Editorial: Multipronged approached needed to tackle MDRO threat
The study revealed the presence of MDROs at an alarmingly high 83.1% and within that, the presence of ESBL-E, a particular type of MDRO, at 70%
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A recent study that was published in the Lancet, a reputed international medical journal, should prompt India to double down on tackling multidrug-resistant organisms or MDRO, commonly known as superbugs. Coincidentally, Union Minister of Health and Family Welfare JP Nadda launched the second version of the National Action Plan on Antimicrobial Resistance (NAP-AMR) (2025–29), which addresses the broader category of microbes that develop drug resistance.
The problem at hand is the presence of organisms that have become resistant to antibiotics and antivirals, and can cause serious illnesses that can’t be cured.
The study revealed the presence of MDROs at an alarmingly high 83.1% and within that, the presence of ESBL-E, a particular type of MDRO, at 70%. Put simply, the first-line basic antibiotics will not be effective, prompting doctors to prescribe stronger, more expensive, and toxic drugs. This has serious repercussions for a resource-scarce country like India, with large sections of people still trapped in economic backwardness.
The second version of NAP-AMR looks impressive on paper, as it emphasises the inter-sectoral coordination and ensuring stronger private sector engagement. The easy availability of antibiotics – and their reckless use without proper medical advice and prescription – is a major cause for the prevalence and spread of MDROs. The government needs to ban the over-the-counter sale of antibiotics. Already, Kerala and Gujarat have reportedly banned it.
In many backward states, people without access to primary healthcare system tend to rely on local pharmacies, which are often run by persons with limited knowledge. Secondly, the consultation fee charged by private medical practitioners is another reason for people taking recourse to OTC antibiotics. Thirdly, in a vast country like India, the regulation of sale and banning certain drugs without prescription is not easy. On top of it, there are commercial pressures exerted by pharma companies. These are systemic issues that are difficult to resolve.
There is a certain symbolism in releasing the NAP-AMR 2.0 on the first day of the WHO’s World AMR Awareness Week (November 18-24), which highlights the importance of awareness in anti-MDRO strategy. The government should involve the private sector and grassroots healthcare NGOs in launching awareness campaigns. This can be done only with adequate government funding, and continuous monitoring and evaluation of campaigns. A laudable initiative is the Red Line awareness, which cautions people against using medicines marked with a red vertical line, including antibiotics, without a doctor’s prescription.
However, the education and training of healthcare professionals can be more difficult. Doctors and nurses are unable to find time to participate in training workshops because of their hectic schedules. They need to be made aware of the treatment guidelines issued by the Indian Council of Medical Research (ICMR) for antimicrobial use in common ailments or syndromes. The medical association and other bodies should come up with innovative online and hybrid models for MDRO training. Likewise, the government and private hospitals should be persuaded to make room for it and make it mandatory to take part in such training. A weak link in the strategy could be the outreach to pharmacists. Given the dangers MDROs pose, the pharmacists’ associations should conduct aggressive campaigns aimed at their members. Lastly, putting in place a robust surveillance system that provides actionable intelligence can help State governments to implement targeted interventions.
