Volume 19 ; Issue 1 ; in Month : 2026 (2026) Article No : 142
Kumari P, Kumar P, Fazal B, et al.

Abstract

Antibiotics have transformed clinical medicine by making previously life-threatening bacterial infections treatable and by enabling complex procedures, transplantation, cancer therapy and intensive care. However, antibiotic exposure is also a major selective pressure for antimicrobial resistance (AMR), particularly when antibiotics are used without a clear bacterial indication, when broad-spectrum agents are chosen unnecessarily, or when dose, route and duration are inappropriate. This narrative review synthesizes the antibiotic-focused content of the undergraduate project “Evaluation of Antibiotic Usage Trends and Rationality in Clinical Practise” with contemporary evidence and stewardship guidance. The review summarizes the principal antibacterial classes—β-lactams, tetracyclines, fluoroquinolones, sulfonamides, macrolides, glycopeptides/lipoglycopeptides and aminoglycosides—with emphasis on mechanisms, clinical roles, safety considerations and resistance mechanisms. It then examines determinants of irrational use, including diagnostic uncertainty, empirical prescribing without microbiological support, self-medication, inappropriate fixed-dose combinations, excessive use of Watch antibiotics, inadequate documentation, patient expectations, limited access to diagnostics and weak antimicrobial stewardship infrastructure. Current evidence supports a structured approach based on syndrome recognition, severity assessment, microbiological sampling where appropriate, local susceptibility data, patient-specific factors, the WHO Access–Watch–Reserve (AWaRe) framework, timely review and de-escalation. India faces a particularly important stewardship challenge because of high antibiotic consumption, substantial community access and heterogeneous regulatory and healthcare environments. Effective stewardship therefore requires coordinated action by prescribers, pharmacists, microbiologists, nurses, administrators, regulators and patients, supported by surveillance, infection prevention, diagnostics and public education. The central message is that rational antibiotic use is not antibiotic restriction: it is the delivery of the right antibiotic, at the right dose, by the right route, for the right duration, only when the expected clinical benefit outweighs the individual and population-level harms.

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