Evaluation of Antibiotic Misuse and Resistance Patterns in Outpatient Clinics Across Pakistan
Keywords:
Antimicrobial stewardship; Antibiotic resistance; Cross-sectional studies; Drug utilization; Outpatients; Pakistan; Prescription audit.Abstract
Background:
Antimicrobial resistance (AMR) has become a critical public health challenge in Pakistan, driven largely by irrational antibiotic prescribing in outpatient settings. Inadequate regulation, empirical treatment, and misuse of broad-spectrum antibiotics have accelerated resistance trends, compromising effective infection management.
Objective:
To evaluate antibiotic misuse and resistance patterns in outpatient clinics across Lahore, Multan, and Islamabad, and to assess adherence to the World Health Organization’s Access, Watch, and Reserve (AWaRe) classification for rational antibiotic prescribing.
Methods:
A multicenter, cross-sectional analytical study was conducted across private hospitals in three major Pakistani cities from January to September 2024. Stratified random sampling was used to collect 1,300 outpatient antibiotic prescriptions. Data were analyzed using IBM SPSS version 26. Descriptive statistics, chi-square, and logistic regression tests were performed, with p < 0.05 considered significant. Resistance data were obtained from hospital antibiograms. Ethical approval was obtained from the Institutional Review Board (Ref No: UOL/PHR/2024/126).
Results:
Of 1,300 prescriptions analyzed, 58.9% were “Watch” antibiotics, 36.2% “Access,” and 4.9% “Reserve.” Ceftriaxone (24.7%) and azithromycin (13.2%) were the most prescribed agents. Only 41.4% of prescriptions adhered to standard treatment guidelines, while polypharmacy occurred in 27.8% of encounters. E. coli showed 72.8% resistance to amoxicillin/clavulanate and 64.5% to ciprofloxacin. Junior prescribers were twice as likely to prescribe “Watch” antibiotics (OR 2.17, 95% CI 1.29–3.65).
Conclusion:
The study reveals a high prevalence of irrational antibiotic use and significant resistance among outpatient pathogens. Strengthened stewardship programs, prescriber education, and stricter prescription policies are imperative to mitigate AMR in Pakistan.
Keywords:
Antimicrobial stewardship; Antibiotic resistance; Cross-sectional studies; Drug utilization; Outpatients; Pakistan; Prescription audit.
