India using too many powerful antibiotics, Lancet study says

A major international study published in The Lancet Public Health says India may be relying too heavily on powerful “watch” antibiotics that should be reserved for specific infections, while using too few first-line “access” antibiotics and too little of the last-resort “reserve” category. The study also suggests that some older antibiotics no longer recommended are still being prescribed more than expected.

The report estimates that India should ideally use 14.7 defined daily doses per 1,000 people per day, but actual consumption is higher at 18.3 doses, with a much larger share coming from the watch category than is recommended. India’s access-antibiotic use stands at 4.5 DID, far below the estimated need of 7.8 DID, while watch-antibiotic use is 9.3 DID against an ideal 6 DID.

Experts say the pattern points to both overuse and misuse. Prof Ramanan Laxminarayan said some patients are exposed unnecessarily to antibiotics while others may not get the right treatment at the right time. The study also notes that India’s infectious-disease burden means it will legitimately need more watch antibiotics than many other countries, but the current balance is still skewed.

The findings align with earlier Indian data. A National Centre for Disease Control survey found that nearly three-fourths of hospitalised patients were on antibiotics, and 57 per cent of prescriptions were from the watch group. Dr Kamini Walia has also warned about unnecessary duplicate antibiotic coverage, heavy IV use, and wide variation in prescribing practices across hospitals.

Antibiotic stewardship, better diagnosis before prescribing, and stricter control on reserve drugs are essential to curb antimicrobial resistance. The study’s broader global analysis found that 72 per cent of countries use more antibiotics overall than estimated to be necessary, while 99 per cent overuse antibiotics that most strongly drive resistance.