For nearly a century, antibiotics have been one of the most reliable tools in medicine, turning once-deadly infections into treatable conditions. But those same medicines are quietly losing their power. Across the world, bacteria, fungi, viruses and parasites are evolving in ways that let them survive the drugs designed to kill them — a process known as antimicrobial resistance, or AMR.

The World Health Organization has declared AMR one of the top ten global public health threats facing humanity: approximately one in six laboratory-confirmed bacterial infections worldwide was resistant to antibiotics in 2023, and bacterial AMR was estimated to be associated with more than 4.7 million deaths globally in 2021.

What Is Antimicrobial Resistance?

Antimicrobials is the umbrella term for medicines that prevent and treat infections — antibiotics against bacteria, antivirals against viruses, antifungals against fungi, and antiparasitics against parasites. Resistance occurs when the microorganisms these drugs target change over time and no longer respond to treatment. As a result, infections become harder to treat, increasing the risk of disease spread, severe illness, disability and death.

It helps to keep two terms straight. Antibiotic resistance refers specifically to bacteria defeating antibiotics. Antimicrobial resistance is the broader category, covering drug resistance in bacteria, viruses, fungi and parasites. So all antibiotic resistance is a form of AMR, but AMR also includes threats like antifungal and antiviral resistance. When public health experts speak of “superbugs”, they generally mean microorganisms that resist multiple drugs — in some cases, nearly all of them.

How Bacteria Outsmart Antibiotics

Resistance is, in part, a natural evolutionary process. Microbes reproduce rapidly and mutate constantly; random genetic changes occasionally produce a bacterium that can withstand a particular antibiotic. The real driver of the crisis is what happens next: selective pressure. When an antibiotic is used, susceptible bacteria are killed while the naturally resistant ones survive, multiply and pass on their resistance traits. Resistance genes can even jump between bacteria, spreading far beyond a single infection.

Human behaviour accelerates this process dramatically. The misuse and overuse of antimicrobials — taking antibiotics for viral infections such as colds and flu, where they have no effect, or stopping a prescribed course early so that surviving bacteria can regroup — give resistant strains repeated opportunities to emerge. Antibiotics should not be used to treat viral infections unless bacterial infections are also present, according to the WHO.

The Human and Economic Cost

The numbers behind AMR are sobering. A WHO surveillance report covering 2018 to 2023 found that antibiotic resistance rose in more than 40 per cent of the bacteria-drug combinations being tracked, with average annual increases ranging from 5 to 15 per cent. The burden is unevenly spread: one in three infections in WHO’s South-East Asia and Eastern Mediterranean regions was resistant to antibiotics, compared with one in five in Africa.

Beyond deaths, AMR prolongs illness, lengthens hospital stays, forces the use of more expensive second- and third-line medicines, and creates financial hardship for affected families. The WHO warns that without effective antimicrobials, the success of modern medicine itself — including major surgery, cancer chemotherapy and organ transplantation — would be at increased risk, since all of these depend on controlling infection. Experts have estimated that resistant infections could cost the global economy some $3 trillion in lost GDP per year by 2030.

The Global Response: One Health

The fight against AMR is coordinated through a framework called One Health, which recognises that human health, animal health and the environment are interconnected and cannot be tackled in isolation. In May 2015, the World Health Assembly adopted a Global Action Plan on antimicrobial resistance, developed by the WHO in collaboration with the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE, now WOAH).

The plan sets out five strategic objectives: improve awareness and understanding of AMR through communication, education and training; strengthen the knowledge base through surveillance and research; reduce the incidence of infection through sanitation, hygiene and infection prevention; optimise the use of antimicrobial medicines in human and animal health; and build the economic case for sustainable investment in new medicines, diagnostics and other interventions. Countries were urged to develop their own national action plans along these lines, bringing together human medicine, veterinary medicine, agriculture, finance, the environment and informed consumers.

What Slowing Resistance Looks Like in Practice

On the human-medicine side, the most important measures are appropriate prescribing, proper diagnostics so the right drug is chosen, and community education about when antibiotics do and do not help. Taking antibiotics exactly as a doctor prescribes, never using leftover prescriptions, and never sharing medication are the behaviours public health agencies consistently emphasise — this is general health information, not a substitute for a doctor’s advice.

Equally important are infection prevention measures that reduce the need for antibiotics in the first place: clean water and sanitation, good hygiene, and rigorous infection control in hospitals, where resistant hospital-acquired infections pose the greatest danger to fragile patients such as those in intensive care, oncology and neonatal units. Better diagnostics matter too, because quick, quality-assured tests help doctors avoid prescribing antibiotics “just in case”.

Why This Matters for India

India sits at the centre of the AMR challenge. The South-East Asia region records some of the highest resistance rates in the world — one in three infections resistant, per the WHO — and antibiotics are often used in the country without professional oversight for conditions where they cannot help. A coordinated national response under the One Health banner, spanning hospitals, farms, pharmacies and the environment, is how the medicines modern healthcare depends on can be protected.

FAQs

What is the difference between antibiotic resistance and antimicrobial resistance?
Antibiotic resistance refers only to bacteria defeating antibiotics. Antimicrobial resistance (AMR) is the wider umbrella term covering resistance in bacteria, viruses, fungi and parasites to any antimicrobial medicine.

Can antibiotics treat a cold or the flu?
No. Colds and flu are caused by viruses, and antibiotics work only against bacteria. Using them for viral infections does not help and contributes to resistance.

Is AMR only a problem for human medicine?
No. Resistant microbes are found in people, animals, food and the environment, and they can spread between them. Antibiotic use in livestock and agriculture, poor sanitation and contaminated water all play a role, which is why the global response follows the One Health approach.

What does “One Health” mean in the fight against AMR?
One Health is the recognition that human, animal and environmental health are linked. The WHO’s Global Action Plan on AMR, adopted in 2015 with the FAO and WOAH, coordinates action across all these sectors rather than treating resistance as a hospital-only problem.

Why are so few new antibiotics being developed?
Developing new antibiotics is scientifically hard and commercially unrewarding: to slow resistance, new antibiotics are used as sparingly as possible, which limits sales. The WHO has described this as an antimicrobial research and development crisis.

Compiled by the Khabar 24h Editorial Desk from publicly available sources.