A brief historical perspective of antimicrobial resistance in India

Antimicrobial resistance (AMR) is the ability of microbes to survive exposure to antimicrobials that were once effective against them. This is a major global crisis and public health challenge of the 21st century that is declared as a silent pandemic, with India among other countries considered one of the hotspots [R. Laxminarayan, A. Duse, C. Wattal, A. K. M. Zaidi, et al., Lancet Infect Dis 13:1057-1098, 2013, https://doi.org/10.1016/S1473-3099(13)70318-9]. The evolution of AMR in modern India's context is embedded in a complex interplay of the timing of antibiotic introduction, a growing dense population, cultural inheritances, infectious disease burden, developing health systems, evolving drug market regulations, environmental and animal sector drivers, socioeconomic factors, and policy/implementation gaps. Central to this discussion are the human patient, animal, and environmental aspects of antibiotic overuse from the historical aspects of AMR in India broadly tracing from early antibiotic use to the current "One Health" challenge. It highlights cultural factors, the evolution of surveillance systems, policy responses, India's efforts, and key lessons in antimicrobial stewardship.