In 2019, the leading international research journal Science reported‍ a rise in antimicrobial resistance (AMR) in central India. Two years later, the research platform Nature Communications identified wetlands in Kerala as emerging AMR hotspots. However, both studies were based on meta-analyses (a process that compares data from independent studies to draw broad conclusions) or indirect data. Researchers were left puzzled: there really wasn’t enough comprehensive ground-level data to validate these conclusions.

This gap in data motivated a team from the Drug Safety Division of the Indian Council of Medical Research (ICMR) – National Institute of Nutrition in Hyderabad, led by Dr Shobi Veleri, to investigate the prevalence of AMR in poultry.

In 2022, the team launched a study focusing on two states: Telangana and Kerala. The recently published research report revealed that the antimicrobial resistance profile in poultry in central and southern India is evolving with distinct features, thus validating the reports published by the international journals.

However, it stated that the severity of AMR profiles in the samples was relatively lesser than those seen in the poultry from the European Union (EU). AMR profiles from the Indian states have not evolved to the extent seen in poultry farms of the European Union (EU). “This suggests that India still has an opportunity to contain the AMR in poultry by putting in place stringent regulations,” says Dr Veleri, in an exclusive interview with GFM.

He also cautions that many farm owners are unaware of the risks of AMR. “Inadequate regulatory supervision contributes to the indiscriminate use of antibiotics. Overcrowding in farms and inadequate biosecurity protocols allow resistant bacterial strains to spread quickly in poultry populations.”

Edited excerpts from the interview:

How did you go about conducting the research?

We collected fresh, warm stool samples from poultry farms in Telangana during July and August 2022, and from Kerala during September and October 2022. Three samples were collected from each farm, separated by at least 3 km. We took a total of 240 faecal samples from 85 poultry farms. As many as 38 of them were located in Telangana, while the remaining 47 were from Kerala. Adhering to the international practice of masking the identity of individual farms, the samples were pooled zone wise. Kerala had three zones: north, middle and south. Telangana had three major mandals surrounding the Hyderabad metropolitan area, which has a large congregation of poultry farms. From the stool, genomic DNA was isolated and genome sequencing was done on an advanced automatic sequencing machine. The output data was analysed by a computer-based programme to avoid human interference.

The study was done by a four-member team from the Drug Safety Division of the ICMR - National Institute of Nutrition from Hyderabad, led by me. Ajmal Aseem, Prarthi Sagar, and N Samyuktha Kumar Reddy were the other members in the team.

What were your major findings from this process?

We identified over 169 distinct AMR genes from the samples. This included high priority pathogens such as E.coli, Enterococcus faecalis, Klebsiella pneumonia, Salmonella typhimurium, Staphylococcus aureus, Pseudomonas aeruginosa, which cause abdominal infections, respiratory tract infections (pneumonia, bronchitis), and urinary tract infections. Notably, southern India exhibited a significantly higher number of resistance genes, compared to central India.

What explains this prevalence of AMR genes in poultry?

All organisms have strong survival instincts. Bacteria, too, have an incredibly fast system to develop resistance against antibiotics that threaten their existence. The more the use of antibiotics, the more chances the bacteria will have to evolve resistance genes.

Antibiotics are used indiscriminately in poultry farms because of the inadequate regulatory supervision. We realised that many farm owners are unaware of the risks of AMR. What compounds the problem is the overcrowding in farms and inadequate biosecurity protocols, which allow resistant bacterial strains to spread quickly in the poultry population.

Environmental factors, too, play a crucial role. Improper disposal of animal waste often leads to the contamination of water sources, which introduces AMR bacteria into the food chain. The proximity of poultry farms to human settlements increases the risk of contact transmission.

How can AMR bacteria spread to humans and the extended environment?

Like most infectious diseases, AMR bacteria can spread through contact: animals to humans and humans to humans. AMR bacteria can also enter the environment through the faeces of humans or animals. A common route for bacterial contamination of the food chain is from faeces via soil to water–and ultimately, the bacteria reaches animals and humans.

Properly cooked food and meat generally degrade 95% of the contaminated bacteria and the DNA in them, except some spore-forming ones. So, avoiding chicken meat is not a solution against the threat of AMR.

The best option is to reduce indiscriminate use of antibiotics.

Also read: The looming crisis of post-antibiotic era

Your study mentions that “the samples exhibited a higher prevalence of gram-negative and anaerobic species”. What does this mean?

Our samples had 44% gram-negative, such as E.coli, Bacteriodes fragiles, Klebsiella pneumonia, Pseudomonas aeruginosa; and 79% of species were anaerobic, such as Clostridium perfringens, Enterococcus faecium, Staphylococcus aureus. Gram-negative bacteria have an extra layer of cell membrane protection: it’s almost like a helmet which protects your head during bike rides. These gram-negatives, upon acquiring AMR genes, get double protection against antibiotics–making it very difficult to kill them via antibiotics. If they evolve to overcome treatment options, we will be facing a serious health hazard.

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The study states that “the severity of AMR in Telangana and Kerala is lesser than European Union.” Does this mean that it’s safer to consume chicken meat in India than in the EU?

We inferred that the severity of AMR profiles in the samples was relatively lesser than those seen in the poultry from the European Union (EU). This is because we could not detect the recently-evolved AMR gene mcr-1, which is resistant to Colistin (a last-resort antibiotic on the World Health Organization’s essential list of medicines to treat AMR) and another newly-evolved resistance gene optrA in our samples. These genes are commonly found in AMR-affected poultry in the EU.

Additionally, the qnr gene, commonly found in the EU, was found at much lower levels in Southern Indian samples. So, AMR profiles from Kerala and Telangana poultry farms have not evolved to the extent seen in poultry farms in the EU. This might be because Indian farmers started using antibiotics much later than their counterparts in the EU. This suggests that India still has an opportunity to contain AMR by putting in place stringent regulations.

How serious is the situation?

AMR is an emerging global threat to the healthcare sector because [if this continues] we will run out of effective antibiotics to treat diseases in humans and animals. The World Health Organization has considered AMR among the top priority in its ‘Sustainable Development Goals’ under the ‘One Health’ practices and principles. The data indicates that AMR genes are in an alarming condition, at least in some regional hotspots in poultry farms. If we miss this opportunity to control its spread, we will be in for a huge health crisis. The findings underscore the urgent need for reducing indiscriminate use of antibiotics through proper stewardship, enhanced biosecurity monitoring measures–and targeted public health interventions to mitigate the growing threat of AMR in poultry as well as its spillage to other organisms.

Also read: What’s lurking in your chicken dinner?

Is it possible to completely avoid the use of antibiotics in the poultry industry?

While it is challenging to completely avoid the use of antibiotics in the poultry industry or any sector for that matter, it is possible to significantly reduce our reliance on them through improved hygienic animal husbandry practices. It is time the poultry industry utilised alternatives to antibiotics, such as vaccines, peptides, and bacteriophages, etc.

