For antibiotics, the right dose is restraint.
India’s dependence on antibiotics as a convenient cure-all for routine illnesses has reached an inflection point. A global study published in The Lancet Public Health has highlighted a worrying imbalance in the country’s antibiotic use: An over-reliance on stronger medicines even as safer first-line medicines remain underused. The World Health Organisation classifies antibiotics into three categories — “access” drugs, which are recommended as first-line treatments for common infections; “watch” drugs, which are broader-spectrum medicines that should be reserved for specific situations; and “reserve” drugs, intended as a last line of defence against highly resistant infections. The study estimates India’s optimal antibiotic use at 9.9 to 14.7 defined daily doses per 1,000 people per day. Actual use, however, stands much higher at 18.3 doses, with “watch” antibiotics at 9.3 doses against a recommended 6 doses. “Access” antibiotics, at 4.5 doses, fall well short of what is needed.
The preference for “watch” drugs reveals the challenge in how antibiotics are understood, prescribed and consumed. A prescription for a broad-spectrum antibiotic can often feel like reassurance both to a patient seeking quick recovery and to a doctor working in an overstretched healthcare system. But each unnecessary dose narrows the options available for future infections. At the same time, the underuse of “reserve” antibiotics in genuinely resistant cases points to another systemic failure: Ensuring that the right medicine reaches the right patient at the right moment. Fragmented healthcare delivery, poor diagnostic access, and — beyond the clinic — the liberal use of antibiotics in livestock and agriculture, all feed India’s rising burden of antimicrobial resistance, where bacteria become resistant to common drugs and infections become more difficult and expensive to treat.
Given the country’s burden of infectious disease, antibiotics will remain indispensable. Addressing the problem must, thus, begin with replacing quick-fix prescriptions with evidence-based care. National Action Plan on Antimicrobial Resistance 2.0 (2025–2029) places antimicrobial stewardship at the heart of the response, seeking to curb inappropriate usage across human healthcare, animal husbandry and agriculture. A stricter and more coordinated compliance mechanism across the pharmaceutical supply chain is essential to curb indiscriminate over-the-counter sales and irrational fixed-dose combinations.