Irrational use of antibiotics is as much a governance failure as a clinical one. Discuss with reference to India's AMR containment efforts.

Antimicrobial resistance (AMR) arises when microbes stop responding to drugs. Irrational antibiotic use is its main human driver. In 2010 India was the largest consumer of antibiotics for human health [1]. Misuse begins at the prescription pad, but it continues because of regulatory and institutional gaps. That makes it as much a governance failure as a clinical one.

Clinical dimension

• Patient "pull": doctors overprescribe for viral illnesses, upper respiratory infections and diarrhoea, where antibiotics are not the first-line treatment [1].
• Uneven prescribing: doctors prescribe differently for similar patients, and relatively few hospitals audit prescriptions [2].
• Weak stewardship: an ICMR survey found poor compliance with antibiotic policies, prescription audits and use-surveillance, especially in government facilities [1].

Governance dimension

• Rules without enforcement: Schedule H1 (2013) restricts over-the-counter (OTC) sale. Yet almost all drugs remain available OTC because of implementation issues [2].
• Industry incentives: financial incentives and pharma promotion encourage antibiotic prescribing, so awareness campaigns need legislative support [1]. UCPMP 2024 bans gifts and hospitality to doctors, but its penalties are mainly reprimand and recovery [3]. In October 2026 the Supreme Court asked the Centre to set up a committee on statutory regulation of pharma marketing [4].
• Capacity deficit: staff are too few and too thinly trained, laboratories are not standardised, and irrational fixed-dose combinations are still sold [2].
• One Health blind spot: few rules limit non-therapeutic antibiotic use in livestock, and the rules that exist lack strict implementation [1].

India's containment efforts

• The National Programme on AMR Containment (NCDC, 12th Plan) and the Red Line Campaign (2016) [1].
• A NAP-AMR aligned with WHO's Global Action Plan [1]. Delhi's SAP-CARD (2020) shows state ownership of the problem [2].

Way forward

• Give UCPMP statutory backing, with penalties that apply to companies [3][4].
• Enforce Schedule H1 through registered pharmacists and tracking of dispensing [2].
• Make accreditation-linked stewardship mandatory in public hospitals [1], and have every state adopt its own action plan [2].

Irrational antibiotic use begins as a clinical lapse but persists because rules go unenforced, incentives are misaligned and capacity is thin. Clinical stewardship needs to be paired with enforceable law, state action plans and a One Health approach. Together these can protect antibiotics as a public good, in line with SDG 3 and the Article 47 duty to improve public health.