‍Also read: How bacteria evolve and survive antibiotics

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Until five years ago, M. Muthulakshmi, a farmer from Thoppupatti village in Dindigul district, Tamil Nadu, relied heavily on chemicals, including banned antibiotics like streptomycin, for her paddy crop. It was her go-to solution to treat bacterial blight, a deadly disease that affects crop yield. But, this crop season, she no longer uses powerful antibiotics. Muthulakshmi has transitioned to natural farming methods after heeding the advice of ‘plant doctors’ over local agri-input dealers.

The input dealers, who were ignorant about this new invasive pest, suggested a combination of random insecticides, which would’ve inadvertently aggravated the population of black thrips, an invasive insect species. “I learnt about it only after frequent visits to the plant clinic," Muthulakshmi says. Aware that the disease occurs primarily between October and December, she now sprays a natural solution made from cow dung as a preventative measure against bacterial blight. This approach has reduced her reliance on fertilisers, lowered plant protection costs, preserved soil quality, and, most importantly, has been a solution to antimicrobial resistance in agriculture.

Also read: Antibiotics abuse is poisoning us and our soil

What are plant clinics?

Given this reality, many farmers, such as Muthulakshmi, have visited plant clinics in the hope of finding solutions.

Developed by the Centre for Agricultural and Biosciences International (CABI) and initiated in India by the MS Swaminathan Research Foundation (MSSRF) in 2012, ‘plant clinics’ are a technological model that educates farmers on preventative measures for pest management and focusses on sustainable crop practices. Just as doctors diagnose human diseases, plant clinics perform a similar role for crops. At a plant clinic, typically set up in a common area within a village, farmers bring samples of their plants to showcase pest symptoms. Each clinic conducts at least two sessions per month, with around 20 farmers attending each. During the peak crop seasons of November and December, clinics increase their frequency to hold weekly sessions.

Plant clinics are managed by plant doctors who are either experts, extension officers or progressive farmers who underwent CABI’s training modules on various plant health issues. These doctors either suggest biological solutions to the crops or, if needed, visit the fields to get a better analysis. “In the case of trees, such as coconuts and palms, when the samples cannot be brought, we visit the farm to get a first-hand analysis of the pest,” says P. Senthil Kumar, a plant doctor.

Precision equipment—including a tablet, microscope, magnifier, laptop equipped with DinoCapture (a software that allows users to capture images from a microscope and annotate them), and a projector—makes the plant clinic a mobile unit that can cater to different villages. All these tools help the farmer understand the type of disease on hand, its cause, patterns, and appropriate solutions, which are mostly na​​ture-based, to address it.

A 2018 MSSRF study on plant clinics states that plant doctors consult a panel of agricultural experts from CABI, MSSRF, Tamil Nadu Agricultural University (TNAU), Krishi Vigyan Kendra (KVK), and the Agriculture Department when faced with issues beyond their expertise. The panel, formed with specialists committed to offering support, helps tackle complex challenges. MSSRF currently operates 37 plant clinics across 205 villages in Tamil Nadu, Puducherry, Assam, Odisha, Kerala, and Madhya Pradesh. The foundation has trained 190 plant doctors—including 47 women—conducted 3,180 clinic sessions, assisted 50,433 farmers (9,468 of them women), and tested 49,588 crop samples.

Tackling new pests

Recently, when black thrips started impacting the chilli crops in South India, farmers with no source of information and without any sense of direction used a combination of irrelevant chemicals. “It is a sucking pest that melts away the petals of chilli flowers, resulting in malformed chillies. Rather than using insecticides [alone], input dealers prescribed a combination of insecticides and fungicides,” Kumar says.

Plant doctors advised the farmers to grow tall growing crops on the border to prevent the invasion of insects. They also suggested setting up blue sticky traps and using neem-based pest repellants as control measures. “Input dealers pushed three to four chemicals as a solution. By visiting plant clinics, farmers could save 60% of the plant protection cost,” Kumar says.

Thangaraj M, a farmer from Pandikkudi village in Pudukkottai district, Tamil Nadu, has been visiting a plant clinic for the past four years to consult with experts about various pests affecting his jasmine, paddy and lemon crops. “I also participate in their workshops to learn about changing climates. In one session, I learned how climate change contributes to the emergence of new pests and the ways farmers can adapt to it,” he says.

Also read: Gujarat’s tribals turn riverbeds into breadbaskets

Changing the perspective

A study conducted by MSSRF revealed that 90% of farmers rely on input dealers for guidance, 5% turn to their peers, 2-3% seek information from friends and relatives, and the remaining 2% rely on traditional knowledge. Shifting farmers’ reliance from input dealers to plant clinics has been a herculean task for the Foundation.

“Farmers were initially reluctant because input dealers were their primary source of pest management advice. However, plant doctors visited the fields, displayed magnified images of pests on laptops, and educated farmers in ways they could easily relate to,” says Dr. R. Rajkumar, Senior Fellow at MSSRF and coordinator of the Plant Clinic Programme.

Lately, being in the dairy business has become tough, as cattle are developing new types of diseases. Earlier, I used to struggle to get a veterinarian to visit for consultation. They are often unavailable during festivals or when busy with other cases. Most times, I had to rely on my husband to call the veterinarian or help take the cow to the nearby hospital. With plant clinics, the solution is just a text away.

The Plant Clinic Programme faces several challenges. While plant doctors recommend bio inputs, these are often less accessible than chemical alternatives in some areas. Input dealers remain a key source of agro-advisories, making it hard to fully replace their role. “However, periodic training for input dealers and collaboration with plant doctors can ensure farmers receive accurate guidance. Educating farmers on the importance of timely and appropriate input use can further address these challenges,” Rajkumar says.

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Even experienced farmers have learnt a great deal from plant clinics. A 75-year-old farmer, Tirupathi Manickam, also from Pandikkudi, says he is a more informed farmer now compared to a decade ago when he used to farm merely for the sake of it. “It was through plant clinics that I was introduced to the scientific procedure of sowing. They taught me not to dry the seeds completely, the right season to sow seeds, and the importance of using unadulterated seeds to achieve a good yield,” Tirupathi says, adding that these learnings have been helpful in cultivating groundnut, paddy, and maize.

These tools have been especially resourceful for women farmers, as plant clinics have reduced their dependence on men—especially since most plant doctors double up as veterinarians. For M. Radha, a 41-year-old farmer from Thirumalaraya Samudram village in Pudukkottai, her primary source of income comes from selling milk from her seven cows. “Lately, being in the dairy business has become tough, as cattle are developing new types of diseases. Earlier, I used to struggle to get a veterinarian to visit for consultation. They are often unavailable during festivals or when busy with other cases. Most times, I had to rely on my husband to call the veterinarian or help take the cow to the nearby hospital. With plant clinics, the solution is just a text away,” she said.

There is growing demand from farmers and stakeholders for more plant clinics. While the MSSRF is working to expand its reach, its capacity as an NGO is limited. “To effectively scale the initiative, training Agricultural Extension Officers as plant doctors and integrating the Plant Clinic Programme into the existing agricultural extension system seems to be the most sustainable solution,” Rajkumar says. MSSRF also conducts online plant clinics for farmers, and is making efforts to develop AI-based plant health advisories.

