💥Join UPSC 2027,2028 Mentorship (July Batch) + XFactor Notes & Microthemes PDF
Talk to Mentor

Civilsdaily

Login

Subject: Health and Antimicrobial Resistance

  • On antibiotics, problem isn’t just overprescribing

    Why in the News?

    A new global study in The Lancet Public Health has again found that India consumes too many broad-spectrum “watch” antibiotics and too few first-line “access” antibiotics, with total antibiotic consumption above the optimal target. The deeper problem is not physician irrationality but the systemic conditions that push doctors toward broader antibiotics in the first place.

    What does the Lancet study find about India’s antibiotic use?

    1. Consumption above target: India’s antibiotic consumption is higher than the optimal target identified in the study.
    2. Skewed drug mix: India’s antibiotic mix is skewed toward “watch” category broad-spectrum drugs that should ideally be reserved for more serious infections, rather than first-line “access” antibiotics.
    3. Documented pattern: This overuse of broad-spectrum antibiotics has been repeatedly documented over the past two decades through surveillance studies, hospital audits and national AMR programmes.

    Why do doctors keep prescribing broad-spectrum antibiotics despite knowing the risk?

    1. Late presentation: Doctors often prescribe antibiotics before a definitive diagnosis is available because patients present late in their illness.
    2. Diagnostic unreliability: Limited or unreliable diagnostic facilities mean treatment decisions cannot always wait for confirmatory tests.
    3. Healthcare-associated infection risk: Inadequate infection prevention and control in healthcare facilities increases the likelihood of healthcare-associated infections, pushing clinicians toward broader-spectrum agents from the outset.
    4. The reframing: In the article’s own terms, antibiotics are often used to compensate for systemic weaknesses in diagnosis and infection control, not administered out of irrational prescribing habits.

    What structural reforms does the article call for?

    1. Infection prevention first: Better water, sanitation and hygiene, wider vaccine coverage, and sustained investment in infection prevention and control programmes in hospitals would reduce the burden of infections that require antibiotics at all.
    2. Diagnostic capacity: India has begun building this through the National Health Mission, the Free Diagnostics Service Initiative and the National Essential Diagnostics List, but laboratory quality, accreditation and turnaround time still need improvement.
    3. Stewardship training: Clinicians need training in antimicrobial stewardship and evidence-based prescribing, alongside community education that antibiotics do not treat viral infections.

    Has India actually made no progress, as the “overprescribing” framing implies?

    1. Reforms already underway: India has established a National Action Plan on AMR, expanded surveillance through the National Centre for Disease Control and the Indian Council of Medical Research (ICMR), introduced antimicrobial stewardship initiatives, and regulated fixed-dose combinations.
    2. Scale argument: A country with nearly one-fifth of the world’s population and one of its largest public health systems cannot transform antibiotic use overnight, and progress should be judged by the direction of ongoing reforms, not only current consumption levels.

    Conclusion

    India’s antibiotic overuse is a systemic problem rooted in late diagnosis, weak infection control and unreliable laboratories, not a simple failure of physician judgment that fewer prescriptions alone would fix. What must change is investment in diagnostics and infection prevention capacity, since asking doctors to prescribe less without fixing those underlying gaps risks costing lives rather than curbing resistance.

    Back2Basics:

    Antimicrobial Resistance (AMR)

    1. Definition: AMR occurs when bacteria, viruses, fungi and parasites evolve to resist the drugs designed to kill them, making infections harder to treat.
    2. India’s National Action Plan: India’s National Action Plan on AMR, coordinated by the Ministry of Health and Family Welfare, covers surveillance, infection prevention, stewardship, research and international collaboration.
    3. Surveillance network: The National Centre for Disease Control and the Indian Council of Medical Research (ICMR) run India’s national AMR surveillance network across sentinel hospital sites.
    4. WHO classification: The WHO’s AWaRe classification divides antibiotics into Access (first-line, low resistance risk), Watch (broader-spectrum, higher resistance risk) and Reserve (last-resort) categories.

    PYQ Relevance

    [UPSC 2014] Can overuse and the availability of antibiotics without doctor’s prescription be the 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.

    Linkage: The PYQ examines antimicrobial resistance caused by antibiotic misuse and the mechanisms needed for its monitoring and control. The article extends the PYQ by explaining that irrational antibiotic use is driven by systemic gaps in diagnostics, infection control and stewardship, and highlights ongoing AMR reforms in India.