Presentation (CTI)

OBJECTIVES: Antimicrobial resistance (AMR) poses a major public health threat globally, with disproportionately severe consequences in rural India, where health systems remain constrained by inadequate infrastructure, limited diagnostic capacity, and suboptimal awareness of antimicrobial stewardship principles. Widespread self-medication, over-the-counter antibiotic availability, and low health literacy significantly exacerbate the AMR burden in these settings.
METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Peer-reviewed articles, national reports, and regional health databases published between 2010 and 2025 were searched across major platforms. Eligible studies reporting AMR prevalence, antibiotic-use behaviours, healthcare system constraints, or stewardship initiatives in rural Indian populations were included. Data were synthesised using thematic analysis, and best-practice interventions from comparable low- and middle-income countries (LMICs) were examined to inform method development
RESULTS: Evidence consistently highlights high rates of irrational antibiotic consumption, frequent empirical prescribing without microbiological confirmation, and limited implementation of infection-prevention practices in rural India. Contributing factors include inadequate access to trained healthcare providers, scarcity of rapid diagnostic tools, weak surveillance systems, and sociocultural beliefs that promote inappropriate antibiotic demand. Barriers are further intensified by fragmented policy enforcement and unregulated pharmaceutical sales. Promising mitigation strategies identified include culturally tailored community education programs, the integration of community health workers as frontline antibiotic stewards, the expansion of low-cost point-of-care diagnostics, and the adoption of digital health platforms to support surveillance and treatment adherence. Multifaceted approaches that combine stewardship, public education, and regulatory strengthening have demonstrated the greatest potential for impact.
CONCLUSIONS: Effective AMR mitigation in rural India requires context-adapted, multisectoral strategies anchored in the One Health framework. Strengthening rural diagnostic capacity, enhancing stewardship through community-based health workers, and improving regulatory oversight are crucial for achieving a sustainable impact. Empowering rural communities through targeted education and participatory engagement will be essential to reducing inappropriate antibiotic use and safeguarding long-term health outcomes