Chandrakant Lahariya | Antibiotics Must Be Protected To Ensure The Healthy Future Of Planet

The discovery of penicillin, followed by the introduction of other antibiotics, revolutionised medical science and is widely regarded as the greatest medical breakthrough of the twentieth century. Antibiotics transformed once-fatal infections into curable conditions and made modern medicine possible. It is estimated antibiotics alone increased average life expectancy by nearly 23 years.

Yet, in less than a century since the most widely recognised antibiotic (penicillin) was discovered in 1928, a new and grave crisis emerged. Bacteria are increasingly becoming resistant to the antibiotics available to us. Medicines that were effective just a few decades ago often fail to treat the same infections today. This is known as “antimicrobial resistance” (AMR). WHO has listed AMR as among the top ten global threats to public health.

This has also led to the emergence of so-called “superbugs” (bacteria that don’t respond to most antibiotics). When antibiotics fail, even simple infections become difficult to treat. Routine medical procedures like surgeries, chemotherapy, or care for premature newborns become far riskier. Hospital stays grow longer, treatment costs increase, and the burden on health systems intensifies.

The causes of this crisis are largely human-made. The most important driver is the overuse and misuse of antibiotics. In India, antibiotics are often prescribed and consumed for viral illnesses like the common cold, cough or seasonal fever – on which these drugs have no effect. Antibiotics are prescription-only medicines, but are commonly sold as over the counter without prescriptions. Many people start antibiotics on the advice of chemists, neighbours or by using leftover medicines from previous illnesses. Each such misuse gives bacteria an opportunity to adapt, survive, and become stronger. Often, antibiotics may be prescribed unnecessarily due to diagnostic uncertainty, patient pressure or fear of complications, particularly where follow-up care is difficult. Many patients demand antibiotics from doctors.

Another major factor is the extensive use of antibiotics in animals and agriculture. They are often given to livestock in high doses to promote faster growth in animal farms or to prevent disease in crowded farming conditions. Resistant bacteria that develop in animals do not remain confined to farms. They spread to humans through food, water, and the environment. Poor waste management further worsens the problem. Antibiotic residues and resistant microbes from hospitals, pharmaceutical manufacturing units, farms and households enter rivers, soil, and groundwater, eventually finding their way into the food chain. This creates ideal conditions for resistance to spread silently and persistently.

The economic and social consequences of antimicrobial resistance are severe. WHO estimates that if current trends continue unchecked, antibiotic resistance could claim up to ten million lives globally each year by 2050 and result in economic losses exceeding $100 trillion. In India alone, it is estimated that around 2.6 lakh deaths in 2021 were associated with infections where antibiotics were ineffective due to resistance. A multi-centre study across ten Indian hospitals found that patients infected with multidrug-resistant bacteria were nearly twice as likely to die as those individuals with infections susceptible to the available drugs.

The impact of this challenge is worse on middle-income and lower-income groups. With a large share of healthcare costs in India paid out of pocket, resistant infections often lead to repeated hospital visits, prolonged illness, loss of wages and catastrophic medical expenditure. For many families, what begins as a simple infection can spiral into debt and long-term financial insecurity. Antimicrobial resistance is therefore not just a policy or public health issue; it is a direct threat to individual households and livelihoods and it widens inequities.

Globally, countries are beginning to recognise the gravity of this threat. Several high-income nations have strengthened surveillance systems to track resistance patterns, enforced strict regulations on antibiotic use, and invested heavily in research to develop new drugs and alternative therapies.

India, too, has initiated policy-level responses, but much more must be done. Antibiotics must be sold strictly against valid prescriptions, and pharmacies should be regularly monitored and held accountable. Greater investment is urgently needed for research and development of new antibiotics, diagnostics and alternative treatment strategies.

However, policies alone will not succeed without public awareness and responsible behaviour. There are a few critical messages that every citizen should know. Preventing infections through hand hygiene, safe drinking water, vaccination, and good nutrition is one of the most effective ways to reduce the need for antibiotics. People should proactively inform their doctors about all medicines they are taking, including antibiotics. Antibiotics should never be started without medical advice, never shared, and never reused. Even when prescribed by a doctor, antibiotics should not be stopped early or altered without consultation, and the full course should be completed. Medicines prescribed for past illnesses should not be used again for similar symptoms, as the cause may be different and bacterial and viral infections may have the same symptoms. There is no role of antibiotics against viral infections, which are effective only against bacteria. Both overuse and underuse of antibacterial accelerates resistance.

It is important to remember antibiotic resistance is not new. Bacteria carrying resistance genes have been found in samples dating back nearly 30,000 years. Resistance to medicines is a natural survival mechanism of pathogens. What is new, and deeply alarming, is the speed at which resistance is spreading today -- driven almost entirely by human misuse of antibiotics. This means the crisis is not inevitable; it is preventable. While the world urgently needs new antibiotics, it also needs to use existing ones wisely. Drug development is not keeping pace with rising resistance. The goal must be not only to cure infections today but to ensure that these life-saving medicines remain effective for our children and grandchildren. The choices we make now will determine whether antibiotics remain one of humanity’s greatest medical achievements or become yet another lost miracle.

Dr Chandrakant Lahariya is a leading practicing physician and health policy specialist