Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications

Saleem, Zikria; Godman, Brian; Azhar, Faiza; Kalungia, Aubrey; Fadare, Joseph; Opanga, Sylvia; Marković-Peković, Vanda; Hoxha, Iris; Saeed, Amna; Algethamy, Manal; Haseeb, Abdul; Salman, Muhammad; Khan, Ayaz Ali; Nadeem, Muhammad Umer; Rehman, Inaam Ur; Qamar, Muhammad Usman; Amir, Afreenish; Ikram, Aamer; Hassali, Muhammad Azmi

doi:10.1080/14787210.2021.1935238

Cited by 47 publications

(49 citation statements)

References 169 publications

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“…Strategic priorities included the establishment of robust antimicrobial surveillance, regulations of appropriate antimicrobial utilization and estimations of the costs of AMR [ 59 , 60 ]. However, there are ongoing challenges with the implementation of the NAP in Pakistan that need addressing going forward [ 61 ].…”

Section: Introductionmentioning

confidence: 99%

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

et al. 2022

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Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: A retrospective review of patient records among five tertiary care hospitals during successive waves was conducted. Data were collected from confirmed COVID-19 patients during the first five waves. Results: 3221 patients were included. The majority were male (51.53%), residents from urban areas (56.35%) and aged >50 years (52.06%). Cough, fever and a sore throat were the clinical symptoms in 20.39%, 12.97% and 9.50% of patients, respectively. A total of 23.62% of COVID-19 patients presented with typically mild disease and 45.48% presented with moderate disease. A high prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite there only being 1.14% bacterial co-infections and 3.14% secondary infections, was found. Antibiotic use significantly increased with increasing severity, elevated WBCs and CRP levels, a need for oxygen and admittance to the ICU; however, this decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus an enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from the WHO’s “Watch” category. Conclusions: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.

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Section: Introductionmentioning

confidence: 99%

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

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“…The increasing risk of antimicrobial resistance due to inappropriate prescribing habits has led to devastating consequences [ 31 ]. The CDC estimated that, in the US alone, 28 lakh individuals contract an antibiotic-resistant infection, and more than 35 thousand individual annual mortality [ 69 ].…”

Section: Artificial Intelligence Vs Antibiotic Stewardship Programmentioning

confidence: 99%

“…In addition, the Centers for Disease Control and Prevention also documented 223,900 incidents of Clostridioides difficile in the year 2017 and around 13,000 people were reported to be deceased [ 69 ]. As a result, the Centers for Medicare and Medicaid Services (CMS) now needed hospitals and nursing homes to implement ASPs [ 70 ].…”

Section: Artificial Intelligence Vs Antibiotic Stewardship Programmentioning

confidence: 99%

“…Based on our review, most studies confirming the benefits of an ASP have focused exclusively on hospital settings, thereby limiting the quantity of available data regarding the benefits of an ASP in outpatient settings. Outpatient ASPs may be difficult to implement due to many obstacles [ 69 ].…”

Section: Artificial Intelligence Vs Antibiotic Stewardship Programmentioning

confidence: 99%

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Application of Artificial Intelligence in Combating High Antimicrobial Resistance Rates

et al. 2022

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Artificial intelligence (AI) is a branch of science and engineering that focuses on the computational understanding of intelligent behavior. Many human professions, including clinical diagnosis and prognosis, are greatly useful from AI. Antimicrobial resistance (AMR) is among the most critical challenges facing Pakistan and the rest of the world. The rising incidence of AMR has become a significant issue, and authorities must take measures to combat the overuse and incorrect use of antibiotics in order to combat rising resistance rates. The widespread use of antibiotics in clinical practice has not only resulted in drug resistance but has also increased the threat of super-resistant bacteria emergence. As AMR rises, clinicians find it more difficult to treat many bacterial infections in a timely manner, and therapy becomes prohibitively costly for patients. To combat the rise in AMR rates, it is critical to implement an institutional antibiotic stewardship program that monitors correct antibiotic use, controls antibiotics, and generates antibiograms. Furthermore, these types of tools may aid in the treatment of patients in the event of a medical emergency in which a physician is unable to wait for bacterial culture results. AI’s applications in healthcare might be unlimited, reducing the time it takes to discover new antimicrobial drugs, improving diagnostic and treatment accuracy, and lowering expenses at the same time. The majority of suggested AI solutions for AMR are meant to supplement rather than replace a doctor’s prescription or opinion, but rather to serve as a valuable tool for making their work easier. When it comes to infectious diseases, AI has the potential to be a game-changer in the battle against antibiotic resistance. Finally, when selecting antibiotic therapy for infections, data from local antibiotic stewardship programs are critical to ensuring that these bacteria are treated quickly and effectively. Furthermore, organizations such as the World Health Organization (WHO) have underlined the necessity of selecting the appropriate antibiotic and treating for the shortest time feasible to minimize the spread of resistant and invasive resistant bacterial strains.

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“…18 These concerns have resulted in multiple activities especially in LMICs, 13 , 19–23 and include the development and monitoring of national action plans (NAP) to reduce AMR. 24–28 …”

Section: Introductionmentioning

confidence: 99%

Using mystery shoppers to determine practices pertaining to antibiotic dispensing without a prescription among community pharmacies in South Africa—a pilot survey

Mokwele

Schellack

Bronkhorst

et al. 2022

JAC-Antimicrobial Resistance

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Background Inappropriate use of antimicrobials is a key factor increasing antimicrobial resistance, a major global public health problem including in South Africa. Key drivers include antibiotics being dispensed without a prescription. Objectives To determine the accessibility of antibiotics without a prescription in community pharmacies in urban areas in South Africa and determine whether counselling was provided when antibiotics were dispensed. Patients and methods Prospective, observational study, employing simulated patients (SPs), presenting with upper respiratory tract infections (URTIs) and urinary tract infections (UTIs), undertaken to establish whether antibiotics can be obtained without a valid prescription in South Africa. This pilot study was conducted in privately owned (n = 20) and corporate (franchised, n = 14) community pharmacies in three regions in Gauteng Province. Results Antibiotics were sold in privately owned pharmacies without a prescription in 80% (16/20) of cases while no antibiotics were dispensed in corporate (franchised) pharmacies. Of the 16 pharmacies selling antibiotics without a prescription, pharmacist assistants were involved in 37.5% (n = 6) and counselling was not provided to 19% of SPs. Ciprofloxacin (42.9%) and metronidazole (28.6%) were the most common antibiotics dispensed. No antibiotics were dispensed for URTIs, only UTIs. Conclusions Dispensing antibiotics without prescriptions can be common among privately owned pharmacies in urban areas in South Africa. Corporate pharmacies, which probably have a greater income, appear to follow current legislation banning such activities. To limit selling with no prescription, community pharmacists and assistants especially in urban areas should be educated on appropriate patient care and legal requirements, with dispensing electronically monitored.

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Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications

Cited by 47 publications

References 169 publications

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

Application of Artificial Intelligence in Combating High Antimicrobial Resistance Rates

Using mystery shoppers to determine practices pertaining to antibiotic dispensing without a prescription among community pharmacies in South Africa—a pilot survey

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