In India, the monsoon season often brings a surge in common illnesses such as seasonal flu, viral fever, diarrhoea, and respiratory infections. These ailments are largely viral and self-limiting, yet frequently treated with antibiotics – medicines that are ineffective against viruses. This pattern of inappropriate antibiotic use, particularly self-medicated usage, is a significant driver of antimicrobial resistance (AMR), which severely undermines public health resilience.
AMR occurs when disease-causing microorganisms develop the ability to withstand drugs designed to kill them, rendering standard treatments less effective or even obsolete. This resistance emerges largely due to the misuse and overuse of antimicrobial medicines in humans, animals, and agriculture. Inappropriate prescribing, self-medication without proper diagnosis, and incomplete treatment courses accelerate this process. Poor infection control, inadequate sanitation, and limited access to clean water further create environments where resistant strains can thrive and spread, making infections harder and costlier to treat while increasing the risk of severe health outcomes.
National Action Plan on Antimicrobial Resistance in India
To address the growing AMR threat, India adopted its National Action Plan on Antimicrobial Resistance (NAP-AMR) in 2017, aligned with the WHO’s Global Action Plan. Built on a One Health approach, the plan focuses on improving awareness, strengthening surveillance, reducing infection incidence, promoting rational antimicrobial use, and enhancing research and collaboration. Key measures include expanding the National AMR Surveillance Network, enforcing prescription-only access for certain antibiotics, and implementing stewardship and infection-control guidelines in healthcare settings. These national efforts provide a framework to curb AMR, but their success depends on tackling everyday misuse, especially the self-medication that escalates during the monsoon season.
Seasonal Illnesses and Self-Medication
The monsoon typically increases humidity and water stagnation, creating ideal conditions for viral and bacterial illnesses. Hospitals across cities report a noticeable rise in viral fever cases, which often include symptoms like fever, cough, headache, body aches, and sometimes gastrointestinal issues. Doctors stress that antibiotics are ineffective against these viral infections and warn against their unnecessary use.
In both urban and rural areas of India, self-medication is widespread. For example, in Uttar Pradesh, over 66 percent of adults report using medicines without consulting a doctor, mainly to treat fever, cough, and cold. Even among medical students in New Delhi, 68 percent admit to self-medicating with antibiotics, often for convenience.
The Escalating Threat of Resistance
Antibiotic misuse during the monsoon exacerbates AMR. A recent study from AIIMS Bhopal revealed that only 39 percent of E. coli strains remain sensitive to ciprofloxacin and only 52 percent of Klebsiella pneumoniae strains respond to meropenem, highlighting a dangerous erosion of drug efficacy. Self-medication is recognized as a major contributor to AMR, not only in India but globally.
Several systemic factors perpetuate antibiotic misuse:
- Easy availability of antibiotics without prescription, including through pharmacies and leftover medicines
- Financial and access barriers, including long wait times or distance from clinics, especially in rural areas or among lower-income populations
- Lack of awareness: Consumers often cannot distinguish between viral and bacterial illnesses.
- Weak prescription regulations, despite legal frameworks like the Drugs and Cosmetics Act stipulating prescription-only antibiotic sales
Recommended Actions
- Empower healthcare providers to be the first line of defence against AMR by avoiding unnecessary antibiotic prescriptions and actively counselling patients on the correct use of antibiotics and the dangers of misuse.
- Launch targeted public education campaigns during the monsoon season to emphasise that antibiotics do not treat viral illnesses such as flu, colds, or viral fevers.
- Strengthen and enforce prescription regulations to restrict over-the-counter antibiotic sales, drawing on successful models such as the Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP).
- Promote adherence to the WHO’s AWaRe guidelines to ensure antibiotics are used appropriately and drug efficacy is preserved.
- Improve water, sanitation, and hygiene (WASH) infrastructure in monsoon-prone and flood-affected areas to reduce diarrhoeal and respiratory illnesses, thereby lowering unnecessary demand for antibiotics.
Dos and Don’ts: What Communities Should Practice
Dos:
- Take antibiotics only when prescribed by a certified health professional and avoid using them for viral illnesses such as colds or flu.
- Complete the full prescribed course even if you start to feel better, as stopping early can allow resistant bacteria to survive and multiply.
- Avoid sharing antibiotics or using leftover medicines, as they may be ineffective or harmful.
- Maintain good hygiene by washing hands regularly, handling food safely, and keeping vaccinations up to date to prevent infections that might otherwise require antibiotics.
- Ask your healthcare provider why antibiotics are needed, how to take them correctly, and what side effects to watch for.
Don’ts:
- Do not self-medicate or take antibiotics without medical advice, as many common symptoms may be caused by viral infections that do not require these drugs.
- Do not stop treatment early simply because you feel better, as this increases the risk of resistant strains surviving.
- Do not request antibiotics if your healthcare provider advises that they are unnecessary, as misuse undermines effective treatment and contributes to community-wide resistance.
Conclusion
The convergence of monsoon-related seasonal illnesses and widespread antibiotic misuse propels antimicrobial resistance to escalate rapidly in India. Without timely interventions spanning public awareness, regulatory enforcement, improved health infrastructure, and clinical stewardship, the efficacy of life-saving antibiotics will be irreversibly compromised. A coordinated strategy addressing both behavioral and systemic drivers is essential to safeguard public health and preserve our antibiotic arsenal.