Why Multi-Drug Resistance Occurs in India

Start with the idea. Then see why the germ, not the patient, is the one that changes.

1. What is antimicrobial resistance?

Antimicrobials are medicines that fight germs. They include antibiotics, antivirals, antifungals and antiparasitic drugs.

Antimicrobial resistance (AMR) means the germs no longer respond to these medicines. Infections then become hard or impossible to treat. The risk of spread, severe illness and death goes up.

When a germ resists several different drugs at once, it is called multi-drug resistant.

Why does this matter? A medicine helps only if the germ responds to it. When the germ stops responding, the medicine is still in the bottle, but it no longer works. Doctors must then reach for other drugs, and fewer options are left.

2. Whose genes change?

Resistance is a natural process. It is driven by genetic changes in the pathogens over time.

The germ changes, not the person. A patient’s own genes do not make a germ resistant.

Human activity speeds the process up. The Press Information Bureau names the overuse and misuse of antimicrobial drugs in humans, animals and plants.

Why do germs change? Many resistance genes are very old. Some have existed in environmental bacteria for thousands or millions of years. Human-made antibiotics did not invent these genes. They select them, until resistant germs become common.

Every dose of an antibiotic puts pressure on the germs around it. Germs that can survive the drug are favoured. Scientists call this selective pressure.

Common misconception: “My body becomes resistant.” Many people believe this. In a survey of 130 university students in Brunei, 99 gave this wrong answer. Your body does not become resistant. The germ does. Resistant bacteria can also spread from person to person.

3. Which resistant germs worry doctors most?

WHO names two Gram-negative bacteria as the leading drug-resistant germs in bloodstream infections. They are E. coli and K. pneumoniae.

These infections often lead to sepsis, organ failure and death.

Multidrug-resistant TB (MDR-TB) is a second example. It is TB caused by bacteria that do not respond to isoniazid and rifampicin. These are the two most effective first-line TB drugs.

MDR-TB can still be cured with other drugs. These tend to cost more and cause more side effects.

This is the heart of the UPSC question. Read each habit and ask one thing: does it help germs change?

4. Why do wrong doses of antibiotics create resistant germs?

WHO says misuse and overuse of antibiotics is one of the main drivers of AMR. Misuse includes taking them when they are not needed. It also includes taking the wrong type.

TB gives a clear example. Drug resistance emerges when medicines are used wrongly. WHO lists incorrect prescriptions, poor-quality drugs and patients stopping treatment early.

So taking incorrect doses of antibiotics is a real cause. This is statement 2 in the UPSC question.

Worked example: TB treatment. TB medicines have to be taken daily for 4 to 6 months. WHO says stopping them early, or without medical advice, can prompt TB bacteria to become resistant.

A closer look at “finishing the course”. Some researchers point out that every use of an antibiotic, finished or not, puts selective pressure on germs. They also note that leftover pills are often saved and used later for another illness. The safe habit is the same either way. Take an antibiotic only when a doctor prescribes it, and follow the advice on dose and duration.

Common misconception: antibiotics work on colds and flu. In the Brunei survey, 41 per cent of students said they do. The survey counted this as a wrong answer.

5. How does antibiotic use in livestock add to the problem?

Antibiotics are used in animals and plants as well as in people. The Press Information Bureau counts misuse in all three as a driver of resistance.

WHO also lists poor infection control on farms among the key factors.

India acted on this in 2019. It banned colistin in food-producing animals. Colistin is a last-resort antibiotic for people.

So using antibiotics in livestock farming is a real cause. This is statement 3 in the UPSC question.

Why is the farm a health matter? Resistance is not a hospital problem alone. Resistant bacteria can travel between animals, water and people.

Colistin shows the link between farm and clinic. A drug kept for emergencies in hospitals can lose its power if farms use it widely.

6. What other factors help resistance spread?

WHO lists several more factors:

• Poor access to clean water, sanitation and hygiene.
• Weak infection prevention and control in homes, hospitals and farms.
• Limited access to vaccines, diagnostics and medicines.
• Little awareness of the rules, and weak enforcement of them.

Too few new antibiotics are being developed. Fewer treatment options are left for resistant infections.

How to read this list. Each factor does one of two things. It makes infections more common, or it makes antibiotics easier to misuse. Poor sanitation falls in the first group. Weak enforcement of prescription rules falls in the second.

7. Why are genetic predisposition and chronic disease not on the list?

The UPSC question offered two traps. Statement 1 was genetic predisposition of some people. Statement 4 was multiple chronic diseases in some people.

Neither appears among WHO’s key factors for the emergence of AMR. The change that matters happens in the germ.

Vulnerable people, such as the very young and the very old, are affected more by resistant infections. That is an effect of resistance. It is not a cause.

The official key marks statements 2 and 3 only as correct.

Check each statement in turn.

• Statement 1, genetic predisposition: wrong. Resistance is a change in the germ’s genes. A person’s genes do not alter the germ.
• Statement 2, incorrect doses: right. Misuse of antibiotics is one of the main drivers of AMR.
• Statement 3, livestock farming: right. Misuse in animals is counted as a driver, and WHO lists infection control on farms.
• Statement 4, multiple chronic diseases: wrong. WHO’s key factors do not list any patient condition.

The trap behind the question. The wrong statements describe the patient. The right statements describe what is done to the germ. Ask one thing about each: does this change how germs meet the drug?

Numbers show why UPSC and the government care. Keep the main ones in your head.

8. How many infections are resistant worldwide?

WHO says bacterial AMR was associated with more than 4.7 million deaths worldwide in 2021.

