India Now Has Its Own Antibiotic, But Here’s the Catch
Bacteria Are Rapidly Evolving to Resist Antibiotics
By Amanjeet Singh and Samriddhi Gupte
Commentary, January 28, 2025
India has developed its first indigenous antibiotic, Nafithromycin, designed to combat drug-resistant bacteria. While it is being touted as a breakthrough, the real issue lies not only in developing new antibiotics but in ensuring their responsible use. Amid the ongoing antimicrobial resistance (AMR) crisis—a phenomenon where bacteria adapt to resist the effects of antibiotics, rendering them ineffective—this new antibiotic alone cannot guarantee a solution.
Globally, AMR has emerged as a leading cause of mortality, surpassing HIV/AIDS, malaria, and even COVID-19, with an estimated 1.27 million deaths reported in 2019 alone, according to World Economic Forum. In India, AMR claimed 300,000 lives in 2019, as noted by Observer Research Foundation.
The misuse of antibiotics is a major factor behind this problem. Many people buy antibiotics over the counter or take them without consulting a doctor, allowing bacteria to adapt and making the drugs less effective over time, in India and elsewhere.
A 2014 survey in Mumbai revealed that less than half of those using antibiotics sought medical advice beforehand, as reported by India Today. This widespread misuse threatens public health by accelerating the development of drug-resistant bacteria.
“Currently, antibiotics are not just prescribed by trained doctors – they are sometimes prescribed based on assumptions and are often freely available in pharmacies,” explained Dr. Subbalaxmi Malladi, Professor of Internal Medicine at NIMS Hyderabad, at a recent event, Stakeholder Consultation on Developing a Sustainable Use Framework for New Antibiotics by Focusing on Strengthening Stewardship.
The problem lies in the easy accessibility of antibiotics, which drives high sales volumes leading to irrational use.
As a result, multi-national pharmaceutical companies are hesitant to introduce new antibiotics in low- and middle-income countries like India, fearing that irresponsible usage could render these drugs ineffective in a short span of time. Between 1999 and 2014, of the 25 new antibiotics developed globally, only 12 were made available in more than 10 low- and middle-income countries.
“We urgently need a systematic approach to help healthcare professionals follow evidence-based guidelines,” said Dr. Malladi.
India’s approach to introducing new antibiotics has seen mixed results.
The tuberculosis drug Bedaquiline, for example, was rolled out cautiously through controlled trials, with access expanding only when healthcare systems demonstrated they could manage it effectively. On the other hand, Ceftazidime-Avibactam, introduced in 2018, initially had restricted use in major hospitals but became widely available by 2023. The lack of oversight during its rollout has contributed to the development of resistance.
“Any new drug should be used judiciously and rationally,” said Dr. P.V.M. Lakshmi, Professor at PGIMER Chandigarh, at the same event. “India should prepare ahead of the introduction of new drugs in the market so that proper use can be promoted.”
Recent fieldwork in Punjab, Telangana and Kerala by the Max Institute of Healthcare Management at the Indian School of Business and International Centre for Antimicrobial Resistance Solutions points to a potential solution: the need for a sustainable use pathway. The core strategy involves strengthening antibiotic monitoring across all healthcare facilities, ranging from local clinics to major hospitals. By systematically tracking the use of these drugs and ensuring they are prescribed only when necessary, India can safeguard the effectiveness of these life-saving medicines for future generations while ensuring they are accessible to those who genuinely need them today.
Without such measures, even groundbreaking drugs like Nafithromycin could lose their effectiveness in a few years.
The misuse of antibiotics affects everyone. When antibiotics lose their effectiveness, even minor infections can turn deadly. This also drives up healthcare costs as patients require longer treatments and more expensive care.
Fighting AMR is a collective responsibility that involves policymakers, healthcare professionals, pharmaceutical companies and even the public. Together, these efforts can ensure that antibiotics remain effective tools in the fight against deadly infections.
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*(Amanjeet Singh and Samriddhi Gupte work at the Max Institute of Healthcare Management Indian School of Business and are associated with the research project titled ‘Towards an Antibiotic Roadmap for the Sustainable Entry and Management of Antibiotic X [TANDEM-ABX]’)
