India at centre of Global Antimicrobial Resistance: What is driving the crisis?

India has recorded the highest prevalence of multidrug-resistant organisms (MDROs) among four countries examined in a major international study published in Lancet eClinical Medicine.

The findings show that more than 80 per cent of Indian patients carry MDROs, underscoring the scale of antimicrobial resistance (AMR) in the country.

The study, released at the start of the WHO’s World AMR Awareness Week (November 18–24), analysed more than 1,200 patients in India, Italy, the Netherlands and the United States who underwent a common endoscopic procedure. India’s MDRO carriage rate was 83 per cent, far higher than Italy (31.5 per cent), the US (20.1 per cent) and the Netherlands (10.8 per cent).

Among Indian participants, 70.2 per cent carried ESBL-producing organisms, which do not respond to multiple commonly used antibiotics. Another 23.5 per cent carried carbapenem-resistant bacteria, resistant even to last-line antibiotics. Carbapenem-producing Enterobacterales were almost absent in the Netherlands and uncommon in the US.

Conditions linked to higher MDRO prevalence included chronic lung disease, congestive heart failure, recent penicillin use, frequent hospital admissions or past medical procedures.

The study notes that these infections require stronger drugs, longer treatment durations and higher costs, along with a greater likelihood of complications.

What is driving the crisis in India?

Experts say the situation in India is shaped by unrestricted antibiotic access, self-medication, weak regulatory oversight, and high infection burdens that lead to frequent antibiotic use.

Dr S S Lal, Public Health Expert and Director of ReAct Asia Pacific, said "This crisis is man-made; we cannot blame bacteria for adapting to the mistakes we make. Easy, over-the-counter access to antibiotics and rising healthcare costs drive widespread self-medication."

Dr Lal explained that AMR is further exacerbated by misuse of antibiotics in veterinary care, poultry, and aquaculture, with limited enforcement of the One Health approach that links human, animal and environmental health.

Hospitals also face challenges such as overcrowding, infection transmission between patients and inconsistent stewardship practices.

Dr Naresh Chawla, former national joint secretary of the Indian Medical Association, said poor regulation and patient practices play a major role.

“AMR in India is driven by weak drug-regulatory functioning, chemists dispensing without prescriptions and patients not following antibiotic instructions. People need to stop taking antibiotics for minor illnesses and complete the full prescribed course. By 2050, AMR may become the biggest cause of mortality,” he said.