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In 2018, Dixit Kundar, a young resident of the Udupi district in Karnataka, paid a huge price for a game of barefoot football in rainy July. The only son of his parents Jai and Pathima, he was admitted to Manipal’s Kasturba Medical Hospital with complaints of high fever, severe headaches, repeated vomiting and trouble with closing his eyes while asleep. Despite medical interventions, his condition worsened as the days passed.

A week after being hospitalised, he succumbed to Melioidosis—a condition that was considered rare at the time. The news sent shockwaves through the public and medical fraternity. Following Kundar’s death, health officials were alarmed by the widespread presence of the causative bacterium, Burkholderia pseudomallei, in the soil, water, and environment of tropical, coastal, and monsoon-prone regions in India.

The bacterium is transmitted through inhalation, small cuts, or ingestion of contaminated water. Kundar had played football in flooded areas near his home, and it is suspected that he may have fallen into a waterlogged field during the game, thus exposing him to the disease.

A 2016 report estimated over 50,000 people contract Melioidosis annually in India, with more than 30,000 deaths. “India was predicted to have the highest burden for the disease (20,000- 52,000 new cases/year with an estimated mortality of 32,000 per year),” reads a 2019 bulletin from the National Centre for Disease Control. Troublingly, over 90% of the total cases in the country have been reported in the last ten years, even as academics predict that since 2005, the incidence of the disease has been underreported owing to misdiagnosis. Globally, the disease affects around 160,000 people each year, causing approximately 89,000 deaths.

Rapid response

Microbiologists believe Burkholderia pseudomallei has been prevalent in India for over a century; it was first described in Myanmar’s Yangon in 1911. “Dixit's death brought attention to a deadly infectious disease that the medical fraternity has issued warnings about since 2005,” says Prof Chiranjay Mukhopadhyay, Director of the Manipal Institute of Virology, who identified the first cluster of cases in 2007.

“It invades cells and destroys them. The infection can be particularly fatal for individuals with diabetes and chronic kidney disease. If left undiagnosed and untreated, patients may succumb within 48 to 72 hours,” Mukhopadhyay adds.

Understanding how India’s geography influences the spread of Melioidosis is critical for developing region-specific prevention strategies.

Fearing an outbreak, a team led by Mukhopadhyay visited every household in Udupi to assess the situation. They collected soil samples, tested drinking water sources, and disinfected stagnant water bodies with bleaching powder, in collaboration with district health authorities. They also urged residents to keep their homes, gardens, and cattle stables clean, as well as advising them to wear shoes when working with soil and water.

Those who work on farms, or even engage in recreational activities in waterlogged areas, are at a higher risk of contracting Melioidosis, warn medical experts. Gardening without gloves, walking barefoot, and consuming contaminated water also increase the risk of infection.

Diagnostic challenges

The disease can appear in a manner similar to pneumonia, septicemia, or acute bone and joint infections during the rainy season. In contrast, in the dry season, patients often present with multiple abscesses and skin ulcers.

For years, microbiologists struggled to diagnose Melioidosis due to symptoms that resemble those of common infections such as malaria, tuberculosis, dengue and the flu. This often led to misdiagnoses and delayed treatment. “A delay in identifying the disease can be fatal, as the infection requires specific antibiotic treatment,” Mukhopadhyay explains.

That Melioidosis can remain dormant in the body for years, resurfacing only when the immune system weakens, only adds to the concerns surrounding its diagnosis. “This characteristic makes it a ‘silent killer’ that can strike without warning. The disease can lie undetected for long periods, posing a persistent and hidden threat,” he said.

Environmental conditions

India's tropical, coastal, and monsoon-affected regions provide ideal conditions for the growth and spread of Burkholderia pseudomallei. While cooler, arid, and high-altitude areas face a lower risk, factors such as flooding, irrigation, and poor sanitation still pose significant threats.

Scientists have found connections between climate change and the spread of Melioidosis—including rising temperatures and more extreme weather events; Burkholderia pseudomallei thrives in warm, humid environments. Higher temperatures and lingering moisture create the perfect habitat for the bacteria in soil. As rainfall and flooding increase, the bacteria migrates from soil to water sources, broadening its spread.

Human intervention, in the form of deforestation, urbanisation, and changes in agricultural practices, also contribute to the spread of the disease. Soil disturbances during the rainy season, combined with strong winds, can release the bacteria into the air, raising the risk of inhalation and infection.

Climate change-induced extreme weather events, such as cyclones and droughts, can significantly alter the dynamics of Burkholderia pseudomallei in the environment. Cyclones bring heavy rainfall and soil erosion, while droughts concentrate the bacterium in soil and water, increasing its virulence during subsequent periods of rainfall. “Understanding how India’s geography influences the spread of Melioidosis is critical for developing region-specific prevention strategies. On the climate change front, raising awareness, improving surveillance, and adopting sustainable practices are essential measures to combat the threats posed by Melioidosis,” Mukhopadhyay says.

Preventive action

To combat the disease's spread, the Indian Council of Medical Research (ICMR) launched MISSION: A Multi-Centric Capacity Building Initiative to Strengthen the Clinical and Laboratory Detection of Melioidosis in 2022. The project involves 15 medical centres across 14 states, including Arunachal Pradesh, Assam, Sikkim, Tripura, Manipur, Meghalaya, Mizoram, Nagaland, Karnataka, Kerala, Madhya Pradesh, New Delhi, Odisha and Rajasthan. The initiative aims to raise awareness about Melioidosis and improve early detection and treatment protocols.

Kasturba Medical College (KMC) in Manipal, a leader in Melioidosis research for the past two decades, serves as the referral centre for the project. The Centre for Emerging and Tropical Diseases (CETD) has developed comprehensive training protocols for healthcare staff, equipping doctors and technicians with the tools needed to diagnose and treat the disease effectively. “Accurate diagnosis is critical for the successful treatment of Melioidosis. This capacity-building initiative aims to empower healthcare facilities across India to identify and manage the disease more efficiently,” Mukhopadhyay informs.

Early diagnosis is essential for effective treatment. “If the diagnosis is delayed, doctors may administer broad-spectrum antibiotics indiscriminately, potentially leading to antimicrobial resistance. This makes proper treatment increasingly difficult. Early and accurate diagnosis is, therefore, vital,” the veteran microbiologist explains.

Greater awareness can be raised if Melioidosis were classified as a notifiable disease, as well as recognised as a neglected tropical disease, he adds. This recognition will increase public awareness and help experts to attract funding and conduct research to combat it. “With the rising number of cases, particularly in tropical regions, we must invest in understanding the disease and developing effective treatments. By categorising it as a notifiable and neglected tropical disease, we can ensure the necessary resources are allocated to combat it, ultimately reducing its impact on affected populations,” he concludes.

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Our bodies are home to a vast community of microbes that not only coexist with us but also play a vital role in maintaining our equilibrium, said Dr Bhavana MV, a microbiologist at Manipal Hospitals.

