District hospitals in MP: No microbiology labs, no experts (Photo source: Patrika)

Not a single district hospital in Madhya Pradesh has a trained MD microbiologist on staff, according to a study by the Quality Assurance Unit of the National Health Mission (NHM), Madhya Pradesh. Only two districts have makeshift microbiology labs, and even there, testing is being carried out by MD pathologists or MSc microbiology graduates rather than qualified microbiologists.

As a result, doctors across the state are prescribing antibiotics based purely on clinical experience and observed symptoms, rather than laboratory-confirmed diagnosis. This has led to widespread and often unnecessary use of "reserve" and "last resort" category antibiotics, significantly accelerating antimicrobial resistance (AMR) among patients.

Report sat unaddressed for three years

Under standard antibiotic protocols, patients with suspected infections are meant to undergo a culture test at a microbiology lab, allowing an MD microbiologist to identify the specific bacterial infection and its severity before an antibiotic is prescribed. However, with hospitals lacking culture-testing facilities, doctors have been dosing patients with antibiotics based on symptoms alone. NHM has reportedly been aware of the gap for three years, but no corrective action has been taken so far.

What the survey found

The NHM Quality Assurance Unit surveyed 864 patients across eight private and two government district hospitals. Overall antibiotic usage was found to be alarmingly high, at 78.9%.

Most antibiotics were prescribed on the basis of clinical experience, as the bacterial culture confirmation rate stood at just 21.9% — meaning many of the antibiotics administered were not actually necessary.
Of the antibiotics prescribed, 53.1% fell under the WHO's "Watch" category — broad-spectrum drugs that carry a higher risk of driving antimicrobial resistance — while 5.5% belonged to the "Reserve" category.
Watch category drugs are meant to be recommended only as a first or second option for specific, limited conditions, precisely to preserve their effectiveness.
Reserve category antibiotics are intended strictly as a last-resort treatment, but this was not being followed in practice at the surveyed hospitals.

The state's Action Plan on Antimicrobial Resistance 2.0 now includes a provision to set up microbiology labs in every district, though no timeline has yet been confirmed for their establishment.