Antimicrobial resistance – No longer just a looming crisis, it’s already here
This article is authored by Dr Mala Chhabra, Dr Sujata E. Mathews and Dr Ajay Shukla.
Imagine a world where a minor cut could turn deadly, and routine surgeries become high-risk procedures—all because antibiotics no longer work. This is the reality the world faces today as antimicrobial resistance (AMR) spreads silently across hospitals and communities, putting millions at risk. The battle against AMR has already begun—and the stakes couldn't be higher. Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites evolve and become resistant to the medicines used to treat the infections they cause. Antibiotics that once cured serious infections now fail to work, leading to longer hospital stays, higher medical costs, and increased mortality.

Take the case of a patient that we encountered recently. The 35-year-old healthy man developed a foot ulcer, with his toes starting to turn black. At first, he tried to treat the wound himself at home. When things got worse, he went to a local clinic and then a private hospital, where doctors gave him advanced antibiotics. But as his condition kept deteriorating, he was referred to our tertiary care government hospital because he could no longer afford private care. Tests revealed that his wound was infected with a drug-resistant bacterium. Despite efforts to treat him, the infection spread throughout his body, causing sepsis—a life-threatening complication. Tragically, he passed away and the official cause of death listed in his medical report was “Sepsis”. But this raises difficult questions: Could his life have been saved? What led a young man to develop such a severe infection? Should the drug-resistant bacteria, not just sepsis, have been noted as the true cause of his death?
Unfortunately, this is not an isolated incident. In our daily practise, we see patients who come in with infections that were once easily treatable but have now become fatal. Many patients that are referred to us usually arrive after multiple rounds of antibiotics, often taken without proper medical guidance. These patients carry drug-resistant infections, making treatment harder. Overcrowded hospitals and inconsistent infection control only worsen the situation. Delays in access to effective diagnostic tools, like antibiotic sensitivity testing, further complicate care, often costing lives. Doctors like us are akin to “weaponless warriors” with limited options, not because we lack the skills, but because our arsenal of antibiotics is failing.
India is particularly vulnerable to the AMR crisis due to high antibiotic consumption, self-medication, and over-prescription. A study published in The Lancet in 2022 revealed that AMR caused nearly 1.27 million deaths globally in 2019, with the highest burden seen in low- and middle-income countries, including India. Yet, these numbers may just be the tip of the iceberg as underreporting, lack of diagnostic resources, and inconsistent data collection lead to many AMR-related deaths going unrecorded. This includes patients who often succumb to infections that no longer respond to first, second or third-line treatments. These micro-organisms tend to be more devastating for vulnerable groups of patients such as newborns, the elderly, and those with underlying chronic medical illnesses like diabetes and chronic kidney, liver, heart, and lung diseases.
The rise of AMR is not just a natural consequence of bacterial evolution—it is largely man-made. Over-the-counter access to antibiotics, improper prescriptions, and a lack of stringent antibiotic stewardship are driving this crisis. For years, antibiotics have been handed out too easily, without sufficient oversight or education about their proper use.
Without reliable data, policymakers and healthcare professionals cannot fully assess the severity of the issue or design targeted interventions. So, what must be done?
First, we need to scale up our efforts in surveillance and reporting. Increased reporting of resistant infections and a national-level commitment to enforcing existing AMR policies are crucial steps. The National programme on AMR Containment of the Government of India, has recognised the need to combat AMR with a National Action Plan on Antimicrobial Resistance. This plan focuses on promoting rational antibiotic use, improving infection control, and conducting AMR surveillance. These actions have been reiterated in the G20 meeting under the presidency of India in 2023 as well as in recent special high level meeting of the UN General Assembly held on September 26 2024. However, these measures face considerable challenges in implementation.
Second, the world must invest in developing new antibiotics and alternative treatments. Policymakers and pharmaceutical companies need to prioritise research and development to discover new antimicrobials. Preventive strategies are equally critical. Sanitation, vaccination, and equitable access to appropriate treatments must be scaled up, especially in low- and middle-income countries.
Finally, the concept of antibiotic stewardship needs to become a core principle of medical practise. This means that all healthcare providers, from doctors to pharmacists, must be educated on the importance of prescribing antibiotics responsibly. We need to shift public perception as well, so that antibiotics are no longer seen as a cure-all, but as powerful tools that must be used with care.
At the hospital, we continue to fight for our patients every day. But without urgent, coordinated action on a global scale, we fear that our efforts may be in vain. The war against AMR is already underway, and it is a battle we cannot afford to lose.
This article is authored byDr Mala Chhabra, senior consultant and associate dean (research), Dr Sujata E. Mathews, professor, department of medicine and Dr Ajay Shukla, director and medical superintendent, ABVIMS and Dr Ram Manohar Lohia Hospital, Delhi.
