When Rekha (name changed) first fell ill, it seemed like nothing out of the ordinary. The 28-year-old, who lived in a small village in Gujarat, experienced the kind of stomach bug many in her community had dealt with before—five days of fever, stomach pain, and diarrhoea. At her local government hospital, the doctor prescribed a combination of ofloxacin (a fluoroquinolone antibiotic that works by inhibiting bacterial DNA replication) and ornidazole (an antiparasitic and antibacterial agent effective for gastrointestinal infections).

Rekha followed the treatment for a few days, but the improvement in her symptoms convinced her to stop early. She returned to her daily routine, and the antibiotics were left forgotten. Within a month, however, the illness came back with a vengeance—higher fever, more severe abdominal pain, and persistent diarrhoea. Alarmed, her family took her to a hospital in Ahmedabad, where they met Dr. Durgesh Modi.

This time, Rekha was diagnosed with typhoid fever caused by Salmonella typhi, a bacterial infection commonly linked to poor sanitation. Dr. Modi prescribed a 10-day course of oral antibiotics, emphasising the importance of completing the treatment. Once again, Rekha’s symptoms improved, and she was discharged. But back in the village, overwhelmed by household responsibilities and the cost of medicine, she cut her treatment short.

One month later, her condition deteriorated further. This time, her family rushed her back to Dr. Modi, who ordered additional tests. The results confirmed a resistant strain of Salmonella typhi—one that no longer responded to the initial antibiotics. Rekha was started on meropenem, a powerful carbapenem antibiotic administered intravenously, which is often reserved as a last resort option for multidrug-resistant infections.

“It’s a vicious cycle,” Dr. Modi explains. “Antibiotics are misused, resistance develops, and then patients like Rekha need stronger, more expensive treatments.”

Rekha’s story illustrates a dangerous pattern: incomplete antibiotic courses, compounded by a lack of education and systemic healthcare challenges, fueling antimicrobial resistance (AMR)

A Growing Crisis in India

Rekha’s story is a reflection of a much larger problem in India, where AMR is an escalating crisis. Poor awareness, easy access to antibiotics, and systemic healthcare challenges all contribute to the issue. In many parts of the country, antibiotics are readily available over the counter without a prescription, leading to rampant misuse.

Studies reveal that more than 50% of antibiotics sold in India are obtained without a doctor’s guidance. This widespread self-medication—often driven by the high cost of healthcare and the difficulty of accessing qualified doctors—makes India the largest consumer of antibiotics globally, accounting for nearly 14 billion doses annually.

For infections like typhoid, resistance to fluoroquinolones such as ofloxacin has become alarmingly common. Approximately 98% of Salmonella typhi samples tested showed reduced effectiveness against the antibiotic ciprofloxacin, meaning the drug did not fully kill or stop the bacteria. Additionally, 36% of these samples had a level of resistance so high that the drug would be ineffective even at increased doses.

Doctors frequently rely on broad-spectrum antibiotics—medications designed to target a wide range of bacteria—without confirming the specific cause of infection. While these antibiotics are useful when the exact bacteria is unknown, their excessive use poses serious risks. They kill not only harmful bacteria but also beneficial ones, disrupting the body’s natural defences. Moreover, exposing bacteria to such powerful antibiotics increases the likelihood of resistance as they adapt to survive future treatments. In many rural areas, the lack of affordable diagnostic tests forces doctors to prescribe these antibiotics preemptively, even when they may be unnecessary. Although hospitals like Dr. Modi’s have started resistance testing, the high costs make it inaccessible for most patients.

Grassroots Action and Education

AMR in rural India involves more than just raising awareness. Many patients struggle to understand why their usual medicines no longer work, often attributing the problem to “bad medicine” or mistrusting the healthcare system. For families already living in poverty, the cost of stronger, more expensive antibiotics is a heavy burden. Some patients may even perceive recommendations for additional treatments as attempts to exploit their vulnerable situations. As Dr. Modi points out, “Explaining that bacteria can adapt and render medicines ineffective feels abstract to people living day-to-day.”

Moreover, the lack of a robust healthcare infrastructure means that many doctors in rural areas must rely on broad-spectrum antibiotics without access to proper diagnostic tools to determine the exact cause of infection. While this is a necessary practice in the absence of clear diagnosis, it contributes to the overuse of antibiotics and, by extension, the acceleration of AMR. In many cases, doctors are forced to prescribe treatments based on symptoms rather than precise diagnoses, perpetuating the cycle of resistance.

These barriers make grassroots education efforts difficult to implement. Doctors like Dr. Modi, who take it upon themselves to educate patients in rural Gujarat, are doing invaluable work by making complex scientific concepts more accessible in local languages. His team conducts awareness drives in nearby villages, educating communities about the dangers of incomplete antibiotic courses and the importance of seeking proper medical advice. In addition to these drives, Dr. Modi has created YouTube videos in Gujarati that simplify complex concepts about medicine in native terms.

“We explain it in simple terms,” Dr. Modi says. “Antibiotics are like a lock and key. If you don’t use them correctly, the bacteria figure out how to break the lock.”

Yet, even with these efforts, bridging the gap between medical science and the lived reality of patients remains an uphill battle.

The road ahead is steep. Addressing AMR in rural India will require more than just education or policy changes—it will demand an overhaul of the healthcare system, better access to diagnostic resources, affordable treatment options, and stronger regulatory enforcement. Without these changes, the fight against AMR will remain deeply entrenched in poverty, ignorance, and systemic healthcare failures. Both patients and doctors are engaged in a continuous battle against resistant bacteria. Still, without stronger support and infrastructure, the war against AMR is one that may prove difficult to win.

The Cost of Inaction

The consequences of AMR are already visible. In India alone, nearly 60,000 newborns die every year due to infections caused by resistant bacteria like Klebsiella pneumoniae and Escherichia coli. These numbers are expected to rise, with AMR predicted to cause 10 million deaths globally by 2050 if left unchecked.

India has introduced initiatives like the National Action Plan on AMR and the Red Line campaign, which labels prescription-only antibiotics to discourage over-the-counter sales. However, enforcement remains inconsistent, particularly in rural areas where regulatory oversight is weakest.

Rekha’s story highlights the urgent need for systemic change: strengthening healthcare infrastructure, regulating antibiotic sales, and prioritising education. It’s a long road ahead, but stories like hers remind us of what’s at stake.

About the author: Aastha Kothari is a recent Master’s graduate in biotechnology from the University of Glasgow. She explores diverse internships in cancer research and biotech startups and is passionate about molecular biology, sustainability, and science communication. She also volunteers as a STEM ambassador to inspire under-represented communities in the UK to pursue careers in science.