India's Antibiotic Usage: A Call for Change to Combat Resistance

Concerns Over Antibiotic Use in India

A significant international study published in The Lancet Public Health reveals that India is overly dependent on 'watch' antibiotics, which are intended for specific bacterial infections when first-line treatments are ineffective. Experts caution that this reliance could exacerbate antimicrobial resistance (AMR), a major global health issue, while also depriving some patients of the antibiotics they genuinely require. The research presents a pioneering global framework to assess the optimal antibiotic usage for countries based on their infectious disease burden and AMR levels. Findings indicate that India's antibiotic consumption is heavily tilted towards broader-spectrum medications, underscoring the urgent need for improved prescribing practices.

Understanding WHO's Antibiotic Categories

What is the WHO's antibiotic classification?

The World Health Organization (WHO) categorizes antibiotics into three groups under its AWaRe framework:

• Access antibiotics: These are the first-choice treatments for common bacterial infections with a lower risk of fostering antibiotic resistance.


• Watch antibiotics: These broad-spectrum antibiotics should be reserved for specific infections due to their higher potential for promoting antimicrobial resistance.


• Reserve antibiotics: These are last-resort medications used exclusively for treating multidrug-resistant infections when other options fail.

Utilizing the appropriate antibiotic at the right moment is crucial for mitigating the rise of drug-resistant bacteria.

Findings from the Lancet Study on India

What the Lancet study found about India

According to researchers, India ideally needs 14.7 defined daily doses (DDD) of antibiotics per 1,000 individuals daily. This should comprise 7.8 DDD of Access antibiotics, 6 DDD of Watch antibiotics, and 0.99 DDD of Reserve antibiotics. However, the current antibiotic consumption in India stands at 18.3 DDD, which includes:

• 4.5 DDD Access antibiotics


• 9.3 DDD Watch antibiotics


• 0.19 DDD Reserve antibiotics

Only 27% of antibiotic use in the country is from the Access category, compared to the ideal estimate of 52.3%. This indicates that many patients may be receiving stronger Watch antibiotics unnecessarily, while safer first-line treatments are underutilized.

The Dangers of Antibiotic Overuse

Why is antibiotic overuse dangerous?

Excessive use of broad-spectrum antibiotics encourages bacteria to adapt and develop resistance to treatments. As antibiotic resistance escalates, infections that were once easily manageable can turn life-threatening. Drug-resistant infections can result in:

• Extended hospital stays


• Increased treatment costs


• Higher risk of complications


• Limited treatment alternatives


• Elevated mortality rates

India faces a unique challenge due to its high incidence of infectious diseases and existing antimicrobial resistance. While the country genuinely requires more Watch antibiotics than many others, experts emphasize that their use must be precisely targeted.

Global Insights on Antibiotic Usage

Global findings raise similar concerns

The research from The Lancet examined antibiotic use across 186 countries and territories, encompassing nearly the entire global population. It revealed that approximately 72% of countries utilized more antibiotics than necessary, with 99% overusing those likely to contribute to antimicrobial resistance. Furthermore, around 60% continued to prescribe antibiotics that the WHO no longer recommends for routine use. Simultaneously, millions globally still lack access to the antibiotics they need, creating a dual challenge of overuse and under-access.

Need for Improved Prescribing Practices

India's prescribing patterns need improvement

The findings are consistent with earlier data from the National Centre for Disease Control (NCDC), which indicated that nearly three-quarters of hospitalized patients received antibiotics during a nationwide survey. Alarmingly, only 6% of prescriptions were backed by microbiological testing, meaning most antibiotics were initiated without confirming the bacteria responsible for the infection. Experts noted the frequent use of ceftriaxone, cefixime, azithromycin, ciprofloxacin, levofloxacin, and piperacillin-tazobactam—all Watch antibiotics that should be prescribed with caution. Reserve antibiotics should be limited to patients with confirmed or strongly suspected multidrug-resistant infections.