Abstract: Antimicrobial resistance (AMR), also known as drug resistance, occurs when microorganisms such as bacteria, viruses, fungi, and parasites evolve in ways that render the medications used to cure the infections they cause ineffective [1]. When the microorganisms become resistant to most antimicrobials, they are often referred to as “superbugs” [1]. AMR is a major public health concern because a resistant infection may kill, can spread to others, and imposes a huge cost on individuals and society [1]. Therefore, this policy brief presents a situational analysis of AMR and advocates for a multi-disciplinary approach to control AMR in India. The most recent and relevant publications on AMR in India were reviewed and analyzed to recommend a comprehensive health policy framework. The study recommends an innovative health policy framework for avoiding emergence, supporting research and development (R&D) for new drugs, and encouraging multi-sectoral coordination. Further amendments to the existing health policy with a targeted approach to prevent the growing epidemic of AMR are required. Failure to do so may cause irreversible damage with high morbidity, mortality, and disability in India.IntroductionThe antibiotics have represented a great revolution for humankind, the development after the World War II of a magic bullet (the antibiotic molecule), as imagined by Paul Erlich, the pioneer of chemotherapy, with the property to kill or inhibit the growth of microorganisms by hitting the microbial structures with low toxicity for host cells and tissues, has determined a new era in the treatment and prophylaxis of infectious disease and in the quality of human life [2].The antibiotic era revolutionized the treatment of infectious diseases worldwide [3]. Antimicrobial usage has brought remarkable improvements in human life. Administering antimicrobial right from birth (especially for pre-term and low birth weight neonates) has increased life expectancy at birth, it has greatly reduced death rates due to communicable diseases [3], injuries and most importantly reduced incidences of fatal diseases like cholera, diphtheria, pneumonia, typhoid fever, plaque, tuberculosis, typhus, syphilis, etc. to an extent of complete eradication [3], [4]. However irrational use of antimicrobial has introduced new forms of public health challenges [1], [5] – resistance to ages long invented antimicrobial by evolving microbes; where microbes do not respond to antibiotic dosage and continues to threaten human life [1], [5]. Practices like over prescription of Antimicrobial, lack of counselling before prescribing them, and improper dosage taken by patients thanks to temporary relief are making situation worse than before [6]. Besides, fear of frequent epidemics of veterinary diseases like bird flu; as a result, on large scale Antimicrobial are administered to chickens in large poultry houses [7]. Similar situation does exist in pig farms, where irrational use of Antimicrobial indirectly releases resistant microbes into food chain [7], [8]. There is need to regulate – private partners, drug distribution systems of chemists, and provide capacity building to employees in poultry and pig farms to use Antimicrobial as per need and that only if prescribed by veterinary doctor. Antimicrobial Resistance is a Global ThreatAdvancement in contemporary medicine and surgery could not be possible without use of anti-microbial drugs [5]. They have remarkably reduced the number of cases with infections and have made it possible to introduction of complex medical interventions [9]. Replacing damaged body parts or organs, advanced surgery and care of premature or low birth weights children are some of the procedures endangered by increasing spread of resistant organisms [9]. Antimicrobial resistance (AMR) is a natural phenomenon, which due to irrational use has been accelerated in last few decades [10]. Figure 1 presents the key facts about anti-microbial resistance. Irrational use includes unnecessarily prescribing antimicrobials in low dosage than required, it also includes use of antimicrobials in unhygienic hospital settings [11]–[13]. High use of antimicrobial in the animals used for food consumption such as in poultry and pig farms is supportive for growing AMR, as it has been a global practice to introduce antimicrobials on large scale to livestock [12]. By 2030, world-wide it is estimated that the consumption of antimicrobials in the livestock sector is increase by 66.7 per cent [14]. International transportation and trading have accelerated the spread of resistant micro-organisms [11], [13], [15]. Besides, research and development of new generations of antimicrobial drugs has almost stopped [5], [16]–[18].Health and Economic BurdenAntimicrobial resistance (AMR) augment the health problems as well as brings huge economic loss in the form of significant reduction in productive days of work by employee who are severely ill [5]. The most common resistant microbes found across India are presented in Table 1. These microbes with higher resistance rate are responsible for high morbidity and mortality due to severe infections. Further, patients infected with resistant microbes are more likely to receive therapies that are inadequate or receive the appropriate therapies in low dosages than recommended [10]. With this risk of spreading that infection increases to other organs and to entire body as well [10]. Patients infected with resistant microbes are more likely to die than those who are infected with regular microbes. Patients infected with resistant microbes. World-wide, Antimicrobial resistance (AMR) causes around 700,000 deaths annually [5], [9], [10], [19], [20]. If such pace remains there, then resistance rates increase by 40% as a result 9.5 million deaths will be there annually [19], [20].AMR increases the cost of healthcare. Patients infected by resistant microbes needs advanced and costly care and are more probably to get admitted to a for serious health consequences [19], [20]. Aggressive antimicrobial therapies and additional laboratory tests adds extra expenditure is due excessive cost on nursing and medical care cost, as well as many other things [15], [20]. As first line drugs do not work even for common ailment, physicians need to prescribe costly second or third-line of antimicrobial drugs [10]. The situation will become worse if current picture of increase in antimicrobial resistance (AMR) remains same.Antimicrobial resistance (AMR) cost more to society. as with more drugs are required to administer with higher cost than usual first line drugs, this will collectively increase the cost of entire healthcare [20]. Increase in cost is directly associated to treatment failure, ill-health and also it results in loss of income due to death and disability [20]–[22]. Indirect cost on seeking health care adds more to the loss in productivity as patient may remain in hospital for longer period which keep him or her away from work [23]. If no effective strategies are put in place, it may result in deaths and disability among citizens in productive age group. This will adversely affect the total GDP.Responding to the Rise of AMRAntimicrobial resistance (AMR) is a major public health concern for India where the burden of infectious diseases is high and consumption of antibiotics is huge and un-regulated [24]. In this regard there is need to devise interventions focused to tackle excessive or irrational use of antimicrobials and limits transmission of resistant microbes into humans, as well as R & D, are needed to control the health as well as economic burden caused by Antimicrobial resistance (AMR). This policy brief recommends the following strategies to prevent consequences of AMR in India:Avoiding emergenceAvoiding spreadEncouraging R & DInnovative policieMulti-disciplinary approachRestricting OTC