Antibiotic Resistance: Is the Western emphasis on stewardship misplaced?

“Antimicrobial Resistance is a complex challenge, with dozens of highly dynamic and intricate determinants. The dominant narrative holds that excessive antibiotic usage fuels high resistance rates. Unfortunately, the association between antibiotic usage and AMR rate is much more complex and nonlinear. Per capita, antibiotic use in India is far lower than the United States and many European countries. Then how can India have a far higher AMR rate than these countries? Isn’t it the disparity in antibiotic use between various countries the most important determinant in the difference in resistance?

There are plenty of publications analysing the relative contribution of various determinants to the overall global AMR burden. A recent publication underscores the concept that at a global level antibiotic consumption was poorly correlated with antimicrobial resistance, though the correlation was strong in developed countries. In developing countries, the high AMR level could be attributed to the dissemination of resistant bacteria due to the poor sanitation scenario, than the volume of antibiotic usage.