Fostering research into antimicrobial resistance in India

I ndia is among the world’s largest consumers of antibiotics. The efficacy of several antibiotics is threatened by the emergence of resistant microbial pathogens. Multiple factors, such as a high burden of disease, poor public health infrastructure, rising incomes, and unregulated sales of cheap antibiotics, have amplified the crisis of antimicrobial resistance (AMR) in India. The Global Action Plan on AMR emphasises the need to increase knowledge through surveillance and research. Box 1 provides examples of global research into AMR and its impact. Most research into AMR is carried out in developed countries. This includes research into the biology of resistant pathogens, 12 mechanisms of AMR, natural sources of AMR, development of new antimicrobials from uncultured bacteria, expanding the chemical diversity of existing antimicrobials, resensitising resistant pathogens against available antibiotics, and development of non-antibiotic agents as substitutes. Table 1 outlines the scope of research into AMR and the importance of the different areas of research. Little such research is being conducted in India, reflecting the situation of AMR research in South East Asia in general. A key strategy of the National Action Plan on AMR (NAP-AMR), launched by the government of India in 2017, is to promote investment for research. We provide an overview of research into AMR in India, describing gaps and possible obstacles. We propose strategies to advance research and to convert research evidence into policies and actions at a local and national level. Methods We searched PubMed for studies, reports, and policy documents on AMR in India using the search terms “antimicrobial resistance, India,” “Antibiotics, India”, and “Antibiotic resistant pathogens, India.” We identified 5530 publications up to August 2016. Articles referring to helminths, mosquitoes, scorpion, steroids, and other unrelated topics were excluded. AMR research in animals, agriculture, and aquaculture were also not considered. A total of 4872 articles, including original research, review articles, case reports, comments, and editorials, on AMR in India were considered for this analysis. We also reviewed patents filed in India for antimicrobial drug discovery, herbal antimicrobial preparations, diagnostic tools for antimicrobial susceptibility, and alternatives to antimicrobials. We relied on information from the United States Patent and Trademark Office; the Office of the Controller General of Patents, Designs, and Trademarks; the Indian Patents and Trademarks Office; and the public database “lens.org.” Two authors (BD and SC) extracted information from relevant publications and all authors analysed the findings according to the type of research domain. We modified and adopted the Parasuraman gap model of service quality to assess our knowledge of AMR. We developed this article based on these findings and our experience. We did not evaluate the quality and robustness of identified publications.