The gut, in particular, houses 90% of the body’s bacteria, which help produce essential enzymes for normal bodily functions. This collection of bacteria-along with archaea, eukaryotes, and viruses–forms the gut microbiome.

The microbiome begins to develop in newborns, as their intestines are initially immature. “As the infant is exposed to various environments and milk, the microbiome develops within 5–6 months,” said Dr Bhavana. “Once it reaches a satisfactory level of maturity, we can introduce solid foods.”

The delicate balance of the gut lining is sensitive to antibiotics. "When we get an infection or illness, it can damage the gut’s protective lining. The food we eat also plays a role, sometimes depleting the good bacteria and giving harmful ones room to grow. As these bad bacteria multiply, they produce polymers that can lead to disease,” said Neha Jain, associate professor at IIT Jodhpur’s Department of Bioscience and Bioengineering.

Long-term impact

Evidence suggests that early exposure to antibiotics can disrupt multiple systems, including the gastrointestinal, immune and neurocognitive systems.

“The gut microbiome is linked to various physiological conditions such as weight management, mood disorders and gastrointestinal issues,” said Akanksha Gupta, co-founder of MicrobioTX, a Bengaluru-based gut health startup.

The rise in antibiotic use in recent years has been directly linked to these issues. The antibiotics we take, even just occasionally, can really disrupt our gut. It can take weeks or even months to recover, even after taking the right dose. Some studies show that certain healthy bacteria are still missing up to six months after taking antibiotics. Just imagine the damage caused when antibiotics are used more than necessary.

"The bacteria stay in groups, not individually. They form a community, which gives rise to antimicrobial resistance," explained Jain. She also stated that her lab is looking into how these communities are formed, their composition, and whether a drug can be designed to prevent this formation.

Also read: What’s lurking in your chicken dinner?

Gut-brain link

Two new studies suggest that Parkinson’s disease might sometimes originate in the digestive tract and travel to the brain, driven in part by a chain reaction involving gut microbes. “Active research has been happening since the last 10 years. However, people have reported in the 80s and 90s that there’s some connection between the gut and the brain,” said Jain.

Researchers suggest that as the concentration of certain microbes increases, movement-related symptoms of Parkinson’s worsen. In those with Parkinson’s, the gut's microbial balance shifts, allowing specific bacterial families to dominate. Among them is E coli, a microbe notorious for causing gut infections.

The studies identified a chain reaction initiated by E coli that leads to abnormal protein clumps forming in the gut. These clumps have also been found in the brains of Parkinson’s patients.

Leaky gut

"Most of the beneficial bacteria in our gut play a key role in breaking down the fibre we consume. However, when there’s a change in this balance, healthy bacteria are lost, and small gaps form in the gut lining. This allows harmful bacteria and viruses to take over, leading to a condition known as leaky gut," said Dr Baby Chakrapani, Honorary Director of the Centre for Neuroscience and Assistant Professor.

"The microbes lining our gut are essential for maintaining good health. Overusing antibiotics can destroy these healthy microbes, which can trigger the onset of various illnesses, including neurological conditions," he added.

At birth, microbial populations are transferred to newborns, primarily through exposure to natural vaginal bacteria. This is why vaginal births are usually better for establishing a strong microbial foundation. Babies born via C-section miss out on this initial transfer and need more time to build their microbiome through breastfeeding and diet in the months that follow. This early microbiome plays a key role in building immunity, giving naturally delivered babies an early advantage in gut health.

However, this balance can later be disrupted by lifestyle factors like exposure to pesticides, antibiotics, and even stress. These factors damage the gut lining, often triggering the onset of various health problems.

The microbes lining our gut are essential for maintaining good health. Overusing antibiotics can destroy these healthy microbes, which can trigger the onset of various illnesses, including neurological conditions.

The researcher, who specialises in neuroscience and brain cell studies, said when we think of neurological conditions like Alzheimer’s or Parkinson’s, we usually focus on the symptoms that appear in people aged 50 or 60. But changes in the brain often begin 20 to 30 years earlier, during a pre-symptomatic stage that goes unnoticed. Subtle symptoms may emerge in this phase, and constipation is a common early warning sign. “It’s one of the changes that signals a disease may develop later,” he said.

Our bodies often signal when something is wrong, but sometimes symptoms stay hidden. In such cases, doctors recommend tests to assess gut health. Typically, these tests involve stool samples.

MicrobioTX has introduced a method that uses a simple finger-prick test instead of traditional stool-based analysis. “The Gut Function test uniquely predicts gut bacteria by analyzing metabolites in the blood using a finger-prick sample. By relying on a machine learning model, GFT allows a user to bypass traditional stool-based testing or genomic sequencing to know his gut profile, making it more affordable, less invasive, and faster, with results available within two weeks,” said Gupta.

Our bodies have both good and bad bacteria. Antibiotics don’t know the difference and kill both. It’s like during a riot–when the police try to stop the trouble, innocent people sometimes get hurt too.

Reversing damage

The misuse of antibiotics is another pressing health issue. “Antibiotics used to be easily available without a prescription, so people got into the habit of taking them for things like colds and coughs. In the last 5–6 years, India has been working to raise awareness about antimicrobial resistance (AMR), but progress has been slow. Many still think they can take antibiotics whenever they want, but that needs to change,” said Jain.

She has been part of a rural outreach programme to tackle the misuse of antibiotics. “We educated people about what antibiotics do and why they shouldn’t be used unnecessarily. We also explained how overuse can lead to AMR.

“Our bodies have both good and bad bacteria. Antibiotics don’t know the difference and kill both. It’s like during a riot–when the police try to stop the trouble, innocent people sometimes get hurt too. If this continues, the innocent ones are lost. This is what happens when we use antibiotics,” she added.

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As the national capital, Delhi may be India's seat of power, but it doesn't have complete control over its own health--an aspect that is frequently affected by the actions of its neighbours. Be it the thick smog that envelops the capital and brings the life of its residents to a grinding halt during winter, or the hidden manner in which the city ignorantly consumes antibiotic-treated food and water. Similarly, Delhi may not be home to pharmaceutical manufacturing factories, but neighbouring states with such facilities often dump waste into common water bodies. This cyclical fate is unlikely to change, say experts, until the states it shares borders with straighten up their act and have their own action plans in place.

Delhi’s unique predicament calls for unique solutions when it comes to antimicrobial resistance (AMR), a crisis identified as one of the top ten global threats to humanity. Antibiotics, our defence strategy against harmful microbes causing life-threatening infections, have disturbed the balance within and without. After the World Health Assembly adopted a global action plan on AMR in 2015, India followed in 2017, and Delhi became the third state to launch its plan in January 2020. 

In alignment with the national action plan, Delhi’s own has identified six strategic objectives: awareness and education; laboratory network for early diagnosis and surveillance; infection prevention and control; optimising antibiotics’ use; research; and, lastly, collaboration between national and international NGOs to implement it at the grassroots level, says Dr Sangeeta Sharma, nodal officer for the Containment of AMR for the Government of the National Capital Territory (NCT) of Delhi.

