THE DOUBLE-EDGED SWORD OF ANTIBIOTICS: OVERUSE AND UNDERACCESS IN INDIA

ABSTRACT
Objective: To examine the dual challenges posed by antibiotic overuse and inadequate access in India,
and to highlight their combined impact on antimicrobial resistance (AMR) among rural and low-income
populations.
Methodology: We performed a literature review of recent studies from India focusing on antibiotic
prescribing practices, resistance patterns, and socio-economic and geographic determinants of access.
Key studies include surveys of community-level AMR in both rural and urban settings, assessments of
antibiotic misuse by informal providers, and environmental “One Health” studies of resistance in
human, animal, and water sources.
Results: Findings reveal high rates of resistance in pathogens from rural communities—resistance to
quinolones, cephalosporins, aminoglycosides, and even carbapenems—often exceeding 25-45% in
some samples. Misuse is common: Antibiotics are over-prescribed, courses terminated early, selfmedication
practiced, and prescriptions often do not match local sensitivity patterns. Conversely, many
rural and low-income populations suffer poor access to essential antibiotics, diagnostic services, and
timely medical care, compounding mortality from otherwise treatable infections.
Discussion: The coexistence of antibiotic overuse/misuse and inadequate access creates a paradox:
resistance advances where antibiotics are used improperly, but lack of access causes preventable deaths.
National guidelines often derive from tertiary‐care settings and may not align with local rural resistance
profiles. There is a need for tailored stewardship, awareness campaigns, regulation of informal
providers, and improved diagnostics in rural and marginalized settings.
Conclusion: Addressing the double-edged sword of antibiotics in India requires a dual strategy: reducing
misuse and over prescription, and simultaneously ensuring affordable, equitable access to effective
antibiotics and diagnostics. Only then can antibiotic efficacy be preserved and public health
safeguarded.