The Growing Burden of Antimicrobial Resistance (AMR) in India

Antimicrobial Resistance, or AMR, is one of the leading threats to global health in the present day. The condition refers to a pathogen developing resistance to an antimicrobial drug, thus leading to the creation of 'superbugs' which can no longer be killed through any traditional treatment. As the United Nations General Assembly High-Level Meeting on AMR, scheduled for September 26, is approaching, the World Health Organization issued guidelines on antibiotic pollution from manufacturing. It is a grim reminder that this crisis has reached proportions that cry out loud for urgent action. 

Antimicrobial Resistance (AMR) Crisis in India

The crisis is peculiarly serious in India due to a combination of factors that involve healthcare infrastructure, cultural practices, and economic constraints. This grim trend was cited by the Indian Council of Medical Research, wherein common pathogens like E. coli, Klebsiella pneumoniae, and Acinetobacter baumannii have gained increasing resistance from the available antimicrobial treatments. As the annual report of the ICMR on Antimicrobial Resistance Research and Surveillance Network quotes, this rising crisis is making the treatment for regular infections quite cumbersome and costly; multifarious effects, with special reference to the comorbid patients.

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Latest News on AMR in India Ban on Key Antimicrobials in Aquaculture (May 2025) In a significant move in May 2025, the Union Ministry of Commerce and Industry (Department of Commerce) issued a prohibition order banning the use of several medically important antimicrobials in India's aquaculture industry (shrimp, prawns, fish, and fishery products). This ban also extends to hatcheries, feed manufacturing units, and processing units. The ban includes 12 antibiotic classes and 6 specific antibiotics, such as fluoroquinolones, nitrofurans, and glycopeptides, based on WHO's list of medically important antimicrobials. Global Action Plan on AMR Update Discussions at WHO (May 2025) The Seventy-eighth World Health Assembly (WHA78) in May 2025 approved a decision to update the Global Action Plan (GAP) on Antimicrobial Resistance for discussion in 2026. This aims to provide a practical framework for the next 10 years to achieve targets set at the UN General Assembly High-Level Meeting on AMR in 2024, including a 10% reduction in global deaths associated with bacterial AMR by 2030.

What is Antimicrobial Resistance?

Antimicrobial resistance or AMR is the capability of microbes like bacteria, viruses, fungi, and parasites to develop resistance to medicines used against them. This resistance develops when these organisms undergo changes, usually mutations, that guard them against the antimicrobial agents, thus making treatments less effective or even completely useless. Due to this fact, common infections are harder to treat; therefore, there is more persistent illness, infection spread, and higher mortality rates. The development of AMR is a serious concern for public health, since this reduces the effectiveness of standard therapies and threatens advances in medical procedures that depend on effective antimicrobial therapy, such as surgery and cancer treatment.

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Factors Contributing to Antimicrobial Resistance (AMR)

Many Indians have the tendency to self-medicate. They use antibiotics without the right advice from the doctor. Besides this economic constraint and lack of access to healthcare drives the practice. Antibiotics are usually used for infections such as viruses in which their action is ineffective, hence driving up the level of resistance.

• Economic Barriers: Costly or sometimes even logistically difficult doctor consultations mean that people soon seek quick fixes from local chemists, who, themselves not recommending adequate treatments, exacerbate not only their condition but also make a wider contribution to the problem of drug resistance.
• Cultural Practices: Other reasons for this tendency are cultural practices and a lack of awareness about antibiotics. People have a general belief that antibiotics can cure everything; for that, they take antibiotics for illnesses that do not even call for antibiotic treatment.
• Broad-Spectrum Antibiotics: In India, most medical practitioners use broad-spectrum antibiotics, which effectively act against a wide variety of infections. Though effective in the short run, this tendency results in greater resistance over time.
• Preventive Prescriptions: Surprisingly, a large portion of antibiotics are prescribed to prevent rather than to treat infection. This unjustified preventive use has contributed immensely to resistance. According to the NCDC's survey on hospital patients, antibiotics were prescribed to 71.9% on average, and around 55% of the total prescriptions were preventive.
• Empirical prescription: Empirical prescription by doctors, based on symptoms rather than diagnosis, involves the inappropriate use of broad-spectrum antibiotics. This is a practice necessitated by the very unsatisfactory state of diagnostic facilities and the urgent nature of so many healthcare settings.
• Need for Diagnostic Tests: Secondly, because diagnostic tests have been introduced which detect with certainty the particular pathogens involved, this ensures that the appropriate antibiotic is prescribed and broad-spectrum antibiotics, which drive the development of resistance, are not used.
• Antibiotic Pollution: WHO guidelines on waste management in antibiotic production highlight a very significant yet commonly neglected contributor to AMR. High concentrations of antibiotics can be introduced into the environment through pharmaceutical manufacturing waste, encouraging the development of resistant bacteria.
• Gaps in Regulation: The potential of pharmaceutical waste to exacerbate AMR is high, though the area remains mostly unregulated. Stringent protocols for waste management are necessary, along with equally strict enforcement of the same, to mitigate this risk.

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Antimicrobial resistance issues have deep and profound impacts on public health, costs of healthcare, and economies globally.

