India's Silent Health Crisis: Expert Warns of Drying Antibiotic Pipeline Amid Rising Resistance
Senior scientist Dr Kamini Walia from the Indian Council of Medical Research (ICMR) has issued a stark warning about the growing threat of antimicrobial resistance (AMR) in India, describing it as a "silent pandemic" that is making common infections increasingly difficult to treat. The alarming situation has drawn attention from top government officials, including Prime Minister Narendra Modi, Home Minister Amit Shah, and Health Minister JP Nadda, who have recently highlighted this pressing public health concern.
The Alarming Statistics Behind India's AMR Crisis
According to data from the Institute of Health Metrics and Evaluation at Washington University, an estimated 2,67,000 deaths in India were attributable to antimicrobial resistance in 2021 alone. Dr Walia reveals even more concerning figures from ongoing research: "In one of the studies we are conducting right now, we are seeing that one in 10 patients in India who are admitted to hospitals with some kind of infection are resistant to last resort antibiotics."
The scale of the problem becomes clearer when considering that 83% of Indians carry resistant bacteria, according to one study. This widespread resistance creates massive treatment gaps and jeopardizes the very foundation of modern medicine.
Why the Antibiotic Pipeline is Running Dangerously Dry
Dr Walia explains the global context of this crisis: "Globally, the antibiotic pipeline is running dangerously dry. While a few antibiotics have been approved over the past two decades, almost none represent truly new classes or mechanisms of action. As antibiotics are overused, we risk exhausting the limited effectiveness of the drugs we already have — without adequate replacements in sight."
This shortage of new antibiotics compounds the problem of resistance development, creating a perfect storm for public health.
Behavioral Factors Driving Antibiotic Misuse
The crisis is significantly fueled by behavioral patterns among Indians. "Whenever Indians have a cough, cold or diarrhoea, they reach out for an antibiotic," notes Dr Walia. Many people don't wait to determine whether their infection is viral or bacterial, despite antibiotics being ineffective against viral infections.
This learned behavior extends to healthcare practices where:
- Patients often rely on pharmacists for what they perceive as seasonal infections
- Physicians sometimes prescribe antibiotics for prophylactic use
- There's insufficient awareness about appropriate antibiotic use
How Common Infections Are Becoming Untreatable
The consequences of AMR manifest in two primary ways. First, patients can become infected with drug-resistant bacteria that require next-level antibiotics. Second, community-acquired infections like urinary tract infections (UTIs) become complicated due to improper antibiotic use over time.
Dr Walia provides a specific example: "The entire treatment of typhoid happens blind. Salmonella typhi strains are becoming resistant to fluoroquinolones, which were previously being used for treatment of this particular infection. Drugs like ceftriaxone and azithromycin are being overused and risk becoming ineffective for treatment of typhoid."
Success Stories and Potential Solutions
There is some hope in the situation. Dr Walia notes that "when you stop using the drugs for a short while, the sensitivity also comes back." She cites the example of typhoid treatment in the 1990s, when the disease became resistant to three commonly-used drugs, but after shifting to different antibiotics, the old drugs regained effectiveness in certain regions after fifteen years.
Kerala provides another encouraging example as the first state to launch an antimicrobial stewardship programme in 2015, focusing on rationalizing antibiotic prescription and awareness at all levels. The state banned over-the-counter sales of antibiotics only last year, achieving reasonable success after a decade-long effort.
Diagnostic Improvements and Government Initiatives
The government's Free Drugs and Diagnostics Services under the National Health Mission is making significant progress by providing free diagnostics at all healthcare levels. Dr Walia, who led the development of the national essential diagnostic list in 2019 and its subsequent revision in 2025, observes tangible benefits: "In one of the sub-centres in Odisha, we saw quite a few patients visiting during our visit. The staff told us that with free tests, people have stopped going to quacks."
Data Collection Challenges and Future Directions
One major challenge in addressing AMR is data collection. ICMR's network is currently limited to 25 tertiary care hospitals with well-functioning clinical microbiology labs. While they publish annual data (now in its eighth edition), Dr Walia acknowledges limitations: "The reason this cannot be taken as representative of the entire country is that this data is coming from tertiary care hospitals where patients come with a previous history of hospitalisation and excessive antibiotic usage."
For comparison, Japan's Nosocomial Infections Surveillance (JANIS) collects data from around 2,000 hospitals, highlighting the need for India to widen its circle of authentic data collection.
Exploring Alternative Therapies
Beyond traditional antibiotics, researchers are investigating alternative approaches:
- Phage therapy: Using bacteria-eating viruses, particularly effective for UTIs, though it requires precision in identifying which phages will work for specific infections
- Monoclonal antibodies: Still in a nascent stage of development for combating resistant infections
Dr Walia emphasizes that phage therapy represents an evolving field that needs customization for patients depending on the nature of infection.
The Environmental and Agricultural Dimensions
While human behavior remains the primary driver of AMR, environmental factors also play a role. ICMR conducted studies at sites in Delhi and Vellore examining pathogens from veterinary, environmental, and clinical samples. The research found "a sizeable overlap of antibiotic resistance genes between human and environmental isolates from hospital surroundings, but very minimal overlap between the human and the animal."
However, vigilance is needed regarding antibiotic residues from food that persist in gut microbiomes, potentially leading to commensal bugs carrying antibiotic resistance genes. The Food Safety and Standards Authority of India (FSSAI) addresses this concern by listing antibiotic residue limits on product labeling.
As India confronts this growing public health challenge, Dr Walia's insights highlight the urgent need for comprehensive strategies combining behavioral change, improved diagnostics, better stewardship programs, and continued research into alternative therapies to preserve the effectiveness of existing antibiotics while developing new solutions.
