment and increasing both morbidity and mortality rates.One challenge with OTC antibiotic sales is that patients may not complete prescribed courses or may self-medicate with drugs they no longer need.

This incomplete use allows bacteria to survive and mutate, making future treatments more difficult. Also, patients may take incorrect doses as well without proper medical guidance, raising the risk of developing resistant pathogens.

The WHO report says resistance is rising faster than new antibiotic development. How do you see India coping with this gap? What can the AMR National Action Plan do to curb misuse?In India, the situation is compounded by poor compliance to infection control protocols, particularly in smaller healthcare facilities and govt-run hospitals where doctor-to-patient ratios are inadequate.

Proper hand hygiene remains one of the most critical measures to curb AMR as it helps prevent cross-infections in hospital settings. India needs to focus on educating healthcare workers, particularly in smaller or overburdened facilities, on the importance of hygiene compliance.

Also, isolation of patients with resistant infections is essential to prevent the spread of these pathogens. Ensuring proper cleaning and disinfection of patient environments such as ventilators, beds, and other medical equipment, is key to reducing cross-contamination.The AMR National Action Plan must also focus on improving awareness among all stakeholders. Healthcare providers, patients, pharmacists, and the general public need to be better educated on the proper use of antibiotics and the potential consequences of misuse.Is India into international partnerships for antibiotic R&D, access to new drugs?India is actively involved in efforts to combat AMR and is part of global initiatives to improve access to newer antibiotics. It’s also making swift strides in antibiotic research, with several novel antibiotics being approved recently, many of which have shown promising results in addressing resistant infections.

However, the country faces significant challenges in ensuring equitable access to newer drugs, especially in rural, underserved areas.What should India’s top priorities be?The current AMR trajectory is concerning. If this continues, many common infections may become untreatable, ushering in a “post-antibiotic era”. This will have far-reaching public health implications, making routine surgeries, cancer treatments, and even childbirth more dangerous due to heightened infection risks. To prevent this, India must focus on these three priorities: