OPINION | India’s escalating 'superbug' crisis

Antimicrobial resistance is a global health emergency requiring immediate attention.

Antimicrobial-resistant (AMR) pathogens are now a serious threat to human health. The emergence of multidrug-resistant bacteria has increased the severity and frequency of nosocomial infections, leading to adverse outcomes.

In 2017, the World Health Organization (WHO) published a list of pathogenic bacteria called ESKAPE pathogens, which are resistant to most common antibiotics, such as β-lactams, ciprofloxacin, tetracycline, lipopeptides, quinolones, and fluoroquinolones—and in some cases, even to the last line of defence, including polymyxins, glycopeptides, and carbapenems. A study conducted in the United Kingdom projected that by 2050, AMR infections may cause 10 million deaths annually.

India's badly hit by superbugs

India carries a substantial burden of AMR infections. Data from the AMR Surveillance Network of the Indian Council of Medical Research (ICMR) shows an alarmingly high number of deaths associated with AMR. According to ICMR estimates, more than 267,000 deaths in 2021 were due to AMR.

A recent study by The Lancet found that although AMR mortality in children under five has decreased in India, mortality among patients aged 70 and above has increased by 80%. The same study revealed that over 80% of Indian patients carry multidrug-resistant bacteria (MDR). Infections caused by MDR pathogens are difficult to treat, often requiring toxic drugs that cause side effects and lead to secondary complications.

Why MDR bacteria are so prevalent in India

In India, the high prevalence of MDR bacteria stems from several factors: rampant misuse of antibiotics, self-medication, and easy access to prescription drugs. Socioeconomic factors—including inadequate sanitation, unsafe drinking water, and limited access to quality healthcare—further contribute to the spread of AMR. These challenges underscore the need for a multipronged approach to mitigate the problem.

Gaps in surveillance and implementation

India must strengthen its AMR surveillance systems. In 2015, WHO launched the Global Antimicrobial Resistance and Surveillance Program to standardize AMR surveillance worldwide and reduce inappropriate antibiotic usage. Although India is a participant, substantial gaps remain at the ground level. Despite global momentum, the implementation of national AMR action plans has faced persistent challenges and has yet to yield meaningful impact.

The urgent need for new antibacterial agents

The rise of “superbugs” has intensified the urgency to develop new antibacterial agents. While companies are reinvesting in antibiotic development, there remains a shortage of genuinely innovative drugs. Current efforts focus on discovering new classes of antibiotics with novel mechanisms of action, which may slow the development of resistance.

One such example is Teixobactin, discovered in 2015, which targets bacterial cell wall synthesis through a unique mechanism. In preclinical studies, Teixobactin has been effective against gram-positive bacteria such as MRSA and Mycobacterium tuberculosis. Another new class—odilorhabdins (ODLs)—was discovered in symbiotic bacteria found in soil-dwelling nematodes. ODLs inhibit bacterial protein synthesis and have shown potent activity against several MDR pathogens.

Recently, a new antibiotic developed in India—Nafithromycin—has shown promise in treating multidrug-resistant infections, particularly Community-Acquired Bacterial Pneumonia (CABP). Alternative therapies, including bacteriophage treatments, are also being aggressively explored.

AMR: A national health priority

AMR is a global health emergency requiring immediate attention. India must act swiftly to curb the spread of resistant pathogens or risk entering an era where common infections become life-threatening. Strengthening AMR surveillance, regulating antibiotic usage, and improving patient data documentation are essential steps. Public awareness campaigns highlighting the dangers of self-medication and over-the-counter antibiotic use must also become a national priority.

(Dr. Richa Priyadarshini is an Associate Professor in the Department of Life Sciences at the School of Natural Sciences, Shiv Nadar University, Delhi-NCR.)

Views are personal, and do not represent the stance of this publication.