The escalating threat of antimicrobial resistance (AMR) demands early education on antibiotics and infection prevention to foster responsible use. AMR is a significant global health challenge with severe implications for patient safety, economic stability and healthcare outcomes—especially in India, where high infectious disease rates, widespread misuse of antimicrobials and environmental pollution exacerbate the issue.
In India’s animal agriculture sector, antibiotics are extensively used, often as growth promoters, accelerating AMR and endangering both animal and human health.
Antibiotics exemplify the tragedy of the commons, where individual misuse creates a collective problem. When antibiotics are overused or misused — whether in healthcare, agriculture, or self-medication — they lose their effectiveness for everyone as bacteria develop resistance. This selfish overconsumption depletes the antibiotic “commons,” rendering these life-saving drugs less effective or even useless, thereby creating a public health crisis.
The tragedy lies in how individual actions that prioritise immediate benefits undermine the collective resource of effective antibiotics, ultimately harming global health.
While responsible use of antimicrobials can slow AMR, misuse — such as over-prescribing and self-medication — amplifies its spread, threatening public health advancements. AMR’s economic impact will disproportionately harm low-income countries, undermining efforts towards Universal Health Coverage and the United Nations-mandated Sustainable Development Goals. Urgent, coordinated global action is essential to address this pressing issue.
In response to the global AMR crisis, India launched the National Action Plan on Antimicrobial Resistance (NAP-AMR) in April 2017. Since then, six Indian states have developed State Action Plans for Containment of AMR (SAP-CAR). Effective AMR containment in India’s federal system depends on strong, accountable state-level governance.
NAP-AMR sets key priorities: increasing AMR awareness, enhancing surveillance and research, strengthening infection control, optimising antimicrobial use and ensuring sustainable funding. Each state customises its SAP-AMR to address local needs while aligning with national goals. The State Action Plan to Combat AMR (SAP-CARD) was introduced in January 2020, with the Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), a non-governmental professional organisation, playing an active role.
Delhi faces challenges in tackling AMR due to its diverse healthcare infrastructure, socioeconomic disparities and widespread antibiotic misuse. Implementing the SAP-AMR requires collaboration among stakeholders, including healthcare providers, government agencies, research institutions and professional organisations.
Professional organisations play a critical role by promoting AMR awareness, training healthcare professionals in antimicrobial stewardship and fostering responsible antibiotic use. By working closely with government bodies, they help monitor AMR trends, support guideline adherence and advocate for policies to enhance infection prevention. For over 25 years, DSPRUD has been at the forefront of these efforts, making key contributions to AMR control in India.
Strategic Priority 1 emphasises raising AMR awareness through communication, education and training for healthcare professionals, policymakers and the public. This aligns with the 2024 World Antimicrobial Awareness Week (WAAW) theme: Educate. Advocate. Act now.
DSPRUD has led impactful initiatives under this strategy, including targeted educational programmes, workshops and campaigns promoting responsible antimicrobial use among various stakeholders, including the public.
Since 2019, DSPRUD has organised AMR awareness campaigns in Delhi schools, reaching over 3,500 teachers and over 900,000 students in collaboration with WHO, the Delhi Government and the National Centre for Disease Control.
Since 2023, DSPRUD, in partnership with ECHO India, has launched a focused three-month online campaign involving more than 250 teachers. These initiatives underscore the critical role of teachers in educating future generations, advocating responsible antibiotic use and fostering a culture of AMR awareness among students and communities.
The recent political declaration on AMR, adopted at the high-level UN General Assembly meeting, also emphasises AMR prevention as a global priority, highlighting the importance of robust national and state action plans.
Capacity building is vital for implementing the NAP-AMR, involving the training of healthcare professionals in antimicrobial stewardship and infection control. DSPRUD has played a key role in this effort, conducting antimicrobial stewardship courses for around 500 clinicians. DSPRUD’s flagship diagnostic stewardship programme addresses the challenge of diagnostic uncertainty — a common reason for "just-in-case" antibiotic use.
This programme guides healthcare professionals through the diagnostic process, integrating infection prevention and control (IPC), diagnostic stewardship and antimicrobial stewardship to enhance accuracy and reduce unnecessary antibiotic use. To date, this course has reached over 1,000 medical professionals and 1,600 nurses.
Through these initiatives, DSPRUD supports Strategic Priority 4 of the NAP-AMR, aiming to optimise antimicrobial use across human, animal and agricultural sectors by promoting appropriate selection, dosage and treatment duration of antimicrobials, ensuring a coordinated response to AMR.
In collaboration with World Health Organization (WHO) India and the National Centre for Disease Control (NCDC), DSPRUD has supported training on the Union Ministry of Health and Family Welfare’s (MoHFW) 2020 IPC modules.
Additionally, DSPRUD tracks AMR trends and antibiotic use, providing essential data to inform stewardship strategies. Statewide prescription audits reveal high antibiotic prescribing rates, underscoring the need for ongoing monitoring to enhance antibiotic practices and guide future interventions.
Strategic Priority 5 identifies research and innovation as critical to advancing the fight against AMR by developing new tools, methods and strategies for effective intervention. DSPRUD contributes significantly in this area by assessing the impact of various AMR interventions, providing valuable data to refine approaches to antimicrobial use.
Furthermore, DSPRUD explores the use of artificial intelligence to predict AMR trends and support clinicians in making informed decisions on antibiotic use. These efforts not only contribute to more targeted and effective AMR management but also pave the way for innovative, data-driven solutions in healthcare.
While DSPRUD remains committed to combating AMR through a multifaceted approach, the way forward involves statewide awareness campaigns, continuous monitoring of antimicrobial consumption and classifying antibiotics under WHO’s AWaRe framework to foster responsible use at various levels of healthcare.
A comprehensive State AMR Operational Plan, focusing on collaboration among government agencies, healthcare providers and research institutions, will ensure a structured and coordinated response to monitor antimicrobial use and assess the effectiveness of interventions. Regular evaluations will promote accountability and continuous improvement, ultimately enhancing health outcomes and preserving the effectiveness of antibiotics for future generations.
Moreover, collaborative platforms for researchers and the pharmaceutical sector should be established, alongside increased funding and infrastructure. This commitment, coupled with integrating artificial intelligence in AMR monitoring, offers innovative, data-driven solutions to tackle the growing AMR challenge effectively.
Sangeeta Sharma is professor of neuropsychopharmacology, Institute of Human Behaviour & Allied Sciences (IHBAS), and president for Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi
Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth