Antimicrobial Resistance in India

Introduction

Antimicrobial resistance (AMR) is now a serious and escalating threat for India and for the world. The WHO’s GLASS 2025 report shows that common bacteria are often resistant to standard antibiotics, and India faces far higher resistance than the global average. GLASS and national data also reveal gaps in surveillance, weak regulation, and slow policy execution. Kerala’s stewardship model and newer antibiotics show solutions exist, but India needs stronger, coordinated action on AMR.

About GLASS-2025

Global Antimicrobial Resistance and Use Surveillance System (GLASS) 2025 is the WHO’s global platform for tracking antimicrobial resistance using standardised, comparable data.

Launched in 2015, it publishes annual reports showing resistance trends across major pathogens.

India joined GLASS in 2018 through the NCDC AMR surveillance network.

GLASS collects data on infections, antibiotic use, and laboratory capacity, helping countries compare resistance levels, identify high-risk pathogens, and strengthen national AMR policies and stewardship programmes.

Highlights from GLASS 2025

Global finding

The 2025 report presents an analysis of data from 104 countries and focuses on resistance trends between 2018 and 2023.

AMR was associated with nearly 5 million deaths in 2019 alone.

High Prevalence of Resistance: An average of one in every six laboratory-confirmed bacterial infections recorded in 2023 was found to be resistant to antibiotic treatment.

Significant Resistance Levels: For key pathogen-antibiotic combinations, the report notes alarming resistance levels:

1. coli resistance: Over 60% resistance to ciprofloxacin and around 40% resistance to third-generation cephalosporins.
2. pneumoniae resistance: Nearly 20% resistance to last-resort antibiotics like carbapenems.
3. aureus resistance: About 20% resistance to methicillin (MRSA).

India specific

AMR in India is described as “a serious and escalating threat.”

In 2023, about one in three bacterial infections in India were resistant to commonly used antibiotics, compared to about one in six globally, with India disproportionately affected.

Key aggravating factors highlighted for India

• Widespread over-the-counter access to antibiotics.
• Self-medication with antibiotics.
• Incomplete antibiotic courses taken by patients.
• Environmental contamination from:
• Pharmaceutical manufacturing
• Hospital waste
• Uneven enforcement of regulations related to antibiotic use and sale.

Limitations of India’s GLASS data

1. Hospital and tertiary-care bias: Most Indian GLASS data comes from NARS-Net labs in tertiary hospitals and medical colleges. This means the picture is driven by serious hospital cases, not everyday infections in primary centres or rural clinics.
2. Under-representation of private and rural sector: NARS-Net sites are mainly public sector medical colleges. Small hospitals, private clinics, and rural laboratories contribute very little data, so rural and peri-urban patterns are not well captured.
3. Limited pathogen and specimen scope: Surveillance includes only seven priority pathogens and five specimen types. Many community-acquired infections and other important bacteria may be missed or under-represented.

Initiatives Taken Against Antimicrobial Resistance (AMR)

1. National Policy and Surveillance

• India has started the National Programme on AMR Containment.
• It enrolled in GLASS (Global antibiotic resistance surveillance report system) in 2017 and participates actively.
• Surveillance networks such as ICMR’s AMRSN / i-AMRSS and NCDC’s NARS-Net collect resistance data from sentinel hospital laboratories.
• The National Action Plan on Antimicrobial Resistance (NAP-AMR), launched in 2017, provides an overall policy framework.

2. State-Level Action: Kerala Model

• Kerala Antimicrobial Resistance Strategic Action Plan (2018) uses an inter-sectoral One Health approach.
• AMRITH (Antimicrobial Resistance Intervention for Total Health), launched in 2024, targets over-the-counter antibiotic sales through inspections, penalties, and public reporting.
• Kerala aims to become antibiotic-literate by December 2025 through awareness and proper antibiotic use initiatives.

3. Regulatory and One Health Measures

• Ban on colistin use as a growth promoter in animal husbandry was imposed in 2019.
• The COVID period strengthened One Health collaborations across human, animal, and environmental sectors.

4. Innovation and Industry Efforts

• CDSCO has approved four new antibiotics: Nafithromycin, Plazomicin, cefepime/enmetazobactam, Tedizolid phosphate.
• The AMR Industry Alliance works to speed up discovery and development of new antibiotics and diagnostics, improve equitable access, and promote responsible manufacturing practices.

Way forward

1. Nationwide AMR surveillance : India needs a wider surveillance system that covers tertiary, secondary, and primary healthcare facilities.
2. More laboratories : Including more laboratories and peripheral centres will help generate representative and reliable resistance data, instead of estimates driven mostly by tertiary hospitals.
3. Strengthen antibiotic regulation : Strict enforcement of prescription-only antibiotic sales is essential. Expanding Kerala’s model of inspections, penalties, and public reporting can reduce over-the-counter misuse and promote safer, responsible antibiotic use across States.
4. Improve One Health coordination:

• Human health, animal health, agriculture, and environmental sectors must work together through strong One Health mechanisms.
• Better coordination will help control misuse in livestock, reduce environmental contamination, and ensure shared responsibility for stewardship.

5. AMR literacy: Awareness campaigns should make AMR understandable for the general population. Schools, civil society groups, and healthcare providers can support basic education on bacteria, antibiotic use, and the risks of incomplete treatment, helping people relate to AMR more closely.
6. Support development and access to new antibiotics: India must encourage innovation through sustained funding, better incentives, and faster but safe regulatory pathways. New antibiotics should target priority pathogens, be safe, affordable, and aligned with stewardship principles to ensure long-term effectiveness.
7. Revitalise State Action Plans on AMR: States need renewed commitment to implement their AMR plans. Clear timelines, adequate budgets, and regular progress reviews can help move AMR from paper frameworks to consistent on-ground action.

For detailed information on Increasing Antimicrobial Resistance in India read this article here

Conclusion

India faces a high AMR burden, incomplete surveillance and weak stewardship, but also has promising models and new antibiotics. Kerala’s experience shows that strong regulation, enforcement and literacy can work. India must scale One Health-based State plans, widen AMR surveillance and support affordable innovation to secure effective antibiotics.

Question for practice

Examine how the GLASS 2025 findings on antimicrobial resistance highlight both the scale of India’s AMR crisis and the gaps in its surveillance and stewardship efforts.

Source: The Hindu