Self-medication, easy antibiotic access drive antimicrobial resistance: Report

Over-the-counter antibiotic sales remain widespread in Delhi, Madhya Pradesh, Andhra Pradesh and Haryana, exacerbating the challenge of antimicrobial resistance (AMR), a new study has found. AMR occurs when microorganisms survive and multiply despite exposure to drugs.

The report, “Understanding Antibiotics Use” by environmental research and advocacy group Toxics Link, surveyed 303 respondents — including consumers, pharmacists and doctors — and found widespread misinformation about antibiotics, high levels of self-medication and persistent over-the-counter sales.

“Misinformation and misconceptions drive self-medication, while easy over-the-counter availability of antibiotics creates challenges in containing AMR,” said Vidhi Mathur, Senior Programme Officer at Toxics Link.

In Haryana, 78 per cent of respondents admitted to taking antibiotics without consulting a doctor, even though 60 per cent agreed that medical consultation was necessary before taking antibiotics. Only 48 per cent believed that taking antibiotics without medical advice can be harmful, reflecting limited awareness of health risks linked to misuse.

Respondents cited prior experience with similar symptoms, advice from family and friends, high cost and limited access to doctors as key reasons for purchasing antibiotics without prescriptions.

Amoxicillin, doxycycline and ciprofloxacin were the most commonly sold antibiotics in surveyed pharmacies in Haryana.

In Delhi, around 50 per cent of pharmacists said they were frequently asked for antibiotics without prescriptions. Among those who admitted to selling antibiotics over the counter, half sold generic drugs and half sold branded ones. Several patients who had consulted doctors reported receiving antibiotic prescriptions without being informed about side effects or AMR risks.

Andhra Pradesh recorded the highest over-the-counter antibiotic sales at 45.5 per cent, with consumption levels as high as 90 per cent. Clinicians cited patient pressure to prescribe antibiotics as a major driver of overuse. Pharmacists in states without a state action plan on AMR, such as Andhra Pradesh and Haryana, were more likely not to maintain records of antibiotic sales.

“The challenge of antimicrobial resistance lies not only in resistant microbes, but in misuse of antibiotics and lack of awareness across society. Tackling AMR requires investment in antimicrobial stewardship training for clinicians, pharmacists and healthcare workers, along with strong regulation and informed communities,” said Satish Sinha, Associate Director at Toxics Link.

India faces multiple AMR drivers, including over-the-counter antibiotic sales, overprescription in hospitals and overuse in the animal food sector. Limited awareness among both the public and healthcare professionals worsens the problem, with antibiotics often demanded even for viral infections. Socio-economic vulnerabilities and low health literacy further encourage self-medication and reliance on untrained providers.

The report recommended adopting a ‘One Health’ approach in policy frameworks, creating proper disposal channels for household antibiotic waste, and establishing monitoring and surveillance mechanisms for antimicrobial sales.