India has the highest number of newborns diagnosed with neonatal sepsis in the world. Sepsis occurs when the body is overwhelmed by its immune response to an infection in its bloodstream and can cause multiple organ systems to fail.

A third of these babies die because the pathogens that cause their infections are resistant to regular antibiotic treatment. What’s worse, there is no formal ban against the overuse of the few reserve medicines that are still effective against these multi-drug-resistant germs. This does not bode well for the country’s future, as antibiotic overuse is a top reason for the evolution of resistant pathogens.

According to the 2019 study, “Neonatal Sepsis in South Asia: Huge burden and spiraling antimicrobial resistance,” published in the British Medical Journal, 16 of 1,000 babies born in India develop sepsis after contracting an infection from unsanitary childbirth practices and poor disposal of medical waste. While antibiotics would normally help treat these infections, multi-drug resistant micro-organisms or ‘superbugs’ are immune to them — leading to the infection developing into sepsis, which can be fatal.

Antibiotic resistance is caused by the evolution of microorganisms in response to antibiotic overuse. Since antibiotics cannot neutralize 100% of the bacteria within a prescribed course, the few bacteria that remain slowly evolve to resist the antibiotic that could previously neutralize them. Excess usage of antibiotics as over-the-counter drugs, over-prescription of antibiotics by doctors, and incomplete courses of antibiotic treatment speed up the evolution. While there is regulation for over-the-counter antibiotic sale under the Indian Central Drugs Standard Control Organisation, there’s no regulation of what doctors can prescribe.

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“For all practical purposes, we have lost most antibiotics due to their unbridled use. For so many newborns, the resources are insufficient. Everything becomes a portal of entry of resistant bugs — through the hands of caregivers, shortage of disinfected equipment, etc,” Ramesh Agarwal, professor of pediatrics at the All India Institute of Medical Sciences and co-author of the study, told Hindu BusinessLine.

While there are a few ‘last resort’ antibiotics used exclusively to treat superbugs, there is no strict regulation for their usage — which means they’re also on the path to becoming obsolete. Colistin, a drug that’s rarely used due to its toxicity and adverse effects, is on its way to being the only resort for treating drug-resistant superbugs. However, SciDev reports that Colistin is used often by poultry farmers to promote chickens’ healthy growth; human consumption of these chickens is speeding resistance to the drug in pathogens that affect humans.

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“While India’s Drugs Technical Advisory Board, part of the Ministry of Health and Family Welfare, has recommended that Colistin and other antimicrobials should not be used in agriculture, there is no formal ban (on the use of Colistin),” wrote Ranjit Devraj for SciDev. Devraj also added that while the Indian Government’s 2017 action plan on antimicrobial resistance is promising, the country’s Antimicrobial Resistance Surveillance and Research Network has not done much — confining itself to the top 20 medical colleges and hospitals, and the study of selected drug-resistant bacteria.

In India, 60,000 newborn babies die from antibiotic-resistant infections each year. India has long been the antibiotics capital of the world, due to squandering a vital resource that has now led to the creation of highly resistant new pathogens that fewer and fewer drugs can combat. Without stricter regulation from the Government’s side and necessary restraint against overprescription from the doctor’s side, the problem will only escalate.