"India's antibiotic overuse and antimicrobial resistance demand evidence-based policy response"
Antimicrobial Resistance (AMR)
microorganisms' ability to withstand drugs designed to eliminate them, rendering treatments ineffective.
AWaRe Classification
WHO framework categorising antibiotics as Access (first-line), Watch (reserved), or Reserve (last resort).
Antimicrobial resistance (AMR) refers to the ability of microorganisms — bacteria, viruses, fungi, and parasites — to withstand the drugs designed to eliminate them, rendering standard treatments ineffective. It is a consequence of evolutionary pressure: every unnecessary or incomplete antibiotic course selects for resistant strains, which then proliferate. The World Health Organisation (WHO) has classified AMR as one of the top ten global public health threats, and India bears a disproportionate share of this burden given its high infectious disease load, dense population, and historically weak pharmaceutical regulation.
India's regulatory architecture for drugs is anchored in the Drugs and Cosmetics Act, 1940, which empowers the Union government under Section 26A to prohibit the manufacture, sale, or distribution of any drug deemed hazardous to public health. The Central Drugs Standard Control Organisation (CDSCO) and the Drug Technical Advisory Board (DTAB) form the scientific backbone of this regulatory process — DTAB reviews evidence and recommends bans, while CDSCO operationalises enforcement. Despite this framework, enforcement at the last mile — the pharmacy counter — has historically been inconsistent, allowing banned formulations to persist in circulation.
Fixed Dose Combinations (FDCs), which combine two or more active pharmacological ingredients in a single dosage form, occupy a central place in India's AMR crisis. While rational FDCs improve treatment adherence (especially in TB and HIV), irrational FDCs — particularly those combining antibiotics with each other or with analgesics — make it impossible to titrate individual doses, obscure adverse reactions, and accelerate resistance. The government banned over 330 FDCs in 2016 and has continued periodic bans since, reflecting an ongoing regulatory struggle.
The WHO's AWaRe classification — Access, Watch, and Reserve — provides the conceptual framework for rational antibiotic use. Access antibiotics are first-line treatments for common infections, recommended as the default choice. Watch antibiotics are broader-spectrum agents that should be reserved for specific, confirmed indications. Reserve antibiotics are the last line of defence against highly resistant pathogens and must be used sparingly to preserve their efficacy. The framework is designed to concentrate use in the Access category while limiting Watch and Reserve use to clinically justified situations.
A recent study published in The Lancet Public Health reveals that India's actual antibiotic consumption pattern inverts this logic. Total antibiotic use stands at 18.3 defined daily doses (DDD) per 1,000 people per day, against an estimated optimal range of 9.9–14.7 DDD. …
Which of the following are the reasons for the occurrence of multi-drug resistance in microbial pathogens in India?
1.Genetic predisposition of some people
2.Taking incorrect doses of antibiotics to cure diseases
3.Using antibiotics in livestock farming
4.Multiple chronic diseases in some people
Select the correct answer using the code given below.
With reference to the WHO AWaRe classification of antibiotics, consider the following statements:
1.'Access' antibiotics are recommended as first-line treatments for common infections.
2.'Watch' antibiotics are broader-spectrum medicines that should be used as the default choice for all bacterial infections.
3.'Reserve' antibiotics are intended as a last line of defence against highly resistant infections.
Which of the statements given above is/are correct?
Which of the following statements best explains why the overuse of 'Watch' category antibiotics accelerates antimicrobial resistance?
Consider the following statements regarding India's regulatory framework for drug bans:
1.Section 26A of the Drugs and Cosmetics Act, 1940 empowers the Union government to prohibit drugs deemed hazardous to public health.
2.The Drug Technical Advisory Board (DTAB) is responsible for the final enforcement of drug bans at the retail level.
3.Fixed Dose Combinations (FDCs) can be banned under Section 26A if found to be irrational or harmful.
Which of the statements given above is/are correct?
The 'One Health' approach to antimicrobial resistance (AMR) recognises that:
With reference to India's antibiotic consumption data from a recent Lancet Public Health study, which of the following correctly describes the key finding?
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