India has one of the highest burden of infectious diseases globally and antibiotic misuse is rampant in India. Covid-19 pandemic saw sky-rocketing sales of antimicrobials. Several thousand deaths, especially of infants, is the result of antimicrobial resistance. Not only humans, but animals also die of AMR due to illegal use in veterinary sector. Poor effluent treatment by pharmaceutical manufacturers and biomedical waste mismanagement has contaminated water bodies.
An unfortunate phenomenon in India is the role of patients themselves in antibiotic misuse. Despite lacking expert knowledge, they pressurise doctors to prescribe antibiotics; ‘Doctor, please give me a strong antibiotic’ is a common request we hear. A visit to the doctor should involve a long list of medications, or the consultation fee goes to waste. A doctor prescribes antibacterials for a clearly benign viral upper respiratory tract infections; if the infection is resolved, they say ‘ such a good doctor’; if it doesn’t, the doctor is judged to be incompetent.
The pandemic exacerbated the trend. Azithromycin was widely prescribed despite little clinical evidence of its effectiveness against covid. Rather than helping, it ended up causing loose stools in some patients. Easy availability over the counter and inexpensive cost are prompting the public to self-medicate themselves with antibiotics.
If antibiotic use is not rationalised, the threat of superbugs, which are not killed by the strongest antibiotics, will only loom larger. Also, the stronger the antibiotic, the greater the side effects. Public and patients in India should understand the science behind antibiotic use and also keep trust in the advice of their doctors.