India is among the countries using far more powerful antibiotics than clinically necessary, according to a major study published in The Lancet Public Health, which warns that the trend is accelerating antimicrobial resistance (AMR) and reducing the effectiveness of life-saving medicines.

The study analysed antibiotic needs across 186 countries using disease burden, antibiotic resistance, demographics and healthcare access to estimate the amount and type of antibiotics each country should ideally use.

The World Health Organization classifies antibiotics into three groups under its AWaRe system. Access antibiotics are first-choice medicines for common infections, Watch antibiotics are stronger drugs meant for “particular specific infections” because they have a “higher potential for resistance,” while Reserve antibiotics are last-resort treatments for multidrug-resistant infections.

The researchers found that most countries are using far more Watch antibiotics than needed. Among 67 countries with available data, “66 (99%) of 67 CTAs used more Watch antibiotics than optimal.”

India was identified as one of the countries relying heavily on Watch antibiotics, even though these medicines are meant to be used only when simpler antibiotics are unlikely to work.

The study also found that many poorer countries lack access to the antibiotics they genuinely need, particularly Reserve antibiotics, despite facing a greater burden of severe infections and drug resistance.

The researchers cautioned that the global goal of ensuring 70% of antibiotic use comes from the Access category is not enough on its own. “Countries with very different absolute levels of antibiotic use can meet the 70% Access target, obscuring both excessive use and crucial gaps in access.”

The study noted that differences in antibiotic use are driven not just by disease levels but also by “cultural, behavioural, health system, or regulatory factors that shape antibiotic use practices.”

Calling for better antibiotic stewardship, the authors stressed that because “primary care accounts for around 90% of human antibiotic use,” reducing unnecessary use of Watch antibiotics in clinics and community healthcare should be a global priority. 

Also read: India’s silent pandemic: Why antibiotics are failing and what it means for your health