Studies show two-thirds of antibiotic prescriptions are unnecessary. Without urgent action, the valley risks becoming a hotspot for drug-resistant superbugs.
Kamran Hamid Bhat
In the feeble and hesitant light of dawn, my mother sent me to the nearby market to purchase medicine for my little brother. The moment I stepped outside, I wrapped a muffler tightly around my face, pulled gloves over my hands, and slipped my feet into foam shoes. As soon as I walked out, the season’s sharp, bitterly cold wind pierced my breath, shredded my throat, and filled my eyes with tears. Step by step, I made it to the chemist and joined the queue of people waiting to buy medication for viral infections. That morning, I felt a deeper pain—not from the cold, but from knowing that my own body had once been counted among the victims of antibiotic resistance. Even today, in Kashmir, awareness about this silent crisis remains painfully absent.
As the morning fog lifts over the valley, it reveals a familiar winter tableau: families huddled around portable heaters, children coughing in poorly ventilated rooms, and pharmacies doing brisk business in antibiotics. What most Kashmiris don’t realise is that they are witnessing the opening act of a health crisis that could turn their home into a breeding ground for superbugs.
Kashmir’s extreme winter creates ideal conditions for the spread of respiratory infections. Temperatures regularly dip below zero, sometimes touching severe lows. Cold air allows viruses to survive longer and travel farther, while dry winter weather depletes the protective mucus barrier in nasal passages that normally traps pathogens. The situation is worsened by temperature inversion—a meteorological phenomenon where a layer of warm air traps cold air and pollutants near the ground, creating thick smog that chokes the valley throughout December.
Dr Murtaza Ahmad Ganaie, a general physician with the Directorate of Health Services Kashmir, explains: “Viruses such as rhinoviruses and influenza flourish in cold, dry conditions. Winter air dries out nasal passages, compromising the mucus barrier. Traditional heating systems like kangris (portable clay firepots) create confined, warm spaces that increase viral transmission among family members crowding together for warmth.”
The scale of the winter health crisis is evident in hospital data. SMHS Hospital in Srinagar registered a 30–35% rise in cases of fever, cold, and cough in December 2024 compared to November. Across the valley, hospitals report that over 10% of their patient load is now associated with flu-like symptoms, stretching already scarce healthcare resources.
Yet, the true emergency lies not in the infections themselves, but in how they are treated. Studies reveal alarming statistics: over two-thirds of antibiotics prescribed in Kashmir are unnecessary. A comprehensive study found that 39% of individuals had self-medicated with antibiotics in the past six months, while 47% admitted to purchasing antibiotics without a prescription.
The disconnect between medical science and public behaviour is striking. Antibiotics such as Azithromycin and Co-Amoxyclav have become household remedies for the common cold, an illness predominantly caused by viruses, against which antibiotics are useless. As one doctor noted, “The urge to use antibiotics like Co-Amoxyclav 625 and Azithromycin has become a cultural reflex, even for viral infections expected to resolve on their own.”
Walk into any chemist shop in Kashmir, and the scene repeats: customers request antibiotics by name, pharmacists dispense Schedule H1 drugs without prescriptions, and no one asks about symptoms or medical history. This unrestricted access has transformed local pharmacies into unregulated dispensaries of potential superbug accelerators.
Research shows the top antibiotics dispensed without prescription are metronidazole (75%), ciprofloxacin (15%), and amoxicillin (10%). The problem is so severe that the Drug and Food Control Organisation in Jammu and Kashmir has cancelled eight pharmacy licenses and sealed 75 shops for violating drug control norms—yet the practice continues unabated.
This culture of self-medication is reinforced by digital misinformation. Many now turn to “Dr Google” or “Dr ChatGPT”, self-diagnosing and self-prescribing based on internet searches rather than professional advice. Family and community recommendations often replace medical consultation, leading to inappropriate, incomplete, or unnecessary antibiotic use.
The ramifications extend far beyond individual patients. Every misuse, every unnecessary course, and every viral infection treated with antibiotics fuels antimicrobial resistance (AMR)—a global health emergency. Doctors at Government Medical College Srinagar already report cases where once-trusted antibiotics fail to work, and previously manageable infections have become stubborn and difficult to treat.
This is not merely a local issue. The World Health Organization ranks antimicrobial resistance among the top ten global threats to human health. Resistant infections already kill an estimated 1.3 million people annually worldwide—a figure projected to rise to 10 million by 2050 unless urgent action is taken.
A landmark analysis in The Lancet estimated that bacterial antimicrobial resistance contributed to nearly 4.95 million deaths in 2019 alone. These numbers underscore a frightening reality: drug-resistant infections are reshaping modern medicine, threatening to render routine treatments obsolete and push healthcare systems toward a post-antibiotic era.
Addressing this crisis requires a multi-pronged approach: stringent enforcement of prescription laws, stricter pharmacy regulation, public education on the difference between viral and bacterial infections, and improved access to diagnostic testing and primary care. Hospitals must implement antimicrobial stewardship programs, while communities need sustained campaigns to promote evidence-based antibiotic use.
Environmental measures are equally crucial: promoting cleaner heating alternatives, ensuring better ventilation, issuing air quality alerts, and raising awareness about vitamin D deficiency—all can reduce the burden of respiratory infections and dependence on antibiotics.
Kashmir stands at a critical juncture. Without immediate action to curb self-medication and antibiotic overuse, the day may come when common infections become fatal. Protecting the efficacy of antibiotics, strengthening health systems, and changing deeply ingrained behaviours are essential to ensuring that the valley—and the world—does not enter a post-antibiotic era.
The writer is a final-year Master’s student of Healthcare Administration
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