Science and Technology › Health and disease

Antimicrobial resistance

Start here explains how antimicrobial resistance arises and what India's plan does about it. The theme then follows resistance in hospitals, on farms and in the environment, and the few new drugs against it. Prelims has asked why multi drug resistance occurs in microbial pathogens in India.

All 2 subjects shown; the 0 that changed from 1 to 15 July 2026 are marked.Show only these

Start here

What this theme is examined on, whatever the news.

Antimicrobial resistance: how it arises and India's plan

Prelims and MainsAdded 20 September

Antimicrobial resistance is microbes surviving the drugs meant to kill them. It is evolution: any use of an antibiotic kills the susceptible microbes and leaves the resistant ones to multiply, and bacteria pass resistance genes to each other on plasmids, so a gene that appears in one hospital can travel across species and continents. The mechanisms are few: enzymes that destroy the drug (beta lactamases, and the carbapenemases such as NDM 1 first described in a patient from New Delhi), pumps that push it out, changes to the target it binds, and biofilms that shut it out. The drivers are overuse in people, use as growth promoters in animals, antibiotic waste from factories in rivers, and poor sanitation that spreads infection. India carries a heavy share of both, which is why it wrote a National Action Plan on antimicrobial resistance in 2017 and banned colistin in food animals in 2019.

The AWaRe classes

Class	Meaning	Examples	Rule of use
Access	first or second choice for common infections; low resistance potential	amoxicillin, doxycycline, metronidazole	should be most of what is used
Watch	higher resistance potential; key targets of stewardship	ciprofloxacin, azithromycin, third generation cephalosporins	limited to specific indications
Reserve	last resort for multidrug resistant infections	colistin, linezolid, newer carbapenem combinations	only when nothing else works, under specialist control

Stewardship means moving use from Watch to Access and keeping Reserve for the few; India's problem is that Watch drugs are sold over the counter.Source: World Health Organization AWaRe classification

The World Health Organization's AWaRe classification sorts antibiotics into Access (first line, low resistance risk), Watch (higher risk, to be limited) and Reserve (last resort, for confirmed multidrug resistance); the target is that at least 60 per cent of use is from Access.
Gram negative bacteria are the hardest problem: their outer membrane keeps drugs out, and carbapenem resistance in Klebsiella, E. coli and Acinetobacter is the reason Indian intensive care units report deaths that were treatable a decade ago.
India's rules: Schedule H1 (2013) put antibiotics behind a prescription and a register; the Red Line campaign (2016) marked their packs; the colistin ban (2019) removed a last resort drug from poultry feed; Kerala had the first State action plan (2018).
One Health: resistance moves between people, animals and the environment, so the plan spans health, animal husbandry, agriculture and pollution; effluent limits for antibiotic residues from factories were set in 2020 draft rules.
New drugs are scarce because they are used sparingly and earn little; India's first indigenously developed antibiotic, nafithromycin, for pneumonia, was approved in 2024, and pipelines abroad are thin.

Mains: Resistance is a commons problem: every prescription that is not needed spends a shared resource, so the answers are regulation of sale, surveillance and sanitation, and no new drug can substitute for them.

UPSC has asked

Prelims 2019: reasons for multi-drug resistance in microbial pathogens in India

Gram-negative bacteria

Prelims and Mains

Bacteria sort into two groups by a nineteenth century staining test, and that split still decides which antibiotics can reach them. Gram-negative bacteria are the harder half, and the reason is structural rather than anything to do with how the drugs have been used.

The Gram stain, devised by Hans Christian Gram in the 1880s, sorts bacteria by whether their cell wall holds crystal violet.
Escherichia coli and Klebsiella pneumoniae are Gram-negative, and cause many hospital infections.
Their outer membrane, which Gram-positive bacteria lack, keeps many antibiotics out.
Once such a strain resists carbapenems, few medicines remain.

What changed

2 Sep 2026
The Indian Express, 2 Sep 2026: Expert Explains | Why India's drug-resistance problem is bigger than antibiotic overuse (opens in a new tab)
2 Sep 2026
- ICMR reported on 2 September 2026 that over 61 per cent of the Gram-negative infections studied in tertiary care hospitals were carbapenem resistant.
- The relative risk of death against susceptible strains ran 1.16 to 1.43, and antibiotic cost 1.1 to 2 times that of a susceptible infection.
- Over 85 per cent of bloodstream infections were healthcare associated.
- The priorities named were infection prevention and control, integrated surveillance, antimicrobial stewardship and newer antibiotics.
The Indian Express, 2 Sep 2026: Expert Explains | Why India's drug-resistance problem is bigger than antibiotic overuse (opens in a new tab)

Antibiotic use in India: the AWaRe classification

Prelims and Mains

The World Health Organization sorts antibiotics into Access (first line), Watch (broader spectrum, for specific situations) and Reserve (last resort).

What changed

27 Jul 2026New subject
- A global study puts India's antibiotic use at about 18.3 defined daily doses per thousand people a day, above the estimated optimal range of 9.9 to 14.7.
- Use of Watch antibiotics is about 9.3 doses against a recommended 6, while Access antibiotics stand at only about 4.5.
The Indian Express, 27 Jul 2026: India uses too many broad-spectrum antibiotics and too few first-line ones, a global study finds (opens in a new tab)