Antimicrobial resistance (AMR) is often seen as a problem tied to pharmacies and weak rules. This view misses the picture. Most people in India do not take antibiotics because a pharmacist tells them to. They take them on their own. This article looks at the side of the equation that is rarely discussed. The role of the patient. It argues that Indian law pays attention to what patients do when they self-medicate. With Schedule H1 in place India must rethink how it handles the rights and responsibilities of patients who buy medicines without a doctor’s help.
THE SCALE OF THE PROBLEM
The figures are indeed alarming. In a study that appeared in the journal The Lancet in October 2022, the Global Research on Antimicrobial Resistance (GRAM) reports that 297,000 people have died due to AMR in 2019 itself. That’s 10.42 lakh people who lost their lives with drug-resistant infection as an underlying cause. Another study estimates that 29.90 lakh people in India have died from sepsis either directly or indirectly. Infections that are resistant to antimicrobial treatment are often more difficult to treat, especially when the drug develops resistance to the infection. The Indian Council of Medical Research published a report on AMR which revealed that 87.5 percent of hospitalized patients, across India, had infections caused by bacteria resistant to antibiotics.
THE PATIENT AS THE DECISION MAKER
An Indian with a fever rarely goes to a physician and goes instead to the nearest store and purchases an antibiotic of her choice. According to a survey conducted in South-East Delhi, 36.4 percent of respondents admitted to using antibiotics without a doctor’s knowledge for common conditions such as cold, cough, or fever. The same survey noted that only 5 percent of respondents had any knowledge about antimicrobial resistance. A similar scenario plays out with children, with 19.8 percent of infected children in a nationwide assessment taken without a doctor’s prescription, and reaching up to 30.7 percent in certain regions.
Although the Drugs and Cosmetics Act and the Pharmacy Act provide guidelines concerning the responsibilities of sellers, there are hardly any references to the knowledge expected of buyers. Therefore, if a self-prescribed antibiotic makes an infection resistant to treatment, the responsibility lies with the buyer and not the seller. Thus, any form of self-medication with antibiotics is dangerous to health.
WHAT HAPPENS AT THE PHARMACY COUNTER
When researchers pose as customers and ask for antibiotics they often receive them without a prescription. In Bengaluru 174 out of 261 pharmacies dispensed antibiotics without requesting a prescription. This is 66.7 percent of pharmacies. The situation was worse in Pune. A similar study found that 248 out of 263 pharmacies sold antibiotics without a prescription. A 2025 study done in Coimbatore showed this trend with 76 percent of surveyed pharmacies giving out antibiotics without a prescription.
WHO GUIDELINES ON AMR PAY ATTENTION TO PHARMACY PRACTICES IN INDIA
These findings reveal a gap between what the law says and what actually happens. Although Schedule H1 medicines need prescriptions many pharmacies ignore this rule. The rules governing prescription medicine sales are in Rule 65(9). Rule 65(11) of the Drugs and Cosmetics Rules, 1945 read with Schedules H and H1. These say that a valid prescription from a registered doctor must be shown before selling drugs. Antibiotics listed under Schedule H1 cannot legally be sold just because a customer asks for them.
A pharmacy that sells a Schedule H1 drug without following these rules may be breaking Section 18(c) of the Drugs and Cosmetics Act, 1940. Punishment comes under Section 27(d). There is also a rule under Section 42 of the Pharmacy Act, 1948. It says only registered pharmacists can prepare or give out prescription medicines.
The issue is not that the rules don’t exist. They do. The real challenge is whether they are followed and enforced where it matters at the counter. Many pharmacies bypass the rules and enforcement is weak.
WHY INDIA’S HEALTHCARE GAP MAKES THIS WORSE
India has one doctor for every 1,298 people according to the National Health Statistics Report. That is below the World Health Organization’s recommendation of one doctor per 1,000 people. The difference is even worse when we look at areas. The urban-to-rural ratio of doctors is 3.8 to 1. Rural areas have 40 percent of hospital beds compared to ones. When families cannot reach a doctor, hospitals become the option. Pharmacies come next. This is not a failure of morals. It is a decision made under conditions.
Laws like Schedule H1 do not consider the reality of Indians. Becoming a doctor takes years of training. In regions the nearest medical college might be hundreds of kilometres away. No patient would travel such a distance just to get a prescription. If the laws assumed that every patient could easily see a doctor they would have been written differently. This imbalance is important. Schedule K, Item 5 of the Drugs and Cosmetics Rules 1945 already allows registered medical practitioners to supply medicines directly to their patients in clinics. That recognizes that many people cannot access a doctor and a pharmacist separately. No such recognition exists for pharmacists. In practice a pharmacist is often the only medical professional rural families ever meet.
THE PIECE: HEALTH LITERACY AS A LEGAL TOOL
laws focus on strict punishment. Patients are expected to know not to buy antibiotics without a prescription. If they do the pharmacist will face penalties under the Drugs and Cosmetics Act. Data from the South-East Delhi study shows this approach may not work. 5 Percent of those who self-medicated were aware of antimicrobial resistance. Instead the law could make pharmacists responsible for improving health literacy. For example the law could require warnings on each strip. Written in languages. Explaining the risks of stopping treatment or sharing medicine with others.
RETHINKING WHO IS ACCOUNTABLE
Pharmacies have become doctor offices. The law should treat them as such. Not because inspectors are too busy to manage over eight lakh pharmacies. Because millions of Indians rely on pharmacies like they would on a doctor. Studies show this is not rare. It is a pattern. This pattern reflects issues. Especially the lack of doctors. The answer is not enforcement. It is creating a system around pharmacies. This includes training staff to give advice to people with viral infections that do not need antibiotics. India already has systems like this for women and new mothers. Why not for people with throats?
THE ECONOMIC PRESSURE ON THE PATIENT
One reason people self-medicate children is money. In the South-East Delhi study financial reasons were the cause. Parents simply could not afford antibiotics. A month’s supply of amoxicillin plus a doctor visit may cost much as a family’s daily wage. Also low-income families are pushed to stop medicine soon as a child’s fever goes down. They cannot afford another round. This puts them in danger. Stopping treatment early can lead to bacteria. The government could fix this by subsidizing courses of antibiotics. It could also educate patients on why finishing treatment’s necessary.
A CONSTITUTIONAL ARGUMENT FROM THE DIRECTION
When it comes to AMR the Indian Constitution is rarely helpful in shaping policy. Laws on AMR are usually based on Article 21the right to life and personal liberty. The argument is that AMR harms health and nutrition which affects rights. The government’s ability to act on AMR through laws is limited by the separation of powers. The legislature cannot tell the judiciary how to interpret Article 21. However if the government wanted to push a policy of patients it would be constitutionally required to do. That is because Article 47 of the Constitution requires the State to improve health and raise nutrition levels. It can be argued that protecting health includes not removing threats like AMR but also helping citizens protect themselves.
CONCLUSION
Pharmacies and tough enforcement of the Drugs and Cosmetics Act are steps but they are not enough. The findings on sales in pharmacies are discouraging, but not surprising. Behind every pharmacist is a patient. The patient’s behavior comes from problems, not enough doctors, financial strain and lack of education. Indian law must recognize these realities. It must adjust policies to include these factors. Punishing the target pharmacist is not enough. The government must ensure that anyone buying antibiotics understands the dangers of AMR. It must also reduce barriers to healthcare for the millions who currently have nothing to do. Self-medicate. With three lakh deaths in India each year linked directly to AMR and, over ten lakh more where AMR plays a role these are not concerns.
