When Life Saving Drugs Stop Working…!

Credit By: DR ARIF ASAD SHAH

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• 08 Apr 2026

We can treat antibiotics as disposable commodities until they fail, or we can begin to treat them as shared, finite resources that must be preserved

ANTIBIOTIC RESISTANCE

For most of us, antibiotics are still seen as miracle drugs. A few pills, a syrup, an injection – and the fever ebbs, the infection retreats, and life returns to normal. This quiet confidence has shaped modern medicine for eight decades. Yet beneath this everyday faith lies a growing crisis: antibiotic resistance, the ability of bacteria to outsmart the very medicines designed to kill them.

Public health experts have been warning for years that we are sleepwalking into a post‑antibiotic era, where common infections become untreatable and minor surgeries turn life‑threatening. Unlike COVID‑19, this crisis has no daily case counts splashed across television screens. It advances slowly, in hospital wards and clinics, in farms and pharmacies, and in our own bodies – largely unnoticed until standard treatments fail.

What exactly is antibiotic resistance?

Antibiotics work by killing bacteria or stopping them from multiplying. But bacteria are living organisms that can adapt. When exposed repeatedly to antibiotics – especially in the wrong dose, for the wrong duration, or when they are not needed at all – some bacteria survive and develop ways to resist the drug. These resistant bacteria then multiply and spread.

Crucially, it is the bacteria, not our bodies, that become resistant. A person who misuses antibiotics does not become “immune” to the medicine; rather, they become a carrier of germs that do not respond to usual treatment. Over time, this makes infections harder and more expensive to cure. In severe cases, it can make them deadly.

The World Health Organisation (WHO) has classified antibiotic resistance as one of the top global health threats of our time. Estimates from recent global studies suggest that bacterial infections associated with antimicrobial resistance already contribute to millions of deaths each year. India, with its huge population, high infectious disease burden and widespread antibiotic use, is among the countries most affected.

How did we get here? The problem is everywhere

Antibiotic resistance is not caused by a single bad habit or one irresponsible industry. It is the combined outcome of what happens in hospitals, clinics, pharmacies, farms, wastewater, and even in our kitchens. Several patterns stand out in the Indian context.

Over‑prescription and misuse in human health

Antibiotics are often prescribed when they are not needed, such as for viral infections like the common cold, flu, or many sore throats. Patients sometimes demand “strong medicine” for quick relief, and doctors, under pressure and short of time, oblige. In some cases, multiple antibiotics are given together without a clear reason. On the other side, many patients stop their antibiotic course as soon as they feel better. They save the remaining tablets “for later” or share them with family members. This half‑hearted use exposes bacteria to the drug without fully clearing the infection – an ideal recipe for resistance.

Easy access without proper oversight

Despite regulations, antibiotics in India can still be obtained fairly easily from some pharmacies without a valid prescription. Self‑medication is common; people reuse old prescriptions, rely on advice from friends, or simply ask the chemist for “something for a fever and throat pain”. In this unregulated marketplace, powerful antibiotics are used for mild illnesses where they are not justified.

Hospital‑acquired infections and poor infection control

Hospitals are places where sick people, invasive procedures, and heavy antibiotic use come together. When basic infection prevention measures – such as hand hygiene, proper sterilisation of equipment, and isolation of patients with resistant infections – are weak, hospitals can become breeding grounds for “superbugs”. These are bacteria resistant to multiple antibiotics, including last‑line drugs that are supposed to be used only in the most serious cases.

Stories of patients developing infections during hospital stays, then requiring ever more expensive and toxic drugs, are increasingly common. For families already struggling with medical bills, antibiotic resistance adds another cruel layer of cost and uncertainty.

Use of antibiotics in animals and agriculture

Antibiotics are not just used in humans. They are given to poultry, cattle, fish and other animals to treat infections, but also sometimes to promote faster growth and prevent disease in crowded farms. Residues of these drugs can enter the food chain, and resistant bacteria from animals can spread to humans through food, water, and the environment.

In some countries, the use of certain important antibiotics in animals has been strictly limited to preserve their effectiveness for human medicine. India has taken some steps in this direction, but enforcement is uneven, and the overall use in the animal sector remains a serious concern.

Environmental contamination

Antibiotic residues and resistant bacteria have been found in wastewater from hospitals, pharmaceutical factories, and urban drains. When such water reaches rivers, lakes, and soil, it can spread resistance genes widely in the environment. This is a less visible, but deeply worrying, part of the problem.

Why should the average Indian worry?

At first glance, antibiotic resistance might seem like a distant technical issue – something for doctors, microbiologists and policymakers to handle. But it has very real consequences for everyday life. Common infections such as urinary tract infections, pneumonia, wound infections, and tuberculosis are already becoming harder to treat. When first‑line antibiotics fail, doctors are forced to use costlier drugs, often with more side‑effects. Hospital stays become longer, bills soar, and the risk of complications rises.