Since AMR affects all spheres of life, it is addressed with a One Health approach, where the health of humans, animals, plants, and environments is taken into account in a unified manner. This has posed a bureaucratic challenge--it requires the health, food, animal husbandry, environment, and industry ministries to work together.

Progress report

As part of the capital’s action plan, doctors, pharmacists, and nurses have undergone training programmes to build capacity, and students and teachers are being educated about antibiotic misuse and resistance. “Often, antibiotics are prescribed ‘just in case’ for conditions like coughs, colds, upper respiratory illnesses, and acute watery diarrhoea, which are predominantly viral and do not require these medicines,” says Dr Sharma, who is also the president of the Delhi Society for Promotion of Rational Use of Drugs (DSPRUD). “In 2022, we launched an integrated diagnostic and antimicrobial stewardship programme to improve diagnosis and reduce unnecessary antibiotic prescriptions. So far, we have trained more than 1,000 doctors, 1,600 nurses, and 450 clinicians.”

When it comes to pharmacists, the focus has been tackling self-medication by buyers and preventing over-the-counter sales of antibiotics. “The DSPRUD also undertook awareness drives for the schools urging people to not use medicines without a doctor’s go-ahead and not to buy antibiotics (especially HI1 drugs) over the counter without prescription,” Dr Sharma adds.

Food is not something that the Union Territory produces daily, and neither is most of its poultry. All of it comes from the states surrounding it.

The plan calls for a particular focus on school students, encouraging and training them to spread the word among the general public. “We wanted children to talk to their parents and keep tabs on antibiotic use within their families, as we saw in the case of the firecracker campaign in Delhi, where there was a deeper penetration of the message,” says Dr Ravindra Aggarwal, chief coordinator, AMR, Government of NCT of Delhi.

Over two years, awareness campaigns organised in collaboration with the WHO, DSPRUD, and the National Centre for Disease Control have reached out to 900,000 students and 3,500 teachers. Most recently, a partnership with the non-profit organisation ECHO India enabled over 250 teachers to be trained, across October and November. Discussions among educators have been centred on the identification of misuse and its prevention, with the aim that the teachers will spread knowledge among their students and communities, Dr Aggarwal added.

Also read: Inside Tamil Nadu's battle against AMR

Unique predicament

 “As a coastal state, Kerala prioritises aquaculture. Whereas Delhi lacks a coast or farmland, thus relying on neighbouring states for food supplies. In that sense, it is a consumption state. Food is not something that the Union Territory produces daily, and neither is most of its poultry. All of it comes from the states surrounding it,” says Dr Robin Paul, a senior veterinarian and consultant at the Food and Agriculture Organization.

The city’s multi-tiered healthcare infrastructure also presents unique challenges. The Union Territory houses a diverse range of healthcare settings, from sub-centres and primary health facilities to super-specialty centres, each with their distinct problems and varying complexities. “The use of antibiotics varies greatly, from minor surgeries to transplants. To preserve the efficacy of antibiotics in life-threatening operations, we need to know which antibiotic to use in the first place,” Dr Sharma adds. The formulation of Delhi’s action plan involves 120 stakeholders from 17 different levels of healthcare to address this multi sectoral and multidisciplinary challenge, she explains.

Also read: Kerala is winning the battle against AMR and how!

Niggling challenges

The COVID-19 pandemic caused a shift in priorities, Dr Aggarwal says, causing AMR to be put on the backburner. “Afterward, we tried but could not set the desired tempo, as leadership at the level of the Directorate General of Health Services (DGHS) in the Delhi government changed.”

Alongside policy, regulation remains a challenge. The Food Safety and Standards Authority of India (FSSAI)’s decision to expand its list of flagged antibiotics, and the intent to tighten norms on the maximum residue levels of antibiotics in animal products, has emerged as a silver lining; these new norms will be effective from April 2025.

Dr Vijay Pal Singh, a veterinarian at the Council of Scientific & Industrial Research--Institute of Genomics and Integrative Biology (CSIR-IGIB), calls attention to the use of antibiotics in animal care--an alarming issue that is understudied. The former joint director at the FSSAI highlights a study conducted at the CSIR-IGIB, which found that dogs in the university's vicinity were completely resistant to the most commonly used antibiotics. Yet, these drugs continue to be rampantly prescribed to animals in veterinary care. “This research, as well as awareness and training programmes to avoid the use of antibiotics in animals, is immensely lagging,” Dr Singh says.

Part of the problem stems from the lack of an established and accepted term for AMR-related fatalities. “I may die from multiple organ failure or another condition, but it will not be marked as AMR. It is an orphaned issue that cannot be quantified or named, and thus, the urgency of the threat is overlooked,” Dr Singh adds.

The veterinarian also points to the absence of a unified platform to share data. “One Health is an entirely completely academic exercise at the moment. Each agency--the FSSAI, Export Inspection, and CDSCO--has its own regulations and laboratories.” Thus, these agencies tend to work in silos. Tackling AMR calls for mandatory surveillance to make informed decisions--which could be facilitated by a consolidated platform that keeps various stakeholders apprised of developments. “For instance, if a certain food item contains too many antibiotics, human doctors should be aware [of this] so that they can adjust their prescriptions accordingly,” Dr Singh explains.

As the rolling out of the second National Action Plan nears, Dr Sharma says that firm guidelines will be established. “However, implementing the plan’s strategic objectives is a monumental task. The government alone cannot do it. All sectors, including NGOs, must leverage each other’s strengths to make meaningful progress,” she says.

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India, the world’s largest producer of milk, contributing 25% to global production, is facing a serious challenge with antimicrobial resistance (AMR). The widespread use of antibiotics to treat cattle infections in the dairy industry is a major driver of this crisis.

“AMR severely hampers the effective treatment of infectious diseases, leading to higher mortality rates, longer hospital stays, and increased healthcare costs,” says Amit Khurana, director of the Sustainable Food Systems Programme at the Centre for Science and Environment (CSE) in New Delhi.

Milk matters

Over the last decade, India's milk production has grown by about six percent annually, reaching an impressive 231 million metric tonnes (MMT) in 2022-23. The growth highlights the importance of dairy farming to India’s economy, with 18 million dairy farmers spread across 230,000 villages, many of whom are women. The National Dairy Development Board (NDDB) aims to boost productivity so the country accounts for one-third of global milk production by 2030.

However, this achievement comes at a cost. The industry heavily relies on antibiotics to manage cattle diseases such as mastitis, a bacterial infection of the mammary glands prevalent in high-yielding crossbred cows. While crossbreeding has boosted milk production, it has also made cattle more susceptible to disease.

“Cross-breeding with exotic breeds was introduced to India mainly to enhance production of milk. This led to the loss of local breeds which have resistance to many diseases. High incidence of diseases in cross-bred animals and the indiscriminate use of antibiotics in dairy animals caused high antibiotic residues in animal products like milk and meat,” states a chapter in the book, Medicinal Agroecology.

