India’s antibiotic combinations thwart efforts to curb drug resistance, say researchers

Rising sales of antibiotic combinations in India could be undermining global efforts to limit antimicrobial resistance, says a study that found dozens of unapproved and sometimes risky formulations on the market.1

India is the world’s top consumer of antibiotics and a hotbed for drug evading bacteria,23 which are exported globally by travellers. The problem is compounded by widespread use of drug combinations that mix antimicrobials and other medicines—known as fixed dose combinations (FDCs)—because one or more of the ingredients is usually unnecessary. This fuels overuse and thus resistance, needlessly exposing patients to side effects.

“We can’t blame all antimicrobial resistance on India, but they are creating a problem for themselves and everybody else with these fixed dose combinations,” said Kathleen Holloway, a retired World Health Organization staffer based at the University of Sussex, UK, who has studied drug resistance in Asia but was not involved in the new study. “There is absolutely no excuse for having all these things on the market.”

Combination products account for almost half of the drugs on sale in India. …