Medical Antimicrobial Prophylaxis in Indian Settings – What to Practice

Background: Medical antimicrobial prophylaxis (AP) is a key preventive measure aimed at reducing disease morbidity, mortality, and transmission, particularly in diverse healthcare environments such as India. While surgical prophylaxis is well-documented, guidance on medical AP remains less explored. Objectives: This narrative review aims to provide evidence-based guidance for healthcare workers and the public on medical AP, covering indications, recommended antimicrobial agents, doses, frequencies, and durations for common conditions in India. Methods: A narrative review of national and international guidelines (including ICMR, MOHFW, NACO, NTEP, WHO, CDC), supplemented by evidence from published literature, was conducted. Data were compiled for common indications of medical AP, focusing on infections relevant to Indian healthcare settings. Results: Medical AP encompasses post-exposure prophylaxis (e.g., for HIV, pertussis, leptospirosis, and meningococcal disease), pre-exposure or travel prophylaxis (e.g., for malaria, HIV PrEP), and secondary prophylaxis in recurrent or latent conditions (e.g., tuberculosis, urinary tract infections, febrile neutropenia, chronic liver disease, cardiac conditions). Despite national recommendations, uptake remains suboptimal in India. Appropriate AP has demonstrated significant benefits in preventing disease transmission, reducing complications, and mitigating antimicrobial resistance. Conclusions: Medical AP represents an essential component of antimicrobial stewardship in India. Enhancing adherence to national guidelines and improving public and healthcare worker awareness can substantially contribute to disease prevention and control.