Mastitis not only threatens public health but also imposes heavy financial burdens on dairy farmers. While mastitis prevalence was below 30% in the 1960s, it now exceeds 60%. A report by the National Dairy Research Institute estimated that in 2012, mastitis caused annual economic losses of Rs 71,655 million, increasing farmers’ reliance on antibiotics as a quick fix.

Studies have found a positive link between this rise in demand for mild, a high yield and mastitis.

“Antibiotics are also eliminated in the milk till seven days post-treatment. However, there is an absence of compliance to milk withdrawal periods following antibiotic administration, which leads to antibiotic residues in milk. Hence, improper use of antibiotic therapy in milch animals poses a threat to the public, especially if milk is consumed unpasteurized,” the study states.

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Antibiotics overload

By 2030, the livestock industry is expected to account for 70% of global antimicrobial use. In India, antibiotic use in animal husbandry is predicted to double by the same period. India ranks fourth globally in antibiotic usage in livestock, but enforcement of regulations on antibiotic use in both human and animal medicine remains weak.

Researchers from CSE have pointed towards an inadequate focus on testing for antibiotic residues in the milk collected by some state milk federations, which process it and sell packaged milk and dairy products under popular brands.

“Farmers often sell milk while the animal is under treatment, which increases the chances of antibiotic residues in the milk,” says Amit Khurana of CSE. “While milk sold directly to consumers is not tested, contrary to what one would expect, processed milk sold in packets is also largely unchecked for antibiotic residues.”

The Food Safety and Standards Authority of India’s (FSSAI) 2018 milk quality survey found antibiotic residues in packed milk samples, revealing gaps in testing and regulation.  

While milk sold directly to consumers is not tested, contrary to what one would expect, processed milk sold in packets is also largely unchecked for antibiotic residues.

Despite efforts, several challenges sustain antibiotic misuse in India’s dairy farming. Weak regulations and limited enforcement allow over-the-counter sales of antibiotics, often without veterinary prescriptions. Inadequate veterinary services leave farmers to self-administer antibiotics, often incorrectly.

The implications of antibiotic misuse in dairy farming extend beyond cattle. Residues in milk and dairy products can introduce resistant bacteria into the human food chain through consumption of milk or dairy products, posing serious health risks to the public. Pathogens such as Staphylococcus aureus and Escherichia coli, common in mastitis cases, are among the resistant strains that threaten public health.

Also read: What’s lurking in your chicken dinner?

No quick fixes

Dr Nabanita Medhi, a microbiologist at Arya Hospital in Guwahati, highlights the gravity of the situation. “The number of pan and multi-drug resistance cases we encounter regularly is astounding. A matter of concern is that no new antibiotics are currently being developed globally. When patients develop resistance to the existing drugs, doctors are left with very few alternative treatment options.”

To combat AMR, experts advocate for systemic changes in the dairy industry, including the adoption of herbal remedies. Katrien van ’t Hooft, a Dutch veterinarian and livestock development expert, and founder of the Dutch Farm Experience and Natural Livestock Farming Foundation, has worked extensively with Indian dairy farmers to promote the potential of ethno-veterinary practices (EVP). These traditional, culturally-rooted methods leverage local knowledge to manage animal health and treat livestock diseases. For example, a formulation combining Aloe vera, turmeric and calcium hydroxide has proven effective against mastitis.

“Revitalise traditional knowledge on herbal medicine, train veterinarians and farmers, and develop scientific substantiation on remedies and practices concerning herbal medicine in dairy farming, gradually replacing antibiotics and other agro-chemicals with herbal products,” Katrien suggests in a co-authored study.

The fight against antimicrobial resistance in dairy farms is not solely the responsibility of farmers but requires a collaborative effort across various stakeholders.

“EVP can go a long way in replacing antibiotics in this sector and reducing antibiotic resistance. But most importantly, it is a low-cost, farmer-friendly option. It can be a game-changer in how diseases are managed without toxic chemicals in the dairy sector,” says CSE director general Sunita Narain.

To tackle AMR, experts recommend a multi-pronged approach. Strengthening farm biosecurity–by isolating sick animals, ensuring clean feeding systems, and maintaining hygiene during milking–can reduce infections and the need for antibiotics.

"The positive impact of ethno-veterinary medicine as an alternative to antimicrobial and chemical veterinary drugs is often overlooked. These remedies are primarily preventive and also curative. We have been able to reduce the incidence of mastitis by over 83% and other infectious diseases significantly. With over 1 million treated cases and an 80% cure rate, the results are undeniable. Of course, the problem is vast, but we need to take positive action" says Dr M N Balakrishnan Nair, Emeritus Professor, University of Transdisciplinary Health science and Technology, Ethnoveterinary science and practice group, Bengaluru.

Educating farmers about alternatives like vaccination and probiotics, along with the importance of veterinary-supervised antibiotic use, is crucial.

“India will need a roadmap to scale up preventive approaches related to animal housing, antibiotic alternatives, vaccines, biosecurity and resilient breeds that help reduce the occurrence of disease in food-animal farms and the need for antibiotics at its first place,” says Rajeshwari Sinha, programme manager, sustainable food systems.

“It also needs a long-term approach to reduce dependence on intensive industrial systems and promote local, decentralised food systems supported by backyard farming,” she adds.

Despite challenges, the country has made progress. In October 2024, FSSAI banned certain antibiotics in food animal production, following an earlier ban on colistin—a critically important antibiotic for human medicine. Under the Muscat Manifesto (2022), India has committed to reducing antimicrobial use in the agri-food sector by 30-50% by 2030.

(Photo credit: https://www.flickr.com/photos/cgiarclimate)

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In 2019, the World Health Organization (WHO) estimated that bacterial antimicrobial resistance (AMR) directly caused 1.27 million deaths and contributed to a total of 4.95 million. Experts across health organisations, medicine, and academia agree that the overuse and misuse of antimicrobials in humans, animals, and plants are the main drivers behind the rise of drug-resistant pathogens.
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In response to this growing threat, Andhra Pradesh became the fourth state in India to introduce its own State Action Plan on AMR in June 2022. The plan, titled the Andhra Pradesh Action Plan for the Containment of Antimicrobial Resistance, outlined various strategies to tackle AMR.

One key initiative was the adoption of a culture-free diagnostic tool powered by artificial intelligence (AI) and machine learning (ML). The tool, called AMRx®, was developed in collaboration with SCIINV Biosciences Private Limited and the Sathya Sai Institute of Higher Learning in Puttaparthi. It aims to help doctors predict bacterial infections and prescribe antibiotics more accurately, promoting the rational use of these medicines. 

The tool is being integrated into Andhra Pradesh's government healthcare system, Dr Care, for use in public hospitals (APAP CAR report 2022, p. 53) “Integrating both these softwares takes time. We are doing multiple tests on compatibility,” said Dr Ratnakar Palakodeti, co-founder and director of SCIINV Biosciences Private Limited.

How AMRx® works

Normally, a patient tells the doctor their symptoms, and the doctor decides whether a culture test is needed. If they go ahead with the test, it identifies the cause and checks for antibiotic resistance. The doctor then prescribes the appropriate medication, but this process usually takes over 24 hours. To avoid delays, the doctor often starts the patient on antibiotics based on an educated guess, without waiting for the test results.

