[Answered] Examine why Antimicrobial Resistance (AMR) is an escalating threat in India. Justify a comprehensive strategy encompassing GLASS surveillance, rational use, and public stewardship to tackle it.

Introduction

WHO’s GLASS 2025 reports that one in three infections in India is antibiotic-resistant, reflecting the world’s highest AMR levels driven by antibiotic misuse, weak surveillance, environmental contamination, and limited antimicrobial stewardship across health, agriculture, and community settings.

Why AMR is an Escalating Threat in India

1. Extremely High Clinical Resistance Rates: GLASS 2025 shows E. coli, Klebsiella, Staphylococcus aureus exhibit carbapenem resistance exceeding global averages. ICU settings show alarming MDR and XDR patterns, raising surgical and hospital mortality.
2. Overuse and Misuse of Antibiotics: India is the world’s largest consumer of antibiotics (Lancet, 2022). OTC access, self-medication, incomplete treatment courses fuel resistance. Veterinary overuse before the 2019 colistin ban worsened resistance in zoonotic pathways.
3. Environmental Drivers: Pharmaceutical effluents, hospital waste, and sewage containing antibiotic residues create hotspots of resistant bacteria—documented in Hyderabad, Patancheru, and Delhi drains.
4. Uneven Surveillance and Data Gaps: Current systems—ICMR’s AMRSN, iAMRSS, NCDC’s NARS-Net—capture mostly tertiary hospital data, overestimating severity but missing community resistance patterns. Rural, primary, and secondary centres remain largely outside the network.
5. Weak Implementation of NAP-AMR (2017–2021): Only Kerala has effectively operationalised a State AMR plan. Most States lack funding, coordination, intersectoral mechanisms, or enforcement capacity.
6. High Infectious Disease Burden: India’s dual burden of TB, diarrhoeal diseases, respiratory infections increases antibiotic consumption and accelerates resistance.

Justifying a Comprehensive Strategy

1. Strengthening GLASS-aligned Surveillance: Why it is essential; GLASS requires nationwide representative data, not sentinel tertiary-hospital snapshots. Accurate resistance maps enable evidence-based antibiotic guidelines and procurement. Measures must be, expanding 500+ NABL-certified labs, integrate private sector data. Build microbiology capacity in district hospitals, CHCs, PHCs. Real-time digital platforms like i-AMRSS must be universalised.
2. Rational Antibiotic Use and Stewardship: Clinical stewardship like mandatory hospital AMSPs, infection prevention and control (IPC) standards. Restrict last-line antibiotics; strengthen prescription audits. Promote narrow-spectrum antibiotic usage guided by updated antibiograms. Regulatory stewardship, enforcing Schedule H1, end OTC sales—Kerala’s AMRITH model shows measurable reduction in misuse. Regulate agricultural and aquaculture antibiotic use.
3. Community and Public Stewardship: Its essential because AMR is invisible to the public; literacy levels remain very low. Experts stress the need to “humanise AMR” so people relate to it. The approach should be mass AMR literacy programmes (Kerala targets “Antibiotic-Literate State by 2025”). School curricula integration, campaigns by ASHAs, NGOs, large non-profits. Behavioural nudges: Red-label antibiotics, mobile reminders for adherence.
4. Promoting Innovation and Access to New Antibiotics: Support Indian R&D efforts like Bugworks developing novel broad-spectrum agents. Respond to WHO’s warning that only 12 of 32 antibiotics in pipeline meet innovation criteria. Incentivise industry via push and pull funding mechanisms, PPPs, and tax credits.
5. One Health Approach: Integrate human, animal, and environmental sectors. Learn from COVID-19’s cross-sectoral collaboration and apply to AMR preparedness.

Conclusion

As highlighted in the Global Research on AMR (GRAM) Study, unchecked resistance threatens decades of medical progress. India must institutionalise GLASS surveillance, stewardship, and multi-sectoral One Health action to avert a looming public-health catastrophe.