Antimicrobial Resistance in India Drives 13.1 Percent Mortality and Doubles Treatment Costs, Review Finds
India: A recent narrative review published in Frontiers in Antibiotics on January 28, 2026, reports that antimicrobial resistance (AMR) in India is associated with an overall multidrug-resistant (MDR) infection mortality rate of 13.1% and nearly doubles median healthcare costs to US$199 per case.
AMR continues to pose a serious global health threat, with most previous analyses concentrating on hospital-acquired infections. Addressing the evidence gap in community-acquired resistance, Murali Munisamy and colleagues from the Department of Translational Medicine at the All India Institute of Medical Sciences (AIIMS), Bhopal, conducted a narrative review integrating national surveillance data with a precision medicine framework. The authors explored how pharmacogenomics, metabolomics, and therapeutic drug monitoring could inform more individualized antimicrobial strategies within the Indian healthcare context.
The review synthesized resistance data from 2018 to 2023 using findings from the National Antimicrobial Resistance Surveillance Network (NARS-Net) and the Indian Council of Medical Research (ICMR). Trends across 50 medical centers were examined, comparing urban and rural settings while focusing on clinically significant high-priority bacterial pathogens.
Key Findings of the Review Include:
- Rising Outpatient Burden: The review reveals that the clinical isolates of Escherichia coli in outpatient department (OPD) settings surged dramatically from 6,525 in 2018 to 18,995 in 2023, reflecting a growing community threat.
- Regional Resistance Disparity: The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Bihar has reached 65%, significantly exceeding the reported national average of 47.8%.
- Escalating Treatment Costs: The review reveals the median cost for managing resistant infections is US$199, nearly double the US$109 required for susceptible cases.
- Pathogen-Specific Mortality: It shows that infections involving carbapenem-resistant Enterobacterales (CRE) and MDR Acinetobacter baumannii contribute to mortality rates as high as 29% for critically ill patients.
- Unregulated Pharmacy Practices: Data indicate that approximately 67% of private-sector pharmacies in urban India dispense antibiotics without a prescription, exacerbating the spread of resistance.
The results suggest that current "one-size-fits-all" treatment approaches are increasingly ineffective, potentially leading to 10 million global annual deaths by 2050 if tailored strategies are not implemented. Consequently, robust antimicrobial stewardship programs (ASPs) should be prioritized to curb the selection pressure of resistant bacterial strains.
The review concludes that clinicians are encouraged to transition toward personalized therapy by integrating therapeutic drug monitoring (TDM) and pharmacogenomic screening to optimize drug dosing within the minimum inhibitory concentration (MIC) levels.
The authors note that although current findings are constrained by limited regional data and underexplored resistance mechanisms, future research must adopt a "One Health" approach that integrates socioeconomic and environmental factors to improve clinical outcomes for vulnerable populations.
Reference
Shinde A, Mohan A, Bulusu VM, et al. Current status of antimicrobial resistance in Indian healthcare system: combating antimicrobial resistance with precision medicine. Front Antibiot. 2026;5:1632790. doi: 10.3389/frabi.2026.1632790
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