Antibiotic prescribing and resistance beyond hospital surveillance networks in India
Kaur, J.; Madaan, V.; Sharma, R.; Agarwal, Z.; Gudi, N.; Bisen, T.; Gupte, S.; Mutreja, A.; Doegar, N.; Singh, H.; Agarwal, G.; Sethi, T.
Show abstract
Hospital-based surveillance captures important components of antimicrobial resistance in India, but community-facing data linking prescribing and resistance remain limited. To address this, we analysed routinely generated prescription and diagnostic data from Tata 1mg from 2023 to 2025. Among 25.7 million medicines prescribed, 10.8% were antibiotics, with Watch antibiotics exceeding Access antibiotics in every state meeting the inclusion criteria. Among 156,000 diagnostic microbiology samples, urine cultures predominated, with Escherichia coli accounting for 60.6% of culture-positive isolates. In urinary E. coli, resistance was low to the Access antibiotics nitrofurantoin and amikacin (4.9% each), but high to the Watch antibiotics ceftriaxone (53.6%) and ciprofloxacin (57.0%). Exploratory cross-correlation analyses identified lead-lag relationships in which resistance to selected Watch antibiotics preceded changes in resistance to Access antibiotics by approximately 3-6 months. Routine digital healthcare data can therefore support community-facing AMR surveillance by jointly characterising platform-recorded prescribing and susceptibility within the observed care pathway.
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