Box.

Future directions for India

1. Promoting further research on the drivers of AMR with due importance to components other than antimicrobial use for human health alone

2. Framing of antibiotic stewardship plans for healthcare settings to monitor and ensure judicious use of antimicrobials, including all tiers of healthcare-primary health centres, secondary and tertiary hospitals

3. Strict vigilance and control over sale of antimicrobial agents. Prescription audit to bring down the over the counter (OTC) sale

4. Disciplinary control over the functioning of hospital effluent plants with periodic assessment and reporting of antimicrobial residue in the discharge

5. Regulation of waste water discharges from pharmaceutical companies with regular monitoring of antimicrobial residues in them along with provision of legislative support to punish offenders

6. Framing and implementing rules and regulations for the use of antimicrobial agents in food animals including farmed seafood

7. Improving agricultural practices by ensuring use of environment-friendly manure and fertilizers

8. Educating the masses at the community level regarding AMR and formulating educational bodies/non-governmental organizations for continued dissipation of information.