The doctor said this was a serious paradox.

On the one hand, antibiotics are overused until they no longer work, driving resistance and exacerbating the rise of deadly superbs. On the other hand, people die because they cannot use these life-saving drugs.

A new study by the nonprofit Global Partnership for Research and Development of Antibiotics (GARDP) aims to study nearly 1.5 million cases of Gram-negative (CRGN) infections that are resistant to carbapenems in eight major low-income countries, including India, Brazil and South Africa. CRGN bacteria are superbacterials that are resistant to online antibiotics – but only 6.9% of patients received appropriate treatment in the countries studied.

India, in its entire course studying antibiotics, lions account for the share of CRGN infection and treatment efforts, but only dealt with 7.8% of its estimated cases, a study in the journal Lancet Infectious Diseases. (A complete course of antibiotics refers to a complete dose that a patient needs to take up a specific period of time to fully treat the infection.)

Common in water, food, environment and human gut, Gram-negative bacteria cause infections such as urinary tract infections (UTI), pneumonia, and food poisoning.

They can pose a serious threat to newborns and older people. Especially vulnerable are hospital patients with less immunity, which often spread rapidly in the ICU and prove difficult (and sometimes impossible) to treat. Treating Gram-negative bacterial infections that are anti-carbapenems is a dual difficulty because these bacteria are resistant to some of the most powerful antibiotics.

"These infections are a daily reality for all ages," said Dr. Abdul Gaffar, an infectious disease consultant at Apollo Hospital in Chennai, India. "We often see patients without antibiotic effects - they die."

Ironically cruel. Despite the world’s attempt to curb antibiotic overuse, a parallel tragedy has quietly aired among poor countries: dying from treatable infections because the right medicine is out of reach.

"The main narrative has been overused for years, but the stark reality is that many people with high drug-resistant infections do not have access to the antibiotics they need in low- and middle-income countries."

The study examined eight intravenous drugs targeting carbapenems—from older antibiotics, including coliform proteins, to newer antibiotics such as Ceftazidime-avibactam. Of the few available drugs, Tigecycline is the most widely used drug.

Researchers blame the treatment gap on weaker health systems and limited access to effective antibiotics.

For example, in eight countries, only 103,647 complete treatment courses were purchased, far below the 1.5 million patients who needed them. This highlights a significant deficit in the global response to drug-resistant infections.

What prevents patients with drug-resistant infections from getting the right antibiotics?

Doctors point out multiple obstacles - reaching the right medical facility, getting accurate diagnostic tests and getting effective medications. Cost remains a major barrier, with many of the antibiotics far exceeding the impact of poorer patients.

"Those who can afford these antibiotics often overuse them; those who can't, and won't get them at all," Dr. Gafar said. "We need a system to ensure access to the poor and prevent abuse of wealth."

To improve access, these drugs must be made more affordable. To prevent abuse, stronger regulations are key.

"Ideally, every antibiotic prescription in a hospital should be signed for a second time by an infection expert or microbiologist," Dr. Gaffar said. "Some hospitals do this, but most hospitals don't. With the right oversight, regulators can ensure that this becomes the standard practice."

Researchers say smarter policies and stronger safeguards are essential to address access issues and curb abuse. But acceptance alone does not solve the crisis - the pipeline of new antibiotics is drying. The decline in antibiotic development and the limited availability of existing drugs are a global problem.

India bears one of the world's largest antimicrobial resistance (AMR) burdens, but it may also be key to fighting it at home and around the world, the researchers say.

"India is also one of the largest markets for new antibiotics, and can successfully advocate for the development and access to new antibiotics," said Dr. Cohen. The country has a strong pharmaceutical base and becomes a hub for AMR innovation, from promising new antibiotics to advanced diagnosis.

Dr Cohen said India could enhance its antibiotic response by generating local data to better estimate demand and identify gaps in care pathways.

This will allow more targeted interventions to improve the use of appropriate drugs.

Innovative models are already emerging – Kerala, for example, is using a “hub and spoke method” to support low-level facilities to manage severe infections. Coordinated or consolidated procurement from hospitals or states can also reduce the cost of new antibiotics for cancer drug programs, researchers say.

If the right antibiotics are not available, modern medicine begins to disband - doctors may lose the ability to safely operate, treat complications in cancer patients, or manage daily infections.

“As an infectious disease doctor, I think proper use is part of the visit (but only part),” Dr. Gaffar said. “When we get new antibiotics, it’s important to save them on the one hand – and save them for the right patients.”

Obviously, the challenge is not only to use antibiotics wisely, but to make sure they reach the ones they need most.