Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved.

Antimicrobial resistance (AMR) occurs when microbes evolve to survive drugs meant to kill them, rendering standard treatments ineffective. India, a high-burden country, faces this partly from misuse of antibiotics.

Does overuse drive resistance?

Yes. Free over-the-counter sale without prescription, self-medication, incomplete dosage courses, use for viral illnesses, and heavy sub-therapeutic use in poultry and livestock all expose microbes to selective pressure, breeding resistant strains such as carbapenem-resistant and NDM-1 organisms.

Available mechanisms for monitoring and control

• Regulation: Schedule H1 of the Drugs and Cosmetics Rules restricts sale of specified antibiotics to prescription only.
• Surveillance: ICMR's AMR Surveillance Network and the National Programme on AMR Containment track resistance patterns.
• Policy: the National Action Plan on AMR (2017) and the Red Line campaign to identify prescription-only drugs.
• Institutions: hospital antibiotic stewardship programmes and infection-control protocols.

Issues involved

• Weak enforcement — pharmacies still sell antibiotics without prescription.
• Poor awareness among patients and prescribers.
• Unregulated use in animal husbandry and environmental release from pharma effluents.
• Fragmented surveillance and limited new-antibiotic development.

Conclusion

Overuse is indeed a major driver of AMR. Containment requires a One Health approach — stringent regulation, stewardship, public awareness, curbs on veterinary and environmental antibiotic use, and investment in research — to preserve antibiotic efficacy.