Targeted Action and Financing the Fight Against Antimicrobial Resistance in Asia 2025

CASE STUDY 1 Manipal Hospitals With a group of 33 hospitals spread across 17 cities, Manipal Hospitals (Manipal) is the second-largest hospital chain in India. For the past two decades, Manipal has been accredited by the National Accreditation Board for Hospitals & Healthcare Providers (NABH) of India, which testifies to their effective infection prevention and control programme, including the establishment of an antimicrobial management programme and monitoring of antimicrobial usage across the organization.102 Beyond the NABH requirements, Manipal has set up a closed intensive care unit (ICU) model in several of its hospitals in Tier 1 cities. The closed ICU model ensures proper containment of infection and engages a cross- disciplinary critical care team that synchronizes and streamlines antibiotic prescriptions for individual patients with multiple comorbidities. Additionally, Manipal has implemented its own electronic medical records (EMR) system, which notifies multiple parties including the central infection control officer whenever an antimicrobial is prescribed and guides attending clinicians on antibiotic administration. Such measures help build a robust infection control system within Manipal and in turn prevent clinicians from over-prescribing antimicrobials for fear of hospital-acquired infections. Despite these measures, Manipal is gearing up to address the growing threat of community-acquired infections. This is not just a problem in hospitals, as drug-resistant bacteria are becoming endemic in the population. For instance, in recent years, incidence of community-acquired methicillin-resistant staphylococcus aureus (CA-MRSA) has increased.103 This increase can be attributed to low public awareness of proper antimicrobial usage. Given that most medications are available over the counter (OTC), patients often self-medicate rather than seeking professional advice, leading to errant dosage and consumption. Such improper use of antimicrobials contributes to AMR, making community-acquired infections increasingly difficult to treat. Additionally, according to the chairperson of the infection control committee at Manipal, the threat of multi-drug resistant (MDR) or extensively drug-resistant (XDR) infections is increasing by “leaps and bounds”, with a substantial increase in such pathogens seen in the last two decades. A steady increase in resistant infections threatens hospital systems with ballooning costs of treatment, as multiple expensive antibiotics and infection control measures are required. Manipal is also concerned about the problem of counterfeit drugs in India, where one in four drugs was found to be fake, counterfeit or substandard in a 2022 study.104 The lack of proper treatment continues to exacerbate the threat of AMR and mounts a growing challenge to healthcare providers such as Manipal. Source: Interview and further response from Manipal Hospitals. Strengthen awareness among the general public and community health workers Investing in public awareness campaigns on AMR offers a powerful opportunity to drive behavioural change and reduce misuse of antibiotics in the Asian context (in both humans and animals). Asia’s diverse and densely populated communities are particularly vulnerable to AMR, making it essential to educate individuals on responsible antibiotic use, the risks of OTC access and the importance of preventive healthcare, such as vaccinations and sanitation improvements. Innovative initiatives, such as leveraging digital platforms, using culturally tailored messaging and implementing school-based education programmes, can ensure widespread reach and impact. Public- private partnerships and collaboration with media outlets and local influencers can further amplify these efforts. Targeted investments in awareness not only empower communities but also alleviate pressure on healthcare systems, paving the way for sustainable solutions to the AMR crisis. Addressing self-medication and OTC antibiotic sales through improved knowledge among the public, alongside investments to strengthen health systems, is key to tackling AMR. Tailored, context- specific strategies that consider local socio-cultural determinants of antibiotic use will maximize the impact of these efforts.105 Targeted Action and Financing the Fight Against Antimicrobial Resistance in Asia 24