India has emerged as the world's largest consumer of antibiotics with a 62% increase in popping habits over the last decade.

As the world braces for its worst ever threat in the last century - global antibiotic resistance due to unnecessary and unregulated popping of antibiotics, an average Indian has been found to be popping over 11 antibiotic pills a year.

India's antibiotic use went up from 8 billion units in 2001 to 12.9 billion units in 2010.

The study "Global Trends in Antibiotic Consumption, 2000-2010," by scientists from Princeton University has found that worldwide antibiotic use has risen a staggering 36% over those 10 years, with five countries — Brazil, Russia, India, China and South Africa (BRICS) — responsible for more than three-quarters of that surge.

Among the 16 groups of antibiotics studied, cephalosporins, broad-spectrum penicillins and fluoroquinolones accounted for more than half of that increase, with consumption rising 55% from 2000 to 2010.

The study quantifies the growing alarm surrounding antibiotic-resistant pathogens and a loss of efficacy among antibiotics used to combat the most common illnesses.

The study has also confirmed an increasing resistance to carbapenems and polymixins, two classes of drugs long considered the last resort antibiotics for illnesses without any other known treatment.

Speaking to TOI, one of the authors Ramanan Laxminarayan said "Indians consume around 11 antibiotic tablets per year. That's five days of antibiotics for every person in the country which is much lesser than the Chinese or Brazilians. An average Chinese popped 7 antibiotic pills a year. However both India and China's numbers are lesser than the Americans who on average pop 22 antibiotic pills a year. The paper confirms that global use of antibiotics is surging and specially in India".

"This is both good news and bad news. It means that more Indians are able to access antibiotics, which are particularly important for those who previously died of easily treatable infections. However, the massive increase in use, both appropriate and inappropriate, is leading to increases in drug resistance. Antibiotic use is the single most important reason for resistance. Also use of last resort drugs like carbapenems has gone up significantly in India, and it is difficult to justify why such powerful antibiotics are being use so much more frequently".

Laxminarayan added "We have to remember that before we had antibiotics, it was pretty easy to die of a bacterial infection. And we're choosing to go back into a world where you won't necessarily get better from a bacterial infection. It's not happening at a mass scale, but we're starting to see the beginning of when the antibiotics are not working as well".

"This paper breaks new ground with the comparative antibiotic consumption data by country of the first decade of the 21st century," said Professor Dame Sally Davies, chief medical officer for England and chief scientific adviser for the Department of Health, London. "There is a direct relationship between consumption and development of antibiotic resistance, so the data is key for us all developing a 'National Action Plans Against Antimicrobial Resistance' as set out in the World Health Assembly Resolution in May".

The study noted that antibiotic use tended to peak at different times of the year, corresponding in almost every case with the onset of the flu season.

In the northern hemisphere, for example, consumption peaked between January and March, while in the southern hemisphere it peaked between July and November. One notable exception was India, for which usage peaked between July and September, correlating with the end of the monsoon season.

The scientists said that programs promoting rational use of antibiotics should be a national and global priority. That process has to begin with the BRICS countries, which are experiencing the highest rates of increase in antibiotic consumption.

Dr Arjun Srinivasan, associate director at Centres for Disease Control and Prevention in Atlanta recently said humans and livestock have been overmedicated to the point that bacteria have grown so resistant to antibiotics that we are now in "the post-antibiotic era". He has added "There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can't".

British prime minister David Cameron recently jumped into the global fight against superbugs and has warned that the world could be "cast back into the dark ages of medicine" where people die from treatable infections because deadly bacteria are becoming resistant to antibiotics.

Cameron has now announced an independent review led by world renowned economist Jim O'Neill to identify why the international market has failed to bring forward new antibiotics.

The PM called for governments and drug companies around the world to work together to accelerate the discovery of a new generation of antibiotics.

The review will set out a plan for encouraging and accelerating the discovery and development of new generations of antibiotics, and will examine: the development, use and regulatory environment of antimicrobials, especially antibiotics, and explore how to make investment in new antibiotics more attractive to pharmaceutical companies and other funding bodies.

About 25,000 people die annually across Europe because of infections that are resistant to antibiotic drugs, Cameron said.

"Growing numbers of bacterial and viral infections are resistant to antimicrobial drugs, but no new classes of antibiotics have come on the market for more than 25 years. Lack of new drugs which are capable of fighting bacteria has been described by the World Health Organization as one of the most significant global risks facing modern medicine," Cameron said.

The PM said "The full scale of the economic burden of drug resistant infections - and the cost of a failure to take concerted action to address it - is not yet fully understood. Resistance to antibiotics is now a very real and worrying threat, as bacteria mutate to become immune to their effects. If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again".

Professor Davies added "The soaring number of antibiotic-resistant infections poses such a great threat to society that in 20 years' time we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations".

Resistance to antibiotics was declared a major global threat to public health by the World Health Organization (WHO).

WHO revealed that resistance is occurring across many different infectious agents specially in seven different bacteria responsible for common, serious diseases such as bloodstream infections (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea.

The results are cause for high concern, documenting resistance to antibiotics, especially "last resort" antibiotics, in all regions of the world.

Antibiotic resistance causes people to be sick for longer and increases the risk of death. For example, people with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection. Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required.

"Without urgent, coordinated action, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," says Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security. "Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating."

Antibiotic resistance-when bacteria change so antibiotics no longer work in people who need them to treat infections-is now a major threat to public health.