Beyond the Hospital: The Critical Role of Primary Healthcare in Combating Antimicrobial Resistance (AMR)—A Narrative Review

Abstract

Antimicrobial resistance (AMR) poses a growing threat to public health, particularly in low- and middle-income countries such as India. This narrative review was conducted using literature extracted from “PubMed,” “Google Scholar,” and reports from the “World Health Organization” and “National Centre for Disease Control” published between 2010 and 2025. Relevant studies, reviews, and policy documents on AMR in primary healthcare (PHC) serves as the first point of contact for the majority of patients and plays a crucial role in influencing antibiotic use. Inappropriate prescribing practices, empirical treatment without diagnostic support, and patient pressure contribute significantly to the misuse of antibiotics in PHC settings. Over-the-counter availability of antibiotics, unregulated use by non-allopathic practitioners, and reliance on syndromic management further exacerbate the problem. In addition, widespread use of antibiotics in the agricultural sector contributes to environmental transmission of resistant pathogens. The consequences of AMR include increased morbidity, prolonged hospital stays, higher healthcare costs, and rising mortality. Addressing AMR in primary care requires a comprehensive approach including capacity building of healthcare providers, promotion of rational prescribing based on standard treatment guidelines, improved access to rapid diagnostic tools, and strict enforcement of regulations related to antibiotic dispensing. Strengthening surveillance systems and integrating AMR modules in medical education are also essential. India’s policy response, starting from the National Policy on Containment of AMR (2011) to the National Action Plan (2017–2022), reflects the growing recognition of the problem; however, implementation has largely focused on tertiary care facilities. Integrating AMR containment strategies within PHC is critical to ensuring early intervention, reducing the burden of resistant infections, and preserving the efficacy of existing antimicrobials. A coordinated effort involving healthcare providers, policymakers, and communities is necessary to effectively address AMR at the primary care level.