Significant Treatment Gaps in Access to Antibiotics to Treat Drug-Resistant Infections in India: Study

New Delhi: India is one of those countries which face the highest burden of antimicrobial resistance (AMR), as microbes like bacteria  become resistant to various medicines  due to their injudicious use. Once traditional antibiotics fail to perform the function that they are supposed to, only a few antibiotics are left to replace them, and they are hard to access.

In India, only 7.8% of such patients, who developed drug-resistant infections, could access antibiotics to treat their illness, according to a recently published study.

This paper published on April 30, 2025, in The Lancet Infectious Diseases assessed the access to antibiotics to drug-resistant infections in eight out of 51 low-and-middle-income countries (LMICs). These included: Bangladesh, Brazil, Egypt, India, Kenya, Mexico, Pakistan. and South Africa.

Global Antibiotic Research and Development Partnership, a non-profit, which is supported by governments of several countries and global civil society groups, funded this research. Anant Mishra of USA's Perelman School of Medicine in Philadelphia authored this study along with four other scientists.

The authors say that these countries were selected owing to “their geographical heterogeneity, substantial burden of antibiotic-resistant infections". 

However, India did fare better than some of the other countries in the group. According to this study the treatment gap was to the tune of 92.17% in India. On the other hand, five countries had a higher treatment gap, in the following order: South Africa (93.05%), Pakistan (96.49%), Bangladesh (99%), Brazil (99.64%), and Kenya (99.75%). The countries that had a relatively smaller treatment gap were Egypt (85.11%) and Mexico (85.08%).

The authors sourced their data regarding procurement and access to medicines from IQVIA and CGRN deaths from Global Burden Disease.

These treatment gaps were assessed for drugs which had become resistant to carbapenem gram-negative bacteria. 

Treatment gaps in countries with restrained health resources a matter of concern

Gram Negative bacteria, as against gram positive bacteria are harder to treat. Carbapenems are a class of antibiotics which is often considered a last resort against many bacteria. Therefore, a carbapenem resistant gram-negative (CRGN) bacterial infection is a potentially worrying condition and a clinician's and patient's nightmare. 

Consequently, treatment gaps, especially in countries with restrained health resources and an already high burden of AMR become a matter of concern.

The authors  estimated 4.78,790 CRGN bacterial infection-related deaths and 14,96,219 CRGN bacterial infections in 2019 in these eight countries. Most of these infections occurred in South Asia, with 10,66,316  estimated to occur in India.

Of these, 7.8% people, that is, 83,468 could have access to antibiotics to treat them. As many as 3,41,221 patients died in the country who needed treatment against the CGRN infections, in 2019. 

Kenya and South Africa, the least populated of the countries selected for analysis, had the lowest numbers of CRGN bacterial infections.

Clearly, a huge treatment gap was leading to a significant morbidity and  mortality.

The authors say that though their assessment was carried out in 2019 but the scale of the problems would have increased since then. 

“Given the continued rise in CRGN bacterial infections, the effects of the COVID-19 pandemic, and dramatic reductions in global foreign aid, we believe that this gap might have increased,” they say. A whole range of factors like the paucity of access to health-care facilities, inadequate timely diagnostics and barriers to accessing appropriate treatments can be some of the causes for significant treatment gaps.

The authors advocate the adoption of the ‘care cascade’ approach which was followed for HIV control, for example, with a formula of '95-95-95'.  It meant that of all potential HIV-infected patients, at least 95% must be aware of their status. Of these 95% patients, at least, 95% must have access to antiretroviral treatment (ART) drugs; and 95% of these people – who get ART drugs – must have viral load suppressed. 

“[The] normative agencies, national governments, and implementing partners worldwide have used the 95–95–95 cascade to identify areas of need, apportion funding, and develop intervention strategies at the global, national, and sub-national levels. The result has been comprehensive coordination across stakeholders and substantial gains in the global HIV response,” the authors say.

On the similar lines, the authors suggest developing a similar cascade care model for treating drug-resistant infections too. In the paper, the authors proposed a blueprint for such a model, with well-defined endpoints, or goals, for every stage. The AMR community could set ambitious targets for the percentages of individuals with antimicrobial-resistant infections accessing care, being accurately diagnosed, and receiving appropriate therapy by 2030, they add.

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