Prevention is not always better than cure. The prophylactic use of antibiotics and the resultant antimicrobial resistance are causing a silent pandemic, leading to five million deaths every year. The World Health Organization has thus rightly called it one of the top public health threats facing humanity and released a list of drug-resistant bacteria most threatening to humans. AMR occurs when pathogens evolve, fortifying themselves against drugs, thereby neutralising the impact of antimicrobials. This crisis is being exacerbated by unethical medical practices, a phenomenon that is especially acute in India. In January this year, the National Centre for Disease Control published a study which revealed that just 45% of patients were prescribed antibiotics to actually treat infections and not as prophylaxis; of this, a meagre 6% were prescribed the drugs after identifying the specific bacteria, a crucial step when it comes to combating AMR and the reason why WHO’s recently-released list is so important. It is precisely the sort of misuse that causes the development of drug-resistant pathogens. AMR invalidates the gains that modern medicine has made over the years and renders other medical procedures and treatments, such as surgery, Caesarean sections and chemotherapy, riskier. Apart from the death toll, it also increases the strain on and costs of health services.

Yet, AMR does not often get top billing when it comes to health policies. Even when such a policy exists — India has had one to prevent the overuse of antibiotics for close to a decade — it is poorly implemented. Earlier this year, the Union health ministry asked physicians to write down the exact reasons for prescribing patients with antimicrobials and instructed pharmacists to not dispense antimicrobials without a prescription. However, the use of such medicines is still not monitored by the government. Some of the problems that make India especially vulnerable to AMR are easily identifiable: the paucity of laboratory facilities to inform clinicians rapidly about what would be an appropriate antibiotic, the lack of adequate training in antibiotic selection, escalation, and de-escalation, and the incentivisation of prescribing practices by the pharmaceutical industry. It is also clear that there is an antibiotic research and development crisis; urgent measures are now required to develop a new line of drugs and ensure equitable access to them. However, it is not doctors and the government alone that are to blame. Patients, too, are impatient with the medical process, expecting immediate relief from ailments. They need to be sensitised to the pitfalls of AMR.