Context: The National Centre for Disease Control (NCDC) recently found that over half of the nearly 10,000 hospital patients surveyed for a study were given antibiotics to prevent, rather than treat, infection. The survey mapped patients treated on one to five days each at 20 tertiary care institutes across 15 States and two Union Territories between November 2021 and April 2022.
It found that 55% of the patients surveyed were prescribed antibiotics as prophylaxis, or as a preventive; only 45% were prescribed antibiotics to actually treat infections; and of them, only 6% were prescribed the drugs after identifying the specific bacteria. This is worrying as India carries one of the largest burdens of drug-resistant pathogens worldwide. Are antibiotics being over-prescribed in India?
Antibiotics are indispensable weapons in the battle against bacterial infections, operating through intricate mechanisms to disrupt bacterial growth and survival. Their remarkable effectiveness lies in the ability to selectively target key components of bacterial biology while sparing human cells.
How do antibiotics function?
- Cell Wall Inhibition:
- These antibiotics exert their influence by obstructing the formation of the bacterial cell wall. Bacteria maintain structural integrity through a rigid cell wall, and when this synthesis is impeded, the osmotic balance is disrupted, ultimately leading to the rupture of bacterial cells.
- Protein Synthesis Inhibition:
- They interferes with bacterial protein synthesis. Specifically, it binds to the bacterial ribosomes, hindering the elongation of the protein chain. This disruption compromises the bacteria's ability to produce essential proteins, stunting their growth and reproductive capabilities.
- DNA/RNA Synthesis Inhibition:
- Ciprofloxacin, a fluoroquinolone, targets bacterial DNA gyrase and topoisomerase IV, enzymes crucial for DNA replication and repair. By inhibiting these enzymes, the antibiotic prevents bacterial DNA from unwinding and replicating, impeding the bacteria's ability to divide and proliferate.
- Metabolic Pathway Disruption:
- This method disrupts the synthesis of tetrahydrofolic acid, an essential component in bacterial metabolism. Without this crucial co-factor, the bacteria are unable to synthesize nucleic acids and amino acids, leading to their demise.
- Example: Trimethoprim
- Disruption of Cell Membrane Function:
- These set of anitbiotics disrupt bacterial cell membranes. They bind to the lipopolysaccharides in the outer membrane of Gram-negative bacteria, causing permeability changes and leakage of cellular components. This disruption compromises the structural integrity of the bacteria, leading to cell death.
- Example: Polymyxins
- Selective Toxicity and Human Cells:
- The beauty of antibiotics lies in their selective toxicity, targeting processes unique to bacteria. This selectivity minimizes harm to human cells, allowing antibiotics to be potent against bacterial infections while sparing the host.
Are antibiotics effective against viruses?
- No, antibiotics are not effective against viruses. Antibiotics specifically target bacteria and work by interfering with essential bacterial processes, such as cell wall synthesis, protein synthesis, DNA replication, or metabolic pathways. Viruses are fundamentally different from bacteria in structure and function.
- Viruses are not classified as living organisms because they lack the cellular structures and metabolic processes that antibiotics typically target. Antibiotics do not have a direct impact on viral replication or infection.
- Antiviral medications are used to treat viral infections. These drugs target specific steps in the viral life cycle, such as viral entry into host cells, replication, and release. Common examples of antiviral medications include oseltamivir (Tamiflu) for influenza and acyclovir for herpes viruses.
It is crucial to use the correct type of medication for the specific type of infection. Inappropriate use of antibiotics for viral infections can contribute to antibiotic resistance and is generally ineffective against the viral pathogens. Always consult a healthcare professional for proper diagnosis and treatment of infections.
What is antimicrobial resistance (AMR) and how did India reach this stage?
- AMR is defined as resistance of micro-organisms to an antimicrobial agent to which they were first sensitive. The present serious concern about AMR is that multiple types of bacteria, particularly in the Indian context — E. coli, Klebsiella, Acinetobacter, Staphylococcus aureus, enterococcus — have even become resistant to some of the latest generation antibiotics. Patients who get infections with these resistant strains of bacteria have a higher possibility of poorer health outcomes due to the resistance.
How did we reach at this situation?
- First, the inappropriate use of antibiotics in non-bacterial infections, both because of prescribing practices and the use of over-the-counter antibiotics.
- Second, inadequate laboratory facilities to inform clinicians rapidly about what would be an appropriate antibiotic even in bacterial infections, based on cultures. So, most clinicians are shooting in the dark.
- Third, the lack of adequate training in antibiotic selection, escalation, and de-escalation.
- Fourth, inadequate monitoring of AMR and control of antibiotic prescription and dispensing practices by health systems in spite of repeated warnings.
- And fifth, the incentivisation of prescribing practices by the pharmaceutical industry.

Cell Wall Inhibition
Example: Penicillin

Protein Synthesis Inhibition
Example: Erythromycin

DNA/RNA Synthesis Inhibition
Example: Ciprofloxacin
AMR is not a stand-alone entity.
- The rate of AMR is directly proportional to steady and strong governance, infrastructure, sanitation, poverty, access to clean drinking water, etc.
- So, in a country with high AMR, reducing consumption of medicines alone will not make any significant change in the rate of resistance.
- While rationalising antibiotics is indeed important not just from the AMR perspective but also as a patient safety measure, other factors such as sanitation in hospitals, basic access to personal hygiene and infection control, are vital.
- COVID-19 taught us the importance of small steps, such as washing our hands and wearing a mask when in public, to counter a huge threat. Fighting AMR needs us to start with these basic steps.









