Antimicrobial resistance: how it arises and India's plan

Prelims and MainsCurrent affairs on this: Antimicrobial resistance

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.
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; Watch antibiotics run at about 9.3 doses against a recommended 6, while Access antibiotics stand at only about 4.5. A Lancet estimate of September 2025 projects that resistance will claim more than 39 million lives over the next 25 years.
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

Further reading: Antimicrobial resistance (WHO) · AWaRe classification of antibiotics (WHO)