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For decades, antibiotics have been one of the most trusted safeguards, and go-to solution people rely on to treat medical conditions. From routine illnesses to life-threatening conditions, they have quietly acted as a medical shield for millions. Yet today, this very shield is under strain, not because of any shortcoming in the medicines themselves, but because of how they are being used, managed, and ultimately released into the environment, said Yashovardhan Agarwal, MD, Welspun BAPL & director Sintex.
Antibiotics are now being detected in surface waters like rivers, ponds, lakes and oceans worldwide. Most of this originates from daily use, passing through wastewater systems and ultimately into rivers. An interaction between such antibiotic-contaminated water and microbes fosters antimicrobial resistance (AMR). Infections caused by these new strains of microbes are no longer effectively treated with antibiotics. This lengthens treatment times when such microbes infect humans, as standard antimicrobial therapies are ineffective against these AMR microbes, he added.
Global estimates indicate that 8,500 tonnes of antibiotics enter rivers, threatening the aquatic ecosystems and human health. Over 6 million km of river stretch worldwide exceed permissible quality thresholds, with Southeast Asia named as the most impacted region. In India, 315 million are challenged with high environmental risk from antibiotic concentrations. There are around 4.95 million AMR fatalities, of which over 1.27 million were attributable to bacterial AMR. It is estimated that by 2050, 10 million could succumb annually to AMR. Such a risk needs to be tackled in a focused, organised and comprehensive manner, said Agarwal.
Even low, but persistent, antibiotic traces in water can trigger resistance patterns in microbes. The threshold required for this often referred to as the minimum selective concentration (MSC), can create conditions for resistance to develop. However, a silver lining here is that this gap can be bridged with our existing understanding and some initiatives in a concerted manner, Agarwal told Pharmabiz in an email.
There are pre-defined systems in place to track antibiotics use closely in hospitals. However, extending similar discipline to effluents generated from hospitals would help us monitor the level of antibiotics leaving hospitals’ wastewater better. Once we understand these, we can design a better treatment infrastructure.
Wastewater systems were designed for a different set of risks. Enhancing them where antibiotic loads are highest around hospitals and manufacturing clusters is a practical way to contain what would otherwise spread. This becomes particularly relevant in India, where official assessments indicate that over 72% of urban wastewater is either untreated or inadequately treated before discharge, he pointed out.
Water storage and distribution are often treated as infrastructure issues. In reality, they also shape public health outcomes. Intermittent supply and stagnation can allow microbial risks to persist longer than expected. Better circulation, reduced stagnation, and periodic monitoring can address this without significant structural change.
In India, estimates suggest that a significant share of antibiotics is consumed outside formal prescription pathways, increasing the likelihood of improper disposal and environmental entry. There are regulatory procedures in place already; however, these procedures are bypassed, resulting in long-term risks. Now what it requires is connecting parts of the system that have so far operated in silos. For long, the focus has been on how antibiotics are prescribed. Now there is need to monitor post usage, waste disposal and treatment of expired stocks to manage the risks appropriately, said Agarwal.
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