Curbing irrational antibiotic use: An urgent call for action in India

Dear Editor,

Antimicrobial resistance (AMR) is a serious and escalating global health concern. In 2019, antibiotic-resistant infections caused an estimated 1.27 million deaths worldwide, and it has been projected that this number could rise to 10 million annually by 2050 if urgent preventive steps are not taken.^[1,2] To combat this crisis, the World Health Organization has emphasized the need for national antimicrobial stewardship programs, which are aimed at optimizing and promoting rational use of antibiotics and preventing the development of resistance.^[3] Such programs incorporate evidence-based prescribing guidelines, prescription audits, and public education. They have proven to be effective in reducing unnecessary antibiotic consumption and improving patient outcomes.^[3,4]

However, implementing stewardship programs in low and middle income countries like India faces unique challenges. Easy availability of over-the-counter access to antibiotics, poor public awareness, and widespread misconceptions contribute significantly to inappropriate antibiotic use.^[5] It has been seen that patients usually take antibiotics without consultation and prescription, like for common viral illnesses such as the common cold and influenza, conditions where antibiotics are of no use unless there is a simultaneous bacterial infection.^[6] In addition to this, patient expectations, poor diagnosis, lack of awareness, and inadequate health-care infrastructure further contribute to the overprescription of antibiotics.^[7] Addressing these challenges requires a multilayered approach that involves rules and regulations, educating patients, and community awareness.

Irrational use of antibiotics is frequently observed in local clinical practices and at smaller health-care facilities. It is common to see patients visiting health-care clinics for minor ailments being prescribed antibiotics by healthcare workers (HCWs). Such practices appear normalized in many communities. However, it is well established that antibiotics have no role in treating common viral infections such as the common cold. The inappropriate use of these medications contributes to antibiotic resistance, jeopardizing treatment options for future generations.^[4,7] These observations underscore the urgent need for awareness among the patients and the HCWs who are responsible for prescribing practices, particularly in community health-care settings. Moreover, the dispensing of antibiotics at pharmacies should be strictly regulated and monitored.

I urge health-care providers, policymakers, and the public to recognize the gravity of irrational antibiotic use and to collectively strengthen efforts to combat AMR. Without timely action, India risks losing one of the most powerful tools in modern medicine, leaving future generations vulnerable to infections that were once easily treatable.