Simple surgeries – from caesarean sections and gall bladder removals to joint replacements – depend on effective antibiotics to prevent and treat infections. Cancer chemotherapy, organ transplants and intensive care are all built on the assumption that we can control bacterial infections. If that foundation weakens, modern medicine as we know it is shaken. India already struggles with a large burden of infectious diseases and high out‑of‑pocket health expenditure. Antibiotic resistance threatens to turn manageable illnesses into long, expensive ordeals, pushing more families into debt and poverty.

Are we doing anything about it?

The problem is not being ignored. India has a National Action Plan on Antimicrobial Resistance and has joined global initiatives to track and combat resistance. Surveillance programmes are trying to gather better data on which bacteria are becoming resistant and to which drugs. Professional bodies have issued treatment guidelines to promote rational antibiotic use.

Some hospitals have started antimicrobial stewardship programmes, in which specialist teams review antibiotic prescriptions, guide doctors on appropriate choices, and monitor usage patterns. A few states have tightened norms on over‑the‑counter sales of powerful antibiotics, and there are efforts to improve infection control and sanitation.

However, these efforts are uneven and often limited to large, urban centres. In smaller towns and rural areas – where a significant portion of India’s population lives and seeks care – the picture is quite different. Informal providers, overcrowded clinics, limited diagnostic facilities and weak regulatory oversight all fuel inappropriate antibiotic use.

What needs to change?

Antibiotic resistance cannot be solved by one law, one technology, or one heroic intervention. It requires a long‑term shift in how we think about and use these medicines, in both human and animal health.

Use antibiotics only when truly needed

Doctors and other prescribers must resist pressure – from patients, families, or pharmaceutical marketing – to use antibiotics for viral or self‑limiting illnesses. Clinical guidelines and diagnostic tests should be used more widely to distinguish between bacterial and non‑bacterial infections.

Strengthen prescription rules and pharmacy practices

Antibiotics, especially the newer and more powerful ones, should never be sold without a valid prescription. Enforcement of existing regulations must be strengthened, not only in big cities but across smaller markets. Pharmacies can also play a positive role by counselling patients on correct use and discouraging self‑medication.

Improve infection prevention and control

Basic measures such as hand‑washing, safe injection practices, proper cleaning of wards and equipment, and isolation of patients with highly resistant infections are crucial. These may sound simple, but they require training, monitoring and resources. Better infection control reduces the need for antibiotics in the first place.

Tackle antibiotic use in animals and agriculture

A “One Health” approach – recognising that human, animal and environmental health are interconnected – is essential. India needs clearer rules on which antibiotics can be used in animals, in what circumstances, and in what quantities. Good farm hygiene, vaccination of animals, and better housing conditions can reduce the need for routine antibiotic use.

Invest in clean water, sanitation and hygiene

Ultimately, the best way to reduce antibiotic use is to reduce infections themselves. Safe drinking water, proper sewage treatment, better waste management and hygiene in homes, schools and workplaces all cut down on the spread of disease. These are basic development goals that double as powerful tools against antimicrobial resistance.

Educate the public and change expectations

People need clear, consistent messages: antibiotics are not magic pills for every fever; they are precious resources that must be used carefully. Finishing prescribed courses, not sharing leftover tablets, and not demanding antibiotics when a doctor says they are not needed – these small actions, repeated at scale, can slow down resistance.

A shared responsibility

There is a temptation to look for villains in the antibiotic resistance story: careless doctors, greedy pharmaceutical companies, reckless farmers, and indifferent regulators. While there are certainly cases of negligence and profit‑driven behaviour, the problem is more systemic.

For decades, antibiotics have been cheap, powerful and widely available. They offered quick fixes in settings where sanitation was poor, diagnostics were limited, and healthcare systems were under pressure. It is hardly surprising that they were overused. But we are now entering the payback phase of this overuse.

The choice before us is stark but simple. We can treat antibiotics as disposable commodities until they fail, or we can begin to treat them as shared, finite resources that must be preserved. The first path leads to more suffering and higher costs, hitting the poorest the hardest. The second demands effort, coordination and patience – but it keeps alive the very tools on which modern medicine depends.

Antibiotic resistance is often described as a “silent pandemic”. It does not cause sudden lockdowns or headlines, but it quietly erodes our ability to treat disease. If India is serious about protecting the health of its people and the gains of its medical advances, then confronting antibiotic resistance must move from the margins of policy documents to the centre of public debate.

The time to act is not when last‑line drugs stop working in every intensive care unit. The time to act is now, in every consultation room, every pharmacy, every farm, and every household that reaches for an antibiotic without asking if it is truly needed.’

(The Author has a PhD in Microbiology, working in Dubai)