In 2023, about 1 in 6 laboratory-confirmed bacterial infections was resistant to antibiotics.

Resistance is highest in the WHO South-East Asia and Eastern Mediterranean regions. There, 1 in 3 reported infections was resistant. India lies in the South-East Asia region.

Why does this matter? One resistant infection in every six means the first-choice drug will fail more often. Treatment options narrow, and illness and death rise.

9. Are people using the right antibiotics?

WHO groups antibiotics into Access and Watch. Access antibiotics are the first-choice treatments for most common infections. Watch antibiotics carry a higher risk of resistance.

In 2022, Access antibiotics made up only about 53 per cent of human antibiotic use. Watch antibiotics made up roughly 45 per cent.

The global target is at least 70 per cent Access use by 2030.

Why do Access and Watch matter? Choosing the right group is one way to slow resistance. Using a first-choice Access drug where it works keeps Watch drugs strong for harder cases. At 53 per cent, the world is still well short of the 70 per cent target.

10. How common is drug-resistant TB?

WHO estimates that 3.2 per cent of people with a first episode of TB in 2024 had drug-resistant TB. Among people treated before, the share was 16 per cent.

Only about 2 in 5 people with drug-resistant TB got treatment in 2024.

India carried about 25 per cent of the world’s new TB cases in 2024.

Why is the second figure so much higher? Wrong or broken TB treatment is one route to resistance, as shown above. People treated before have had more chances for this to happen. So their share of drug-resistant TB is about five times higher.

India has a national plan, a prescription rule and a public campaign. It has also made its first home-grown antibiotic.

11. How many Indians die from resistant infections?

The Press Information Bureau says about 6 lakh lives are lost in India each year due to resistant infections.

It also notes that India has a large share of the global pneumonia burden.

Why is this especially serious here? India carries a large share of the global pneumonia burden. The Press Information Bureau calls a new pneumonia antibiotic especially important for this reason.

12. What is the National Action Plan on AMR?

India launched its National Action Plan on AMR (NAP-AMR) in 2017. It covered 2017 to 2021 and followed the Global Action Plan on AMR.

It names six strategic priorities:

• Improve awareness and understanding.
• Strengthen knowledge through surveillance.
• Reduce infections through prevention and control.
• Optimise the use of antimicrobials in health, animals and food.
• Promote investment, research and innovation.
• Strengthen India’s leadership and collaboration.

In 2022, national consultations were held to develop NAP-AMR 2.0.

How to remember the six priorities. Think: know, watch, prevent, use wisely, invent, lead. Awareness and surveillance come first. Prevention and wise use follow. Research and leadership close the plan.

13. What do the Red Line campaign and Schedule H1 do?

The Health Ministry launched the Red Line campaign. It tells people not to use medicines marked with a red vertical line, including antibiotics, without a doctor’s prescription.

Antibiotics are listed under Schedule H and H1 of the Drugs Rules, 1945. They are sold only on a registered doctor’s prescription.

For Schedule H1 drugs, the seller records each supply in a separate register. These records are kept for three years.

The CDSCO has placed 24 high-end antimicrobials under Schedule H1.

Why a red line on the pack? The line is a cue at the point of purchase. It tells the buyer to ask a doctor first. Schedule H1 adds a paper trail. Because each supply is written down, misuse can be traced later.

14. What new steps has India taken?

In 2019, India restricted colistin in food-producing animals. The analysis credits two triggers. Resistance genes were found in pigs in China, and resistant bacteria were found in food samples in India.

On 20 November 2024, India launched Nafithromycin. It is the country’s first indigenous macrolide antibiotic, made by Wockhardt with support from BIRAC.

It targets community-acquired bacterial pneumonia caused by drug-resistant bacteria. The course lasts three days. In December 2024, it was awaiting final approval from the CDSCO.

Two kinds of steps. The colistin rule closes a source of resistance. Nafithromycin adds a new tool for doctors. A good Mains answer covers both kinds of step.

UPSC set this in the 2019 Civil Services Preliminary paper. Learn the verbatim question, then the reasoning.

15. What did the CSP 2019 question ask?

The question was Q98 in General Studies Paper I.

1. Genetic predisposition of some people 2. Taking incorrect doses of antibiotics to cure diseases 3. Using antibiotics in livestock farming 4. Multiple chronic diseases in some people

Select the correct answer using the code given below.

• (a) 1 and 2
• (b) 2 and 3 only
• (c) 1, 3 and 4
• (d) 2, 3 and 4

The official answer key gives (b) 2 and 3 only. Statements 1 and 4 are the traps.

How to solve it fast. Statement 1 appears in options (a) and (c). Statement 4 appears in options (c) and (d). Rule out both statements and only one option is left. That is the option the key marks.

What the examiner is testing. The question tests one idea. Resistance is a change in the germ, and human habits drive it. Learn that idea and you can answer similar questions on any antimicrobial.

16. What should you revise before the exam?

Use this list:

• Cause: pathogens change through genetic changes. Humans speed it up.
• Real human causes: wrong antibiotic doses and antibiotic use in livestock.
• Not causes: a person’s genes, or having chronic diseases.
• MDR-TB: resistant to isoniazid and rifampicin.
• India: NAP-AMR 2017, Red Line campaign, Schedule H1, colistin ban in 2019.
• Official key: CSP 2019 Q98 is (b), 2 and 3 only.

Revise the list line by line.

Common misconceptions to drop:

• “My body becomes resistant.” The germ does.
• “Antibiotics work on colds and flu.” The survey counted this as wrong.
• “Genes or chronic illness cause resistance.” Neither is on WHO’s list of key factors.