Some 83 percent of Indian patients carry antibiotic-resistant bacteria before they even enter a hospital. The resistance was not coming from prescription drugs at all.
Published Nov 24, 2025 | 7:00 AM ⚊ Updated Nov 24, 2025 | 7:00 AM
Synopsis: India’s high rates of antibiotic resistance may be driven less by medical misuse and more by daily exposure to antibiotic-contaminated food, water and the environment, a new study has found. Researchers report that 83 percent of Indian patients carry resistant bacteria even before entering hospital, with evidence pointing to routine antibiotic use in vegetables, aquaculture, poultry and dairy as key sources.
The global conversation about the growing threat of antibiotic resistance often largely focuses on prescriptions and patient habits: too many pills, taken too often, for all the wrong reasons.
But researchers investigating why India’s resistance rates tower above those of countries in Europe or the United States have recently uncovered something startling that upends that view.
The resulting study, published in The Lancet eClinicalMedicine, found that many patients who reported taking no antibiotics were still carrying high levels of resistance.
Some 83 percent of Indian patients carry antibiotic-resistant bacteria before they even enter a hospital, it found. The resistance was not coming from prescription drugs at all.
“Resistant bacteria are entering the body through food, milk, agricultural products, through the environment itself,” says Dr D Nageshwar Reddy, chairman of AIG Hospitals and lead author of the study.
This finding emerged after intense debate with international researchers who could not understand how Indians showed extreme resistance without reported antibiotic use. The conclusion pointed to widespread contamination in the environment.
Walk through any agricultural area in India and you will see farmers trying to maximise yields from limited land. Bigger produce means better prices and more income for families working on thin margins. This pressure has led to a practice that on the surface appears ingenious but has disastrous consequences: adding antibiotics to help crops grow larger and resist diseases.
“Another important and surprising thing is that even in our food, to produce bigger cabbage or bigger cauliflower, or even in coconut to produce better coconuts, antibiotics are being used,” Dr Reddy revealed.
The practice extends across vegetable cultivation, from leafy greens to root vegetables and fruits. Farmers apply antibiotics through soil amendments or foliar sprays, believing they are protecting their crops and improving yields.
The antibiotics do not disappear after harvest. They remain in the vegetables you buy, wash, cook and serve. Each meal becomes a low-dose antibiotic exposure, and while individual exposures might seem negligible, they accumulate.
Your body hosts trillions of bacteria in your gut, on your skin and in your mouth and throat. These bacterial populations encounter antibiotics every time you eat treated vegetables. The weakest bacteria die while the strongest survive and multiply.
“In all these areas, agriculture, farming, everything, the government should take very, very strict action. In Western countries, in fact, all these are banned and they take very strict action, but I think we also have to go into this,” Dr Reddy said.
Coastal India has seen explosive growth in aquaculture, with fish and shrimp farming becoming major economic activities. These operations pack thousands of fish or shrimp into relatively small ponds, creating conditions where disease can spread rapidly and wipe out entire stocks.
The solution many farmers have adopted seems logical: add antibiotics to the water to keep the stock healthy.
“In aquaculture a lot of antibiotics are used in the fish ponds and shrimp ponds to get healthier fish and shrimp temporarily. They add antibiotics in the water,” Dr Reddy explained.
When you buy that fish at the market, you are buying flesh that has essentially been marinating in antibiotics throughout its growth. Cooking kills the fish, but it does not eliminate the antibiotic residues or the resistant bacteria the fish carried.
Those bacteria enter your digestive system, and some survive to colonise your gut. Even if most die during digestion, the survivors can transfer their resistance genes to your native gut bacteria through horizontal gene transfer.
“Aquaculture should be very strongly controlled,” Dr Reddy emphasised. The challenge lies in enforcement across thousands of small-scale operations scattered along coastlines and inland water bodies, where monitoring is minimal and economic pressures make antibiotic use attractive despite long-term risks.
Chicken has become one of India’s most affordable protein sources, with prices remaining relatively stable even as other food costs have risen. This affordability did not happen by accident.
It stems from industrial farming practices that use antibiotics to make healthy birds grow faster and survive crowded conditions.
“The misuse of antibiotics is not only among humans. It is widespread in animals, especially in poultry, where antibiotics are used extensively despite regulations,” Dr Reddy noted.
The antibiotics serve dual purposes: they prevent disease in crowded coops where thousands of birds live in close proximity and they act as growth promoters, allowing birds to reach market weight faster with less feed.
