The WHO Global Antimicrobial Resistance Surveillance System (GLASS) Report 2025 highlights that AMR in India is a “serious and escalating threat”

About  Global Antimicrobial Resistance Surveillance System (GLASS) 

• The Global Antimicrobial Resistance Surveillance System (GLASS) was launched by the WHO in 2015.
• It aims to standardise AMR data collection, support countries in surveillance capacity, and create comparable global databases.

Key Findings of the GLASS Report

• High Resistance Rates: In 2023, around one-third of bacterial infections in India were resistant to common antibiotics, a rate significantly higher than the global average of one in six.
• Contributing Factors: Overuse, misuse of antibiotics, and weak surveillance are key contributors to India’s AMR crisis. 
  • The widespread over-the-counter access to antibiotics, self-medication, and hospital contamination exacerbate the situation.
• Health Burden: India’s high infectious disease burden and inadequate healthcare infrastructure make it disproportionately vulnerable to AMR.
• Infection Hotspots: Resistance was particularly high in serious infections such as those caused by E.coli, Klebsiella pneumoniae, and Staphylococcus aureus, especially in ICUs.

India’s Surveillance and Data Limitations

• Inconsistent Data Representation: 
  • Most AMR surveillance comes from tertiary hospitals, skewing the national resistance rates as these centers handle severe, complicated infections. 
  • There is a need for a more comprehensive national surveillance network that includes secondary and primary care facilities.
• Incomplete National Estimates:
  • AMR levels in India, especially for gram-negative pathogens, are among the highest globally. 
  • The ICMR’s  Antimicrobial Resistance Surveillance and Research Network (AMRSN) and NCDC’s National Antimicrobial Resistance Surveillance Network (NARS-Net) are key data sources, but their scope remains limited to major hospitals, leading to a potential overestimation of national resistance levels.

Challenges and Limitations in Tackling AMR

• Slow Progress in Implementation: Despite the National Action Plan on AMR (NAP-AMR), only a few states have formally launched state-specific action plans.
• Limited Regulatory Enforcement: India’s antibiotic stewardship remains inadequate, with Kerala’s AMR plan standing out as a model for other states to follow.

Global and National Initiatives

• International Collaboration: The WHO emphasizes urgent surveillance improvements and rational antibiotic use globally. 
  • India’s active participation in GLASS is crucial but requires better representation of data from rural and community health sectors.
• Global AMR Threat: AMR costs the global economy billions annually, with high resistance rates in developing countries, leading to higher mortality rates and increased healthcare costs.
• Kerala’s Success: Kerala’s Antimicrobial Resistance Intervention for Health (AMRITH) program aims to stop the OTC sale of antibiotics and has seen slight reductions in AMR levels. 
  • The state enforces penalties for non-compliance and conducts awareness campaigns to educate the public on responsible antibiotic use.
• Awareness and Literacy: Kerala’s antibiotic literacy program, set to be completed by December 2025, aims to build public awareness and education on rational antibiotic use, which is crucial to combating AMR.
• Policy Interventions: The 2019 Ban on Colistin (previously used widely as a growth promoter in livestock) is considered a major positive step.

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Policy Recommendation

• Strengthen Surveillance Networks: India must expand its surveillance network to include secondary and primary care hospitals, ensuring that data reflects national resistance levels more accurately.
• National Coordination: Implement coordinated AMR action plans at the state and national levels to improve regulation, data-sharing, and antibiotic usage.
• Public Awareness: Expand public education on AMR, ensuring that communities understand rational antibiotic use and the long-term impact of misuse.
• Global Cooperation: India must continue to engage internationally to develop new antibiotics and global policies that prevent AMR escalation.

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