Antimicrobial Resistance: How to prescribe responsibly

Imagine a world where a scratch can be fatal, where childbirth is a gamble and pneumonia is a death sentence. This is not an imaginary scenario, this is the reality we may face if antimicrobial resistance (AMR) is not controlled. In India where antibiotics are popped like candies for coughs or fevers, AMR is no longer a distant threat. It is here, quietly eating into the efficacy of life saving medicines. But there is hope. By understanding the problem and being responsible, every individual; doctors, patients, farmers and policymakers can be a warrior in this war

Resistance to antimicrobials occurs when bacteria, fungus, virus or parasites evolve in an attempt to overcome the drugs administered to destroy them. It is like a hide and seek scenario where the microbes master all our moves. Antibiotics are taken excessively or misplaced by being prescribed for viral illnesses (which the antibiotics cannot address) or broken in the middle, providing practice grounds for such germs to mutate. Very soon, drugs we depend upon become ineffective.

In India, the stakes are uniquely high. Crowded hospitals, unregulated pharmacy sales and cultural habits (like self medicating with leftover pills) create a perfect storm. A 2022 study by  Indian Council of Medical Research (ICMR) found that over 75% of patients in ICU units had infections resistant to common antibiotics. 

 

Indian AMR Crisis:

Antibiotics are not just for critical care. They protect us during surgeries, chemotherapy and childbirth. If resistance spreads, routine medical procedures could turn risky. A Delhi based surgeon once shared, I fear a time when a minor appendix operation might kill patients due to untreatable infections.

Hidden Dangers: Did you know? Over 60% of antibiotics in India are used in poultry and livestock to speed up growth, not treat diseases. Resistant bacteria from animals can jump to humans through food or water. That chicken curry or paneer tikka, it might carry more than just spices.

Cost of Ignorance: AMR hits the poorest hardest. Longer illnesses mean more hospital days, pricier drugs and drained savings. For daily wage workers, this could spell disaster. 

 

Prescribing Responsibly: Physicians face immense pressure from patients demanding quick fixes to overcrowded OPDs. Yet, prescribing antibiotics just in case does more harm than good. A pediatrician in Lucknow added, parents often beg me for antibiotics for viral fevers. But I have learned to say no firmly and explain why.

 

Doctors role:

Follow the test before you treat rule: Confirm bacterial infections with diagnostics. 

Use the access, watch, reserve framework (WHO guidelines) to prioritize safer antibiotics.

Educate patients, not just treat them. 

 

Patients role:

Doctor, can you give me a stronger antibiotic ? How many times have you asked this ? Patients must understand, antibiotics are not magic bullets. A runny nose or sore throat is often viral. Taking antibiotics just in this case is not useful at all.

Never self medicate. That leftover pill from last year ? Trash it. 

Complete the full course stopping early breeds superbugs. 

Ask questions: Is this antibiotic necessary ?

 

Pharmacists role:

Pharmacists should act like gatekeepers, not salesmen.

In India, pharmacies often dispense antibiotics without prescriptions for quick profits. This is not just illegal, it is dangerous. A Chennai based pharmacist, now refuses: I would rather lose a customer than contribute to their death.

 

Role of Policymakers:

While India’s National Action Plan on AMR (2017) is a start, enforcement is not strict. Stricter laws on over the counter sales, antibiotic use in farming and public campaigns (like Kerala’s Break the Resistance initiative) are critical. 

 

A United Fight:

AMR is not a problem for someone else to solve. When a farmer stops overusing antibiotics in chickens, when a mother stops pressuring her doctor for unnecessary pills and when a medical student pledges to prescribe wisely, they are all saving lives. 

 

Conclusion:

Antimicrobial resistance is a slow tsunami, but it is not unstoppable. Just as India rallied against polio and HIV, we can conquer AMR. The next time you reach for an antibiotic, pause. Ask yourself: Am I fueling the fire or dousing it ? The power to preserve these miracle drugs lies not in a lab, but in our hands.

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