Antimicrobial Dispensing Practices during COVID-19 and the Implications for Pakistan

Abstract

Antibiotics are one of the most frequently dispensed classes of medicines. However, excessive misuse and abuse enhances antimicrobial resistance (AMR). Previous studies in Pakistan have documented extensive dispensing of ‘Watch’ and ‘Reserve’ antibiotics, which is a concern. In view of this, there is a need to assess current dispensing patterns following COVID-19 in Pakistan. A cross-sectional study was undertaken, collecting dispensing data from 39 pharmacies and 53 drug stores from November 2022 to February 2023. Outlets were principally in urban areas (60.9%), with pharmacists/pharmacy technicians present in 32.6% of outlets. In total, 11,092 prescriptions were analyzed; 67.1% of patients were supplied at least one antimicrobial, 74.3% antibiotics, 10.2% antifungals and 7.9% anthelmintics. A total of 33.2% of antimicrobials were supplied without a prescription. Common indications for dispensed antibiotics were respiratory (34.3%) and gastrointestinal (16.8%) infections, which can be self-limiting. In addition, 12% of antibiotics were dispensed for the prevention or treatment of COVID-19. The most frequent antibiotics dispensed were ceftriaxone (18.4%) and amoxicillin (15.4%). Overall, 59.2% antibiotics were ‘Watch’ antibiotics, followed by ‘Access’ (40.3%) and ‘Reserve’ (0.5%) antibiotics. Of the total antibiotics dispensed for treating COVID-19, 68.3% were ‘Watch’ and 31.7% ‘Access’. Overall, there appeared to be an appreciable number of antibiotics dispensed during the recent pandemic, including for patients with COVID-19, alongside generally extensive dispensing of ‘Watch’ antibiotics. This needs to be urgently addressed with appropriate programs among pharmacists/pharmacy technicians to reduce AMR.

COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Lusaka, Zambia; Findings and Implications for the Future

“…The consequences include the disruption of early diagnosis and management of patients with cancer, as well as severe effects on the routine follow-up of patients with cardiovascular disease, including diabetes [ 75 , 78 , 79 , 80 ]. Alongside this, there have been high rates of inappropriate prescribing of antibiotics among patients with COVID-19 across LMICs fueling antimicrobial resistance (AMR), which is already a considerable concern across Africa [ 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. Consequently, it is vital that patients across Africa are fully vaccinated to reduce the consequences of COVID-19, as well as the unintended consequences, which have occurred as a result of a variety of measures introduced to reduce the spread of the disease in the absence of effective vaccines and treatments.…”

Untitled

“…The 2016 UN General Assembly declaration propelled AMR into international focus, securing attention, funding, and leadership commitment (Gul et al, 2023) while overshadowed by COVID-19, political awareness of AMR persists. The AMR community comprises diverse sectors committed to addressing the issue across human health, animals, agriculture, and the environment (Wellcome Trust, 2020).…”

Exploitation of microbial activities at low pH to enhance planetary health

“…There are many ways to combat the spread of AMR. The first is to limit the use of antibiotics only to those pathological conditions that specifically require them, something that was even more worryingly neglected during the COVID-19 pandemic, in high-income as well as in low- and middle-income countries (Amarsy et al 2022 , Rizvi and Ahammad 2022 , Gul et al 2023 ). The second approach is to develop new strategies to combat infectious diseases by applying good practices in the healthcare settings where the risk of becoming infected by a pathogen increases significantly (Frost et al 2018 ).…”