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Antimicrobial Resistance (AMR), a growing global public health threat, is severely affecting the management of infectious diseases. Microorganisms are increasingly developing the ability to resist the killing effects of antimicrobials (AMs), rendering these drugs less effective or even completely useless in fighting the microbes. This alarming trend is once again substantiated by recent findings from the National AMR Surveillance by the Institute of Epidemiology, Disease Control and Research (IEDCR).
The scale and severity of this threat were laid bare in the latest surveillance data of the IEDCR. Covering 96,477 patients between July 2024 and June 2025, the IEDCR found that nearly four in every ten patients admitted to intensive care units (ICUs) are not responding to available antibiotics, largely due to overuse and misuse.
Even more concerning is the revelation that multidrug-resistant pathogens among ICU patients have reached a staggering level of 89 per cent, highlighting serious shortcomings and a clear lack of prioritisation in the current public health response. Small wonder that any extrapolation of these data to the national level, covering millions of patients, would paint an even grimmer picture.
Irrational and inappropriate use of antimicrobials, causing AMR, is a well understood natural consequence. A close relationship has been documented between the excessive and unnecessary use of antimicrobials and the development of drug resistance. The emergence and spread of AMR are complex phenomena due to improper knowledge of AMs usage and inadequate interactions between the prescribers and the patients, along with lack of adequate attention of the regulatory bodies and the policymakers. Noncompliance with recommended dose of AM is another major problem. Easy availability without prescription also leads many patients to self-prescribe antibiotics, contributing to the mictobes' drug resistance ability .
Besides, sporadic use of antibiotics in poultry, fisheries and agriculture introduces resistant bacteria into the food chain, ultimately harming consumers. A recent study revealed that more than 90 per cent of poultry farms in the country use antibiotics indiscriminately. In addition, samples of nearly two-thirds of fish and chicken meat contain bacteria associated with antibiotic-resistant infections.
The WHO and other international bodies rightly addressed AMR as the biggest threat to the management of infectious diseases. Each year, World Antimicrobial Awareness Week (WAAW) is observed during 18-24 November, aiming to raise global awareness of antimicrobial resistance and promote best practices to reduce its spread.
The WHO has also issued several key guidelines to support countries in tackling AMR, including its Global Action Plan on Antimicrobial Resistance, which outlines strategic priorities such as improving awareness, strengthening surveillance, reducing infection rates, optimising antimicrobial use and investing in new medicines, diagnostics and vaccines.
Besides, there is a need to promote the appropriate and cost-effective use of antimicrobials, prohibit their sale without a qualified health professional's prescription and improving infection-prevention practices to curb the spread of resistant pathogens. It is also essential to regulate the manufacturing, sale and distribution of counterfeit antimicrobials, eliminate their circulation in informal markets and significantly reduce the use of antimicrobials in food-animal production.
The WHO recommends the development of a national antibiotic policy and the formation of a multisectoral national alliance against AMR to ensure a coordinated approach to regulating the use of antimicrobial agents. These measures are designed to promote behavioural change among prescribers and communities, encourage the rational use of antimicrobials, build capacities for efficient surveillance, strengthen diagnostic systems for microbial diseases and reinforce infection-prevention and control programmes. The recommendations further emphasise the need for a strong national governance mechanism, robust surveillance systems, a functional AMR reference laboratory, the integration of AMR topics into education and training curricula, improved hygiene practices and strengthened regulatory systems to guarantee access to quality antibiotics.
Public health experts at a recent seminar marking World Antimicrobial Awareness Week 2025 highlighted the scale of the crisis and the need for unified efforts to curb antibiotic misuse. One of the most concerning issues highlighted in the seminar was the persistent weakness of AMR surveillance, marked by limited environmental data and inconsistent laboratory reporting. Participants stressed the need for low-cost antimicrobial stewardship interventions and joint hospital teams comprising clinicians and microbiologists. Strengthening the link between those who treat patients and those who analyse laboratory samples is essential for developing effective protocols and improving reporting quality. Without reliable laboratory systems, the national AMR response remains fundamentally compromised.
Challenges in implementing the National Action Plan on AMR were also brought to the fore. Insufficient laboratory capacity and low motivation among stakeholders continue to impede progress. Experts emphasised the need for sustainable financing, private-sector engagement and stronger regulatory enforcement against unauthorised antibiotic sales.
Overall, experts say combating antimicrobial resistance requires more than policy documents and technical guidance. It demands coordinated efforts, strong regulatory enforcement, sustained investment and meaningful public engagement. Without a whole-of-society approach, antibiotic misuse will persist, laboratory systems will remain fragile and resistant pathogens will continue to spread.
It is time to elevate AMR containment to a national priority supported by robust surveillance, strict regulation, empowered frontline workers and active community participation. This requires establishing a comprehensive laboratory-based surveillance system covering humans, birds, fisheries and animals; prohibiting the sale of antimicrobial agents without the prescription of an authorised professional; and enforcing laws and regulations governing the production, quality control and marketing of these medicines. These measures are expected to strengthen national capacity to combat AMR and build a more resilient health system.