4 min readJul 30, 2026 06:30 AM IST First published on: Jul 30, 2026 at 06:30 AM ISTThe latest global study in The Lancet Public Health has again highlighted what infectious disease experts in India have known for years: India uses too many broad-spectrum “watch” antibiotics and too few first-line “access” antibiotics. It estimates that India’s antibiotic consumption is higher than the optimal target and that the antibiotic mix is skewed towards drugs that should ideally be reserved for more serious infections.The tendency to overuse broad-spectrum antibiotics has been documented repeatedly over the past two decades through surveillance studies, hospital audits and national antimicrobial resistance (AMR) programmes. The more important question is why physicians continue to prescribe them.AdvertisementThe answer lies less in irrationality than in the realities of clinical practice. Doctors frequently prescribe antibiotics before a definitive diagnosis is available because patients often present late. Diagnostic facilities are limited or unreliable, and treatment decisions cannot always wait. Similarly, inadequate infection prevention and control in healthcare facilities increases the likelihood of healthcare-associated infections, prompting clinicians to choose broader-spectrum agents from the outset. In other words, antibiotics are often used to compensate for systemic weaknesses.If India wants to reduce inappropriate antibiotic use, it must address these underlying drivers. The first priority is strengthening infection prevention. Better water, sanitation and hygiene, wider use of vaccines, and sustained investment in infection prevention and control programmes in hospitals will reduce the burden of infections that require antibiotics. While initiatives like Kayakalp have improved cleanliness in public hospitals, preventing healthcare-associated infections requires continuous investment in trained infection-control personnel, surveillance systems, antimicrobial stewardship and institutional accountability.The second priority is strengthening diagnostic capacity. Rational antibiotic prescribing is only possible when clinicians have confidence in laboratory results. India has begun building this through the National Health Mission, Free Diagnostics Service Initiative, National Essential Diagnostics List and expanded lab networks. Improving laboratory quality, accreditation, turnaround time and confidence in microbiology reports is equally important.AdvertisementEducation is central. Clinicians need training in antimicrobial stewardship and evidence-based prescribing. Communities must understand that antibiotics do not treat viral infections and that demanding them for every fever is harmful in the long term.It is equally important to recognise that India has not been standing still. Over the past decade, the country has established a National Action Plan on AMR, expanded surveillance through the National Centre for Disease Control and Indian Council of Medical Research, introduced antimicrobial stewardship initiatives, strengthened essential diagnostics, regulated fixed-dose combinations and increased political recognition of AMR as a national priority. These are substantial structural reforms that take years to translate into measurable changes.you may likeA country that accounts for nearly one-fifth of the world’s population and manages one of the largest public health systems cannot transform antibiotic use overnight. Progress should be judged not only by current consumption patterns but also by the strength and direction of ongoing reforms.International reports are valuable when they stimulate action, but repeating what is already well established adds little unless accompanied by practical solutions. Reducing antimicrobial resistance will not be achieved by asking doctors simply to prescribe fewer antibiotics. This can cost lives. It will be achieved by creating a health system where they can safely prescribe the right antibiotic, for the right patient, at the right time and the country is committed to achieving this.The writer is senior scientist and programme officer, AMR, ICMR