India is confronting a grim paradox in the battle against deadly superbugs driven by antibiotic resistance. While antibiotics are overused to the point they often fail, leading to rising drug resistance, many patients still cannot access these crucial medicines, resulting in preventable deaths.

A new study by the Global Antibiotic Research and Development Partnership (GARDP) examined access to antibiotics for nearly 1.5 million cases of carbapenem-resistant Gram-negative (CRGN) infections across eight major low- and middle-income countries, including India, Brazil, and South Africa. CRGN bacteria are resistant to last-line antibiotics, yet only 6.9 percent of patients received proper treatment in the studied countries.

India bears the largest burden of CRGN infections and antibiotic treatment efforts, procuring 80 percent of the full courses of studied antibiotics but managing to treat only 7.8 percent of estimated cases. Gram-negative bacteria, commonly found in water, food, and the environment, cause infections like urinary tract infections, pneumonia, and food poisoning. These infections especially threaten newborns, the elderly, and hospital patients with weakened immunity, often spreading rapidly in intensive care units (ICUs).

Doctors in India regularly witness patients for whom no antibiotic works, leading to fatal outcomes. This reflects the cruel reality that while global focus remains on curbing antibiotic overuse, many patients in poorer nations die from treatable infections due to lack of access.

The study highlighted eight intravenous antibiotics active against carbapenem-resistant bacteria, including older drugs like Colistin and newer ones such as Ceftazidime-avibactam. Tigecycline was the most widely used among these. However, treatment gaps stem from weak health infrastructure, poor access to diagnostics, and prohibitive costs. For example, only about 103,647 full treatment courses of Tigecycline were procured across all eight countries, a fraction of what was needed.

Physicians cite multiple barriers to accessing proper treatment in India, such as difficulty reaching appropriate health facilities, limited diagnostic capabilities, and unaffordable drug prices. Many patients cannot afford these life-saving drugs, while those who can afford them often misuse antibiotics, accelerating resistance.

Experts recommend ensuring affordable access to antibiotics for poorer patients while implementing stronger regulation to prevent misuse. Some hospitals already require a second opinion from infection specialists before prescribing antibiotics, a practice that should become standard.

Besides improving access, curbing misuse requires smarter policies and safeguards. Yet access alone will not solve the crisis, as the antibiotic development pipeline is drying up worldwide. India carries one of the heaviest global burdens of antimicrobial resistance but also has a strong pharmaceutical base that could drive innovation in new antibiotics and advanced diagnostics.

Researchers urge India to generate local data to better estimate antibiotic needs and identify gaps, enabling targeted interventions. Innovative models such as Kerala’s hub-and-spoke system support lower-level health facilities in managing serious infections. Coordinated procurement across hospitals and states could reduce costs of newer antibiotics, similar to successful cancer drug programs.

Without access to the right antibiotics, modern medicine is at risk of unraveling. Doctors could lose the ability to safely perform surgeries, manage cancer complications, or treat common infections. Appropriate antibiotic use must be balanced with ensuring availability for patients who need them most.

The challenge is clear: India must not only promote wise antibiotic use but also guarantee equitable access to save lives and combat the growing superbug threat

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