• Increased Mortality and Morbidity: Diseases which were formerly classified as treatable infections, hence easily manageable with conventional antibiotics, have now become life-threatening. Surgical procedures also carry a greater risk due to life-threatening infections, as do cancer treatments and organ transplants.
• More Costly Healthcare: Resistant infections tend to require longer stays in the hospital, additional testing, and more expensive medication. Increases in the need for intensive care facilities and isolation strains healthcare resources.
• Economic Impact: Other economic impacts include reduced productivity and increased absenteeism. Increased treatment costs translate into increasing health premiums and a greater financial burden on individuals and businesses. At a global level, AMR is anticipated to carry severe economic burdens that could reduce GDP globally by several trillion dollars by 2050.
• Social Impact: Resistant infections disproportionately affect the most vulnerable populations, which include the elderly, children, and those with immune deficiencies. Failures in effectively treating infection may further erode public confidence in medical institutions and health professionals.

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Addressing AMR will require a multi-dimensional approach, including prevention, education, and strict regulation.

• Hygiene Practices: The facilitation of frequent hand-washing, safe food preparation, and good hygiene in general significantly cuts down on the incidences of infection, thus reducing antibiotic use.
• Vaccination: Extension of vaccine coverage, especially pneumococcal and influenza vaccines, prevents bacterial infection that would have necessitated the use of antibiotics. Although vaccines are available, their uptake is still low; there is a need for more awareness and access.
• Proper Use of Antibiotics: There is a need for sustained education of health professionals on prudent use, which should be reserved for severe cases treated in hospitals. This will help slow down the development of resistance.
• Public Awareness: Awareness among the public can be done through an effective campaign on hazards of self-medication and incomplete courses of prescribed antibiotics with a view to reducing risks of developing resistance.
• Diagnostic Testing: This will help in using antibiotics more precisely and appropriately by promoting diagnostic tests for finding out the exact pathogens responsible for infection.
• Pharmaceutical Waste Management: There is a need to implement and strictly follow stringent regulations in the disposal methods of pharmaceutical waste. WHO guidelines do provide a framework, but it is up to the national authorities to see these are followed rigorously.
• Surveillance and Research: There is a dire need for continuous surveillance of the trends in AMR, as well as research into new antibiotics and other modes of treatment. Knowledge of the pathways of resistance, mainly from manufacturing facilities, may aid in the formulation of effective countermeasures.
• Global Cooperation: The issue of AMR is global in nature. Collaboration between countries in terms of sharing data, resources, and best practices will translate into an improved global response to the crisis.

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Initiatives Taken by the Government to Tackle Increasing AMR

Several initiatives have been taken by the Indian government along with international organizations to combat AMR.

• National Action Plan on Antimicrobial Resistance, 2017-2021: Through the Ministry of Health and Family Welfare, NAP-AMR has been initiated with a full-fledged strategy in combating AMR. It involves improving awareness and understanding of AMR, enhancing surveillance, reducing the incidence of infection, optimizing the use of antimicrobial agents, and investments in new medicines, diagnostics, and vaccines.
• Regulatory Measures: The Indian government has listed some antibiotics under Schedule H1, which has a requirement for maintaining records by chemists concerning sales and purchases to avoid over-the-counter dispensation. Other than this, the government has banned the use of colistin in poultry farming in order to limit resistance increase in veterinary lineages.
• Awareness Programs: Government has started awareness programs through media about the judicious use of antibiotics. There is also continuous medical education among health professionals regarding prudent use of antimicrobial agents.
• Control and Research: The National Antimicrobial Resistance Surveillance Network, NARS-Net, has been set up to monitor and trace the resistance patterns across the country. More funds are being spent to research new antimicrobials, alternative therapies, and mechanisms of resistance.
• Infection Prevention and Control: Various initiatives like Swachh Bharat Abhiyan have been undertaken to improve sanitation and hygiene, which would also help reduce the acquisition of infection. Guidelines and protocols regarding infection control in the community and healthcare have been focused on and strengthened to prevent the spread of resistant pathogens.
• International Collaboration: India collaborates with the World Health Organization and other international bodies to align its strategies on AMR with the global efforts. Similarly, the country engages in international research collaborations to develop new antimicrobials and diagnostic tools.

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Conclusion

Antimicrobial resistance is a critical challenge that threatens to undermine decades of progress in health care. While addressing it, the regulation has to be strict; public awareness, judicious use of antibiotics, strong infection control practices are required, along with international cooperation. Continuous effort and vigilance are very much called for. The initiatives taken by the government of India are in the right direction.

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UPSC Previous Year Questions

Year	Question
2014	Can overuse and the availability of antibiotics without doctor’s prescription be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved.

UPSC Practice Questions

1. Discuss the major factors contributing to the rise of Antimicrobial Resistance (AMR) in India. What are the implications of this trend for public health and the economy? Suggest measures that can be taken to effectively address this issue. (250 words)
2. Evaluate the initiatives taken by the Indian government to combat Antimicrobial Resistance (AMR). How effective have these measures been in addressing the issue, and what additional steps should be considered to strengthen the fight against AMR? (250 words)
3. Antimicrobial Resistance (AMR) poses a significant threat to global health and economic stability. Critically analyze the role of international cooperation in tackling AMR and highlight the contributions and challenges faced by India in aligning with global efforts. (250 words)