PATTERNS OF ANTIBIOTIC MISUSE IN OUTPATIENT CLINICS AND ITS ASSOCIATION WITH ANTIMICROBIAL RESISTANCE IN PAKISTANI COMMUNITIES: A MULTISITE OBSERVATIONAL STUDY
Keywords:
Antibiotic Resistance; Antimicrobial Stewardship; Cross-Sectional Studies; Drug Misuse; Outpatients; Pakistan; Self-MedicationAbstract
BACKGROUND: Antimicrobial resistance (AMR) has emerged as a critical global health threat, largely driven by the misuse and overuse of antibiotics, particularly in low- and middle-income countries. In Pakistan, widespread self-medication and inappropriate prescribing practices have intensified this problem, contributing to rising rates of resistant bacterial infections.
OBJECTIVE: To investigate patterns of antibiotic misuse in outpatient clinics and assess its association with antimicrobial resistance across multiple regions of Pakistan.
METHODOLOGY: A multisite observational cross-sectional study was conducted from March to October 2022 across six hospitals in Pakistan. A total of 460 outpatients and 100 physicians were surveyed using structured questionnaires assessing antibiotic use, self-medication, and prescribing behavior. Laboratory data from 550 bacterial isolates were analyzed for resistance patterns using the Kirby–Bauer method and Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis included chi-square tests, t-tests, correlation, and multivariate logistic regression, with significance set at p < 0.05. Ethical approval was obtained from the Institutional Review Board (KEMU/IRB/22/367).
RESULTS: Self-medication without prescription was reported by 46.5% of participants, incomplete antibiotic courses by 39.6%, and pharmacy access without prescription by 58.5%. A significant correlation was found between regional misuse rates and resistance patterns (r = 0.61, p = 0.004). E. coli and K. pneumoniae exhibited high ciprofloxacin resistance (71.3% and 68.4%, respectively), while meropenem resistance remained relatively low (6.3–14.2%). Physician data indicated that 56% prescribed antibiotics empirically and 32% did so under patient pressure.
CONCLUSION: Antibiotic misuse is pervasive in outpatient settings across Pakistan and strongly associated with rising antimicrobial resistance. Immediate implementation of stewardship programs, stricter prescription control, and nationwide public education are essential to mitigate this public health crisis.
KEY TERMS: Antibiotic Resistance; Antimicrobial Stewardship; Cross-Sectional Studies; Drug Misuse; Outpatients; Pakistan; Self-Medication
