Combating Antimicrobial Resistance in India—Reply

In Reply: Dr Sehgal's description of the situation in India echoes remarkably similar complaints about antibiotic misuse and overuse in the United States and other industrialized countries. More than a decade ago, a task force of the US National Institutes of Health Study on Antibiotic Use and Antibiotic Resistance Worldwide attempted to evaluate the social, behavioral, and practical factors affecting antibiotic use in different countries.¹ This report concluded that the problem in developing countries, which purchased only about 20% of the worldwide antibiotic supply in 1988, was more often one of antibiotic underuse and incorrect usage, in contrast to the overuse in industrialized nations. In developing nations, the greater burden of bacterial infectious diseases and the use of inappropriate treatment courses, often with antibiotics of poor quality and potency—in India, for example, more than 80 different brands of ciprofloxacin are produced locally²favor the emergence of resistant bacteria, whose spread is enhanced by crowding and poor sanitary conditions.³