AMRx® changes all of that. It supports the doctor’s judgment, boosts their confidence, and often removes the need for a culture test altogether. With AMRx®, the entire process is much quicker and more efficient.

A conventional culture test costs Rs 800, but this machine learning model, trained on over 100 parameters across different demographics, provides rapid insights. It validates the doctor’s judgment, flags resistant antibiotics, and serves as a clinical decision support tool.

 "The patient consults the physician, who uses the app. If the patient had visited earlier, all records are readily available on the application. Otherwise, the physician inputs clinical symptoms–such as the history of antibiotics and current symptoms–into the app. Within two minutes, the app processes the data, even in resource-limited facilities without diagnostic centers, and predicts bacterial infections and antibiotic resistance patterns instantly."

This approach supports physicians’ decisions, reduces reliance on culture tests, and offers cost-effective insights. “A conventional culture test costs Rs 800, but this machine learning model, trained on over 100 parameters across different demographics, provides rapid insights. It validates the doctor’s judgment, flags resistant antibiotics, and serves as a clinical decision support tool,” Dr Palakodeti added.

The tool won the Startup India Grant, the Federation of Asian Biotech Associations’ Best Startup Award, and the Economic Times Award for Industry Healthcare Solution of the Year. 

Antibiotic stewardship

Antibiotic stewardship involves using antibiotics responsibly and only when needed. This includes selecting the right antibiotic, determining the correct dose, prescribing for the appropriate duration, and ensuring antibiotics are used exclusively for bacterial infections. The app has the potential to drastically cut down on antibiotic usage. 

“The tool significantly reduces the diagnostic workload. If the app determines a negative case, antibiotics don’t need to be prescribed, thus avoiding unnecessary treatment. For example, 50 percent of cultures show negative results, yet 16 percent of such patients received empirical antibiotics which were unnecessary—something this tool can help prevent," said Dr BE Pradeep, the head of Antimicrobial Resistance Laboratory at the Satya Sai Institute of Higher Learning and the principal investigator who co-developed and clinically validated the tool.

"Between 2021 and 2023, we studied multiple hospitals across India and evaluated 15 different antibiotics for susceptibility. This tool is critical in controlling the emergence of AMR. It can integrate seamlessly with any hospital's Electronic Medical Information System (EMIS), capture essential data, and support antibiotic stewardship programs with instant updates,” he added

‍Implementation delays‍

Integrating AMRx® with the Dr Care platform, designed to create digital health records for patients visiting government health facilities in Andhra Pradesh, is a mammoth task. “Dr Care and AMRx® operate on different platforms, making integration necessary. Additionally, the data feeding process is time-consuming,”  Dr Palakodeti said. 

The tool's primary users are general physicians, and ensuring their adoption is crucial. In government hospitals, a general physician typically spends less than five minutes with each patient, juggling long hours and a heavy workload. AMRx® is designed to ease this burden, but many doctors may not be familiar with using technology. 

"Some of the doctors are hesitant as they are not familiar with using technology," said Prof Rangineni Jayaprada, a microbiologist at Sri Venkateswara Institute of Medical Sciences (SVIMS) and co-principal investigator on the project. To address this, the team has been running intensive training sessions for two to three months, involving two doctors and two healthcare professionals from each government hospital across 30 medical colleges and hospitals.

The challenge is not just about rolling out a tool; it’s about ensuring it’s used effectively by those who need it most. This is where the project’s true potential lies: it’s not just a step forward for Andhra Pradesh—it’s a model that could scale across India, tackling antimicrobial resistance on a national level. The app’s success hinges on both technological integration and on-the-ground training, making it a critical experiment in how health tech can shift the entire ecosystem of healthcare in India. If it works here, it could change the way we think about tackling AMR everywhere.

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Humanity has been warned. First, by Sir Alexander Fleming, and now, decades later, by the World Health Organization: if Antimicrobial Resistance (AMR) isn’t addressed, it could cause millions of preventable deaths each year.

It’s a scary thought. But do people truly understand the threat?

While researchers understood AMR through lab studies and clinical data, communicating its urgency to the public needed something more powerful. So scientists at Harvard Medical School and Technion-Israel Institute of Technology devised a powerful way to display bacterial evolution in response to antibiotics in a strikingly visual way.

Evolution on display

Famously known as the MEGA-Plate Petri dish experiment, or Microbial Evolution and Growth Arena plate, this study showed how bacteria evolve resistance over time. To capture bacterial mutations as they occurred, researchers designed a large petri dish filled with a nutrient-rich agar medium. At 2-feet long and 4-feet wide, the dish was divided into zones with increasing antibiotic concentrations, from none on the outer edges to extremely high levels at the centre.

E. coli bacteria were introduced to the outer edges, and as they multiplied, they began to spread toward the next zone with a low dose of antibiotics. In each antibiotic zone, some bacteria mutated to develop resistance, allowing them to survive and move inward. As the bacteria approached the highest concentration zones, only the most resistant strains continued to thrive.

The experiment illustrated natural selection in action, as viewers watched bacteria evolve from lower to higher antibiotic zones over two weeks. Time-lapse images captured the bacterial waves as they mutated and advanced inward. 

When bacteria fight back

The MEGA-plate experiment demonstrated how bacterial resistance develops gradually, underscoring the dangers of using low or sub-lethal doses of antibiotics, reinforcing the critical need for appropriate antibiotic use to prevent the rise of superbugs.

As bacteria progressed across the petri dish, even small populations adapted to survive, showing just how difficult it is to contain resistance, highlighting the urgency of developing alternative treatments and improving antibiotic stewardship to avoid a future where even routine infections become untreatable.

World as a petri dish

The MEGA-plate experiment is a powerful analogy for how our world acts as a breeding ground for microbial evolution, and, by extension, antibiotic resistance. Just as bacteria evolved within the controlled petri dish, microbes mutate and adapt in various ecosystems, such as soil, water, and even within our bodies, often at an accelerated pace due to human activity.

Let’s look up close.

Soil, one of the richest microbial habitats, is home to a vast diversity of bacteria and fungi, many of which naturally produce antibiotics. These microbes develop resistance genes as a survival mechanism, spreading them to other bacteria through horizontal gene transfer. Agriculture further accelerates this process by introducing antibiotics in livestock farming, creating an environment where resistant strains thrive.

Waterways face a similar threat. Antibiotic residues and resistant bacteria from sewage, agricultural runoff, and industrial waste enter rivers, lakes and oceans. The water bodies act as conduits, enabling bacteria to transfer genes across diverse species, driving global antibiotic resistance.

Our bodies are not exempt; our gut microbiomes host trillions of microbes, some of which can mutate or acquire resistance genes when exposed to antibiotics. This makes our microbiomes potential incubators for antibiotic resistance, especially with improper or excessive antibiotic use.

All of these encourage the survival of only the most resistant strains, creating superbugs that withstand multiple drugs. Our actions–through antibiotic overuse, improper waste disposal, and agricultural practices–are speeding up microbial evolution and resistance.

