India’s struggle with antimicrobial resistance (AMR) often appears abstract, buried in reports and statistics. Yet, sometimes, a personal episode captures the problem more sharply than any dataset. A routine viral infection, treated very differently in India and Brazil, reveals how medical culture, regulation and enforcement shape antibiotic use — and why India is paying a heavy price for getting this balance wrong.
A routine illness that exposed systemic contrasts
For most Indians, healthcare for common ailments operates within a familiar formal–informal ecosystem — doctors, pharmacists, and social advice networks. Over time, patterns become predictable. Even when a doctor clearly diagnoses a viral infection like a cold or flu, prescriptions often include antibiotics, justified as “preventive” measures against possible secondary bacterial infections.
This approach is not driven by ignorance of medical science — doctors know antibiotics do not act against viruses — but by habit, patient expectations, defensive medicine and weak regulation. The result is routine antibiotic exposure for conditions the human immune system can resolve on its own.
Brazil’s protocol-driven medical discipline
The experience in Brazil unfolded very differently. Pharmacies there refused to dispense antibiotics without a prescription from a locally licensed doctor. Even a valid foreign prescription carried no authority. This regulatory barrier forced consultation within the public health system.
At the government urgent-care centre, the clinical approach was conservative and evidence-based. Despite symptoms that, in India, often trigger antibiotic prescriptions — prolonged fever, congestion, coloured sputum — the diagnosis remained viral. Treatment focused solely on symptom relief and monitoring, not microbial eradication.
Crucially, even when a sputum culture later showed moderate bacterial growth, antibiotics were still withheld. The rationale was simple: not all bacterial presence warrants treatment. The body often clears minor bacterial colonisation without pharmacological intervention.
The deeper issue: Preventive misuse of antibiotics in India
This contrast highlights a central flaw in India’s antibiotic culture — the preventive mindset. Antibiotics are frequently prescribed not because they are necessary, but because they are available, expected and perceived as harmless insurance.
Globally, antibiotics are treated as curative tools of last resort. In India, they often function as default additions to prescriptions. This distinction matters because every unnecessary antibiotic course accelerates the evolution of resistant bacteria.
India at the epicentre of antimicrobial resistance
The consequences of this culture are now visible at scale. India bears one of the highest burdens of AMR globally, with estimates suggesting nearly 3,00,000 deaths annually linked directly to drug-resistant infections.
Surveillance data from the Indian Council of Medical Research (ICMR) shows high resistance levels to commonly used antibiotics such as:
- Amoxicillin
- Ciprofloxacin
- Azithromycin
In many hospitals, 40–70 per cent of bacteria causing pneumonia, bloodstream infections and urinary tract infections show resistance to first-line treatments. This means infections that were once easily treatable now require stronger, costlier and more toxic drugs — or, in some cases, have no effective treatment left.
Beyond hospitals: Antibiotics in the food chain
Human misuse is only part of the problem. Antibiotics are extensively used in India’s poultry and livestock sectors, not just to treat disease but to promote faster growth. This practice creates reservoirs of resistant bacteria that move seamlessly from farms to food to humans.
The implication is stark: many individuals carry resistant bacteria without being ill. When a serious infection eventually strikes, standard antibiotics may fail, leaving clinicians with limited options.
Policy awareness without implementation
India is not short of policy intent. The National Action Plan on Antimicrobial Resistance (NAP-AMR) was formulated in 2017 with a multi-sectoral approach covering human health, animal husbandry and environmental waste. A revised plan for 2025–2029 was released recently.
Yet, the first plan largely remained on paper. Key reasons include:
- Weak enforcement of prescription-only antibiotic sales
- Inadequate surveillance and laboratory capacity
- A healthcare culture prioritising quick relief over long-term stewardship
The contrast with countries like Brazil lies not in medical competence, but in regulatory discipline. Strict control over antibiotic prescribing and dispensing changes behaviour across the system — doctors, pharmacists and patients alike.
Why medical discipline matters
Antimicrobial resistance is not caused by a single bad prescription, but by millions of small, routine decisions taken across the healthcare system. The principle is simple but difficult to enforce: antibiotics should be used when they are needed, not when anxiety or convenience demands them.
Without strong regulation and cultural change, India risks entering a post-antibiotic era where routine infections once again become life-threatening.
What to note for Prelims?
- Antimicrobial Resistance (AMR): ability of microbes to resist drugs designed to kill them
- India’s National Action Plan on AMR: first launched in 2017; revised for 2025–2029
- Role of ICMR in AMR surveillance
- Link between antibiotic use in livestock and human AMR
What to note for Mains?
- Preventive versus curative use of antibiotics in India
- Regulatory and enforcement gaps in healthcare governance
- One Health approach linking human, animal and environmental health
- AMR as a public health, economic and national security challenge
- Need for behavioural change alongside policy frameworks
