Antimicrobial resistance is described as a “slow-moving Tsunami” and a top global health threat, particularly affecting low and middle-income countries. A key strategic tool to engage with this challenge is effective monitoring to improve knowledge and awareness and support evidence-based interventions. However, LMICs have an inadequate capacity, resources, infrastructure, and culture to implement digital interventions. To engage with this challenge within the context of a public hospital in India, a global AMR hotspot, empirical work is carried out in studying the design and implementation of an AMR monitoring system and in understanding the process of antibiotics use and associated challenges in their digitization. A practice-based perspective informs understanding of these empirical problems, and how practices evolve into institutional work. This paper contributes to understanding the challenges and approaches to implementing AMR digital monitoring systems.