Antimicrobial resistance (AMR) is a major public health issue, with India carrying one of the largest burdens of drug-resistant pathogens worldwide. Agricultural and commercial application of antimicrobials in the animal sector and human behaviour are both key factors in the growing threat of AMR. However, it is the rampant overuse and misuse of antimicrobials in the home and in hospital settings that is the biggest culprit in the emergence and spread of resistant microorganisms.

To adequately tackle the threat of AMR, it is imperative to fill the gaps in our knowledge regarding the prevalence of AMR in India. We must also ensure that innovation is enhanced, accessibility is increased, and stewardship practices are greatly improved. The objectives of this study were:

• Assess the current healthcare structure and the situation of AMR in India
• Evaluate the scope of the National Action Plan on AMR (NAP-AMR) and assess the progress of its implementation 
• Outline problems of the antimicrobial market in India about innovation, access, and appropriate use 
• Suggest policy recommendations from India’s perspective to improve innovation, increase access, and reduce overuse and misuse of “high-end” antimicrobials (defined here as relevant Watch and Reserve categories of the WHO AWaRE list that treat critical-priority pathogens in the Indian Priority Pathogen List (IPPL))

The methodology used in this study involved several approaches, including the compilation of an antimicrobial surveillance database using data from two sources—the mapping of the Indian surveillance list against the World Health Organization’s (WHO) classification of antimicrobials, and the creation of the Indian Priority Pathogen List (IPPL).

The study also involved the creation of a drug pipeline and approval database, which compared the IPPL list with the drugs approved by the Food and Drug Administration (FDA) and the Central Drugs Standard Control Organization (CDSCO) in the same period. The researchers reviewed the NAP-AMR and state action plans, summarized their strategic objectives, and analysed their current implementation status. Literature for secondary review was identified through a systematic search of peer-reviewed journals using seven online databases. Gray literature was identified by searching the references of key review articles and the archives of key organizations and advocacy groups.

Finally, the researchers conducted thirty-two stakeholder interviews, using the snowballing technique to explore viable solutions to reduce the risk of antimicrobial resistance. Of the 32, four were executives from pharmaceutical companies, 18 were subject matter specialists, and 10 government agency representatives were interviewed.