Dr Reddy illustrated the pervasiveness of this contamination with a striking example:
“Just imagine a country’s soldier. He is going and fighting for us. An army soldier is fighting, and he gets a wound infection. He goes to a hospital, they give antibiotics, and still we are not able to save him. This is a complete population-level problem. No matter how many precautions you take, even the chicken you cook at home, those chickens also may have antibiotics infused in them,” he said.
Dr Reddy acknowledged that regulation exists on paper but enforcement remains weak. The economic structure of poultry farming, with tight profit margins and intense competition, creates strong incentives to use antibiotics despite the rules.
Perhaps no food carries more emotional weight than milk, particularly in India where dairy consumption is woven into culture and where parents prioritise giving children milk for nutrition.
The image of healthy, wholesome milk faces a disturbing reality: dairy operations use antibiotics extensively and those antibiotics end up in the milk supply.
“I think one is dairy, very important,” Dr Reddy said when discussing priority areas for regulation. “Milk production should also be very strongly controlled.”
Dairy animals receive antibiotics to treat infections like mastitis, to prevent disease in crowded facilities and sometimes to boost milk production. Regulations require withdrawal periods between antibiotic treatment and milking to allow drugs to clear the animal’s system, but these protocols are not always followed, particularly in small-scale operations.
“Children are drinking milk that contains antibiotic residues, which contribute to resistance,” Dr Reddy explained. The impact on children is especially concerning because they are building their microbiomes during crucial developmental years. Early exposure to antibiotics, whether through medicine or food, can alter bacterial populations in ways that affect immunity, digestion and susceptibility to infections throughout life.
The dairy contamination pathway differs from vegetables or meat because milk is often consumed raw or minimally processed in many Indian households. While boiling kills bacteria, it does not eliminate antibiotic residues, meaning children receive regular low-dose antibiotic exposure with every glass of milk.
The food-based antibiotic exposure does not exist in isolation. It compounds with environmental factors to create cascading health crises. Dr Reddy connected pollution directly to resistance outcomes in ways that show how multiple problems intersect.
“Pollution produces chest infections. If these people are already having drug-resistant organisms, the chest infection cannot be treated with normal antibiotics. We have to go very high in antibiotics. Cost increases, response is not there, and right now many of the organisms are only responding to one or two very, very expensive antibiotics,” he explained.
Consider the sequence: a person has been consuming antibiotic-laced vegetables, fish, chicken and milk for years. Their gut harbours resistant bacteria as a result. They live in a city with poor air quality. Pollution triggers a respiratory infection. They go to a doctor who prescribes standard antibiotics for the chest infection. But those antibiotics do not work because the bacteria in their respiratory system have already learned resistance from environmental food exposure. The infection worsens, requiring hospitalisation, stronger antibiotics and far higher costs.
“Suppose there’s a water infection and you get diarrhoea. These people again can’t be treated because they already have resistant organisms,” Dr Reddy continued. Water contamination, another environmental factor, creates the same compounding effect. Polluted water causes infection in someone already carrying resistant bacteria from food and treatment fails.
The stark differences in resistance rates between countries reflect regulatory approaches to food and agriculture. The Netherlands, with just 10.8 percent of patients carrying resistant bacteria, provides a working model of comprehensive control.
“What we can see is that the incidence of resistant bacteria depends on how developed the country is. The lowest incidence is in the Netherlands, that means they are the most developed in terms of hygiene, public health, poultry regulation and agriculture. They are very, very strict,” Dr Reddy observed.
In the Netherlands, using antibiotics as growth promoters in livestock is banned. Applying antibiotics to crops is prohibited. Dairy operations face regular testing for antibiotic residues with heavy penalties for violations. Aquaculture operations cannot use antibiotics in water. These are not aspirational guidelines; they are enforced regulations with inspection systems and consequences.
“The second best is the United States because they also have strong regulations. Third comes Italy, because Italy has fewer regulations. And the worst is India, because we have the least regulations,” Dr Reddy said. The correlation is mathematically clear: more regulation equals less resistance.
Interestingly, Dr Reddy noted that even African countries show less resistance than India, not because of superior regulations but because antibiotics simply are not as available for misuse. “What is shocking is that even Africa has less resistance than us. The reason, of course, is that antibiotics are not easily available there, so they haven’t been misused as much.”
India occupies the worst position: high availability of antibiotics for use in food production, combined with minimal regulation and weak enforcement. The result is environmental saturation with antibiotics and resistant bacteria.