Wake-up call

The MEGA-plate experiment is a stark wake-up call, vividly illustrating that AMR is not just a scientific concern but a global threat. The rapid spread of AMR highlights how our world has become a vast breeding ground for resistant microbes. With certain infections already becoming untreatable, AMR poses a serious threat to global health, endangering surgeries, cancer treatments, and routine medical care. The thought of a post-antibiotic era–a future where minor injuries or common infections could be fatal–is daunting.

Combating this looming crisis requires a unified response, advancing antibiotic stewardship, investing in new treatments, and adopting practices that limit the spread of resistant bacteria across healthcare, agriculture, and communities. Acting now is the only way to ensure the future of modern medicine and protect generations to come.

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In West Midnapore, West Bengal, Joymalya Halder manages a one-acre poultry farm, raising 14,000 broiler chickens five times a year. Each flock matures in just 38 to 42 days under tightly controlled conditions. The process involves three rounds of vaccinations and strict temperature regulation to ensure the birds grow optimally.

“Poultry birds are very susceptible to temperature changes. If they catch the flu—signalled by specific noises—an antibiotic is administered to prevent mortality,” said Halder.

But there’s a catch. “While antibiotics reduce mortality, they impact weight gain. Birds don’t eat as much after receiving antibiotics, which leads to losses,” he added.

Halder recalled a particularly challenging episode with a batch of 3,000 birds. “If one bird falls sick, the disease can spread rapidly, affecting the entire flock. Even a small change in the Feed Conversion Ratio (FCR) can cause big losses.”

An ideal FCR, Halder said, is 1.5. This means a bird should weigh 1 kg after consuming 1.5 kg of feed. But fluctuations in market prices can make or break a farmer’s bottom line. “Right now, raising a bird costs Rs 95 per kg. If the market price is between Rs 100 and Rs 110, we’re safe. But if it drops to Rs 88, we incur a loss of Rs 7 per kg. For 14,000 birds, that’s Rs 98,000 gone,” he said.

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Boon or bane?

Since the 1940s, antibiotics have been used as growth promoters (AGPs) in animal farming to meet rising global meat demand. While the Bureau of Indian Standards (BIS) recommends avoiding AGPs in poultry feed, they remain readily available and widely used.

The implications are alarming. A joint study by Toxic Links and World Animal Protection uncovered high levels of antimicrobial resistance genes (ARGs) in poultry farms in Tamil Nadu and Andhra Pradesh. Samples revealed ARGs against 15 critical antibiotics in 11 out of 14 groundwater and poultry litter tests.

PK Patil, principal scientist at the Central Institute of Brackishwater Aquaculture, underscored the problem’s complexity. “The unscientific use of antibiotics accelerates antimicrobial resistance (AMR) in animals. To effectively address AMR, we need to tackle its root causes,” he says.

Patil’s research focuses on how antibiotics degrade in the environment, particularly in soil and water. He has observed a stark contrast between India and Northern Europe. “In Europe, antibiotics persist longer in the environment. But here, high temperatures and intense sunlight speed up their degradation,” he said.

Correct usage involves knowing which antibiotics to use, their dosages, duration, and administration methods. Education on the types, concentrations, and doses of antibiotics is crucial in India.

Still, the risks remain high. Misuse of antibiotics–especially those critical for human health–blurs the line between animal and human medicine. “Some antibiotics are important for humans, while others are meant for animals. It’s crucial not to mix them, as animal-specific antibiotics should not be used in humans and vice versa. However, this distinction is often overlooked, leading to potential misuse,” he added.

Patil also stressed the importance of understanding global and Indian antibiotic usage patterns. He called for a coordinated, national-level programme to establish clear guidelines for antibiotic use and monitor AMR trends continuously.

"Correct usage involves knowing which antibiotics to use, their dosages, duration, and administration methods. Education on the types, concentrations, and doses of antibiotics is crucial in India," he said.

Mapping AMR

A recent study by the Drug Safety Division of the Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN) in Hyderabad has revealed critical insights into antimicrobial resistance (AMR) in poultry. Researchers analysed AMR gene profiles from chicken farms in Kerala and Telangana, uncovering distinct resistance patterns.

Southern Kerala emerged as a hotspot, showing the highest concentration of AMR genes. The study collected chicken faeces samples from farms across Central and Southern India. Genetic material from these samples underwent whole genome sequencing, uncovering significant levels of gram-negative and anaerobic bacteria.

The findings highlighted regional differences. Southern India showed a greater abundance of AMR genes compared to Central India, with E. coli more commonly detected in the southernmost areas. Interestingly, the AMR profiles from these farms resembled patterns seen in poultry farms in the European Union (EU). However, researchers found no evidence of the mcr-1 gene in E. coli—a gene associated with resistance to colistin, a last-resort antibiotic for severe infections.

Also read: How our meat industry is feeding antibiotic resistance

Growing concerns

India is the world’s third-largest egg producer and fourth-largest chicken meat producer, with broiler production concentrated in Tamil Nadu, Andhra Pradesh, Maharashtra, Uttar Pradesh, and Telangana. This scale of production raises concerns about antibiotic residues in poultry products.

When laying hens receive antibiotics, traces of the drugs can build up in their eggs. After administration, antibiotics are absorbed in the chicken’s intestines and travel through the bloodstream to the ovaries and oviducts. Since the ovaries create the egg’s contents, residues are more likely to appear in the yolk and albumen.

Cooking methods such as boiling, steaming, frying, or microwaving can break down some antibiotic residues. However, research shows that boiling affects only certain drugs. This means that even when residues are undetectable, they may still pose health risks, making eggs potentially unsafe to eat.

By 2030, antimicrobial usage in India is expected to exceed the global average by 40%. In 2021 alone, the country administered 2,160 tonnes of antimicrobials to livestock. Vijay Pal Singh, principal technical officer (Veterinary) at CSIR-Institute of Genomics and Integrative Biology, emphasised the need to prioritise human-critical antibiotics.

“These are antibiotics that are considered ‘last-resort’--highly effective and essential for human health. We should ensure these antibiotics are reserved exclusively for human use,” he said.

The PM effect

Shivaji Bhattacharya, a wildlife expert and former deputy director of Animal Resource Development at the Government of West Bengal, noted that antimicrobial resistance would continue to develop even without antibiotic use.

“One cause of AMR is PM2.5, and another is the pharmaceutical industry. Untreated effluents released during antibiotic production pollute air and water, worsening the problem. As the antibiotics industry grows, so does this issue,” he said.

Research conducted across 116 countries between 2000 and 2018 revealed strong links between PM2.5 pollution and antibiotic resistance. These links have strengthened over time. According to The Lancet, PM2.5-related AMR caused an estimated 0.48 million premature deaths in 2018, resulting in 18.2 million years of life lost and an economic impact of USD 395 billion annually.

As the poultry industry continues to grow, striking a balance between productivity and sustainability is crucial. The cost of inaction may prove too high for both farmers and public health.

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