The latest global study in The Lancet Public Health has again highlighted what infectious disease experts in India have known for years: India uses too many broad-spectrum “watch” antibiotics and too few first-line “access” antibiotics. It estimates that India’s antibiotic consumption is higher than the optimal target and that the antibiotic mix is skewed towards drugs that should ideally be reserved for more serious infections.

The tendency to overuse broad-spectrum antibiotics has been documented repeatedly over the past two decades through surveillance studies, hospital audits and national antimicrobial resistance (AMR) programmes. The more important question is why physicians continue to prescribe them.

The answer lies less in irrationality than in the realities of clinical practice. Doctors frequently prescribe antibiotics before a definitive diagnosis is available because patients often present late. Diagnostic facilities are limited or unreliable, and treatment decisions cannot always wait. Similarly, inadequate infection prevention and control in healthcare facilities increases the........

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