Antibiotic Resistance in India: Drivers and Opportunities for Action

Antibiotic Resistance and Use in IndiaAntibiotic resistance is a global public health threat [1], but nowhere is it as stark as in India [2].The crude infectious disease mortality rate in India today is 416.75 per 100,000 persons (author calculations based on World Bank data and the Global Burden of Disease, 1990 [1,2]) and is twice the rate prevailing in the United States when antibiotics were introduced (roughly 200 per 100,000 persons) [3].A mix of poor public health systems and hospital infection, high rates of infectious disease, inexpensive antibiotics, and rising incomes is coming together to increase prevalence of resistant pathogens and is increasing the burden of untreatable neonatal sepsis and health-care-associated infections [4]. Summary Points• Antibiotic use is a major driver of resistance.In 2010, India was the world’s largest consumer of antibiotics for human health.• Access to antibiotics is rising, which portends well for the large proportion of India’s population that has thus far had poor access to these life-saving drugs.• The convergence of factors such as poor public health infrastructure, rising incomes, a high burden of disease, and cheap, unregulated sales of antibiotics has created ideal conditions for a rapid rise in resistant infections in India.• Over-the-counter, nonprescription sales of carbapenems in India are among the highest in the world and contribute to growing carbapenem resistance among Gram-negative organisms.• Improving regulation of drug production and sales, better managing physician compensation, and encouraging behavior change among doctors and patients are of immediate priority.