Mapping the scarcity of data on antibiotics in natural and engineered water environments across India

Antimicrobial resistance is a growing public health concern, increasingly recognized as a silent pandemic across the globe. Therefore, it is important to monitor all factors that could contribute to the emergence, maintenance and spread of antimicrobial resistance. Environmental antibiotic pollution is thought to be one of the contributing factors. India is one of the world's largest consumers and producers of antibiotics. Hence, antibiotics have been detected in different environments across India, sometimes at very high concentrations due to their extensive use in humans and agriculture or due to manufacturing. We summarize the current state of knowledge on the occurrence and transport pathways of antibiotics in Indian water environments, including sewage or wastewater and treatment plants, surface waters such as rivers, lakes, and reservoirs as well as groundwater and drinking water. The factors influencing the distribution of antibiotics in the water environment, such as rainfall, population density and variations in sewage treatment are discussed, followed by existing regulations and policies aimed at the mitigation of environmental antimicrobial resistance in India, which will have global benefits. Then, we recommend directions for future research, development of standardized methods for monitoring antibiotics in water, ecological risk assessment, and exploration of strategies to prevent antibiotics from entering the environment. Finally, we provide an evaluation of how scarce the data is, and how a systematic understanding of the occurrence and concentrations of antibiotics in the water environment in India could be achieved. Overall, we highlight the urgent need for sustainable solutions to monitor and mitigate the impact of antibiotics on environmental, animal, and public health.