Combating Antimicrobial Resistance in India

“The world is on the brink of losing these miracle cures,” says WHO Director-General, Dr Margaret Chan referring to antibiotics that were hailed as “wonder drugs”, the miracles of modern medicine.

WHO’s first global report on antimicrobial resistance (AMR) in 2014 reveals that it is no longer a prediction for the future. AMR is happening right now, it is not a country specific issue but a global concern that is jeopardizing global health security.

AMR is of particular concern in developing nations, including India, where the burden of infectious disease is high and healthcare spending is low. The country has among the highest bacterial disease burden in the world. Antibiotics, therefore, have a critical role in limiting morbidity and mortality in the country.

"We are seized of the challenges of antimicrobial resistance,” says Mr Anshu Prakash, Joint Secretary, Ministry of Health & Family Welfare, Government of India.

Elaborating further, he says, “Effective antibiotics have been one of the pillars of modern medicine, allowing us to live longer and healthier. We have initiated significant steps to combat the growing threat of AMR in the country.”

In 2011, the Health Ministers of the WHO South-East Asia Region articulated their commitment to combat drug resistance through the Jaipur Declaration. Since then, there has been a growing awareness of the need for appropriate tracking of drug resistance, and all countries have agreed to contribute information to a regional database.

The 2015 WHO multi-country survey revealed widespread public misunderstanding about antibiotic usage and resistance. The survey highlights for India are of concern:

What is antimicrobial resistance?

Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it.

  • Three quarters (75%) of respondents think, incorrectly, that colds and flu can be treated with antibiotics; and only 58% know that they should stop taking antibiotics only when they finish the course as directed.

  • More than three quarters (76%) of respondents report having taken antibiotics within the past 6 months; 90% say they were prescribed or provided by a doctor or nurse.

  • While 75% agree that antibiotic resistance is one of the biggest problems in the world, 72% of respondents believe experts will solve the problem before it becomes too serious.

“AMR has huge implications for India. There is a need to have in place a good comprehensive AMR National Action Plan in line with the Global AMR action plan,” says Dr Henk Bekedam, WHO Representative to India.

A very significant part of out-of-pocket expenditure on health care is on medicines, but longer treatments, with ineffective drugs and/or second line expensive antibiotics is pushing the treatment costs higher. On the other hand, higher priced drug regimens are less likely to be adhered to, which again contributes to the AMR.

“This situation needs to be interrupted and reversed not only for safeguarding people’s health but also for providing protection against health care costs and people going into poverty,” says Dr Bekedam.

An issue that needs to be addressed in India is the regulation of the medical sector, particularly in the prescription of medicines. Lack of knowledge among medical practitioners as well as general public on rational use of antibiotics aggravates the issue.

Improved management of the health care delivery systems, both public and private, will minimize conditions favourable for the development of drug resistance.

It is also important to improve efforts to prevent resistant infections by changing how we produce, prescribe and use antibiotics.

More information on antimicrobial resistance is available at: