India’s total use of antibiotics more than doubled from 2000 to 2015, new research says, making the country the world’s biggest consumer of antibiotics and stoking fears of increasing antibiotic resistance.

Globally, total antibiotic consumption soared 65% during the time period studied. At the forefront were India with a 103% increase, China with 79%, and Pakistan with 65%, according to an international team led by Eili Y. Klein of the Center for Disease Dynamics, Economics & Policy, and Simon A. Levin of Princeton University (Proc. Natl. Acad. Sci. USA 2018, DOI: 10.1073/pnas.1717295115). The researchers analyzed antibiotic consumption in 76 countries and projected total global antibiotic consumption through 2030.

When calculated as doses per 1,000 inhabitants per day, global antibiotic consumption rose 39%, with India increasing 63%, China increasing 65%, and Pakistan increasing 21%. In high-income countries, total consumption increased modestly while doses per 1,000 inhabitants per day fell 4%.

“Of particular concern was the rapid increase in the use of last-resort compounds” such as glycylcyclines, oxazolidinones, carbapenems, and polymyxins in all countries, the authors say. “Radical rethinking of policies to reduce consumption is necessary, including major investments in improved hygiene, sanitation, vaccination, and access to diagnostic tools both to prevent unnecessary antibiotic use and to decrease the burden of infectious disease.”