ANTIMICROBIAL resistance is an escalating crisis claiming some 700,000 lives annually in Pakistan. It is the third leading cause of death, trailing only cardiovascular disease and maternal and neonatal disorders. These alarming statistics, shared recently at the National Antimicrobial Stewardship Summit 2024, underscore a grave situation. Antibiotics, heralded as ‘wonder drugs’, have saved countless lives. However, their rampant misuse has precipitated a public health emergency. Pakistan, the third largest consumer of antibiotics globally, consumed Rs126bn worth of these medicines in 2023 alone. The consequences of overuse are dire, with bacteria now exhibiting resistance even to third and fourth-generation antibiotics. Many factors contribute to this crisis. Self-medication, ‘prescriptions’ by quacks, incomplete courses of antibiotics, and substandard production practices are primary culprits. Moreover, the misuse of antibiotics in livestock worsens the problem, contributing to 80pc of antimicrobial resistance cases in this sector. This not only impacts human health but also threatens food security.

The government must aim to increase understanding of antibiotic resistance among both healthcare professionals and the public, through awareness drives, healthcare professional training, patient education, school and community programmes and the distribution of information material at hospitals, clinics and pharmacies. The government must also enforce strict regulations on the sale of antibiotics, ensuring they are available only through prescription by licensed doctors. Additionally, there should be stringent oversight of drug companies to guarantee the production of high-quality antibiotics. Moreover, investment in healthcare infrastructure is crucial. Strengthening antimicrobial stewardship programmes that promote appropriate use of antibiotics in hospitals can curb over-prescription. These programmes should incorporate lessons from past health crises, including the Covid-19 pandemic, which saw a spike in antibiotic use despite clinical guidelines advising against it for viral infections. Also, vaccination programmes can play a pivotal role in preventing infections that might otherwise necessitate antibiotic treatment. The success of the typhoid conjugate vaccine campaign in Sindh demonstrates the efficacy of such initiatives. The spectre of AMR looms large, threatening to render common infections untreatable and reversing decades of medical progress. Only through sustained efforts can we hope to turn the tide against the devastation antibiotic misuse can cause and safeguard public health for future generations.

Published in Dawn, May 27th, 2024