In a first, K'taka develops action plan for antimicrobial resistance

Karnataka is developing its own State Action Plan on antimicrobial resistance (AMR), a first and a long-pending initiative. 

The five-year plan, which awaits cabinet approval, is designed as a living document that can adapt to changing needs. 

The state has opted for a model anchored in the One Health framework - integrating human, animal and environmental health. The government appointed an expert adviser to lead the efforts through an evidence-based study. 

“Karnataka’s resistance patterns, antibiotic usage trends and local pathogens differ from other states. Without a context-specific strategy, we risk fighting AMR with a one-size-fits-all approach that simply won’t work,” said Prof Swetavalli Raghavan, Adviser on AMR to Karnataka, Professor of Practice at St Joseph’s University, and the primary author of the plan. 

“The proposed plan is built on five foundational pillars - regulate, monitor, educate, prevent and lead - aligned with WHO and national AMR goals, and backed by real field evidence and hyper-local strategies tailored to Karnataka’s socio-ecological landscape,” she told DH. 

Over the past year, she has visited 11 districts and interviewed over 400 stakeholders across the pharmaceutical industry and supply chain, healthcare facilities, farms and veterinary networks, the community and the government. 

“Our study shows rampant misuse in fisheries and animal husbandry and over the counter sales of antibiotics exceeding 75% of all antibiotics sales,” she said. 

The plan proposes a statewide surveillance grid connecting public health laboratories with veterinary, aquaculture and environmental laboratories, having early warning alerts for AMR hotspots and systematic tracking of antimicrobial use in the veterinary sector, thus linking the department of Health with the departments of Animal Husbandry, Fisheries and Agriculture for effective implementation. 

The plan also emphasises public education and awareness campaigns, besides reducing the need for antimicrobial treatment by improving infection prevention and control practices in community settings. 

A stock survey across 10 districts revealed that quality antimicrobial drugs, which are less likely to cause AMR, are inconsistently available, even in urban areas. There is also a wide disparity between public and private supply chains, which could potentially push people towards self-medication and over-the-counter use of broad-spectrum or substandard antibiotics, therefore driving AMR. 

Ensuring equitable, affordable, and rational access to antimicrobial drugs whilst restricting excess use is another goal. 

“My focus is moving from unregulated access to smart access, where every antibiotic that reaches the shelf is the right one, for the right patient, at the right time, and for the right reason.” 

Swetavalli’s study also found that agricultural run-off and industrial effluents are among the biggest unregulated sources of antimicrobial contamination in the environment. 

Given that there are no standardised protocols for the treatment and disposal of unused or expired antibiotics, she suggested ramping up surveillance capacity at the State’s Drug and Food Testing laboratories and setting up at least one such lab in Bengaluru, Mysuru, Belagavi, and Kalaburagi. She also noted establishing collection points for expired or unused antibiotics from farms, veterinary clinics, agri-retailers, and households would work well.