THE recent tragic deaths due to certain antibiotic injections across various hospitals in Lahore have once again exposed the alarming state of antibiotic prescription and use in Pakistan.

Antimicrobial resistance (AMR) is an escalating crisis worldwide, but in our country, the overuse and misuse of antibiotics has touched reckless propo-rtions with disastrous consequences.

A major contributor to this crisis is the injudicious prescribing of antibiotics by healthcare providers, often without clear clinical indications or proper diagnostic support.

The situation is further exacerbated by the over-the-counter (OTC) availability of antibiotics, allowing their rampant misuse by the general public. This unchecked consumption not only incre-ases resistance, but also leads to severe adverse reactions, as seen in the recent fatalities.

Shockingly, most healthcare institu-tions in Pakistan lack formal antimicrobial stewardship programmes (ASPs) — structured initiatives that guide rational antibiotic use. Without ASPs, prescribers have no accountability, and inappropriate prescribing remains the norm rather than the exception.

Additionally, pharmaceutical companies, instead of promoting responsible pres-cribing, often prioritise profit over ethics, aggressively marketing broad-spectrum and injectable antibiotics with little oversight.

Another glaring gap in the national healthcare system is the absence of clinical audits to assess the competence of healthcare providers in prescribing antibiotics.

Regular audits and feedback mech-anisms are crucial to identifying and rectifying prescribing errors, yet such systems are non-existent in most hospitals. Without quality control measures, the healthcare system continues to perpetuate the irrational use of antibiotics, further fuelling resistance and patient harm.

The time for complacency has long passed. Urgent action is needed now by the authorities, such as strict regulation of antibiotic prescribing and OTC sales, mandatory implementation of ASPs in all healthcare institutions, curbs on unethical marketing practices by the pharmaceutical industry, regular clinical audits of institutions, and training programmes for healthcare providers.

Pakistan cannot afford to ignore the devastating consequences of antibiotic misuse. The recent deaths should serve as a wake-up call for policymakers, healthcare institutions and regulatory authorities to take immediate and decisive action.

If we fail to act now, we risk entering a post-antibiotic era where even minor infections would become untreatable.

Dr Azra Mahmud
Lahore

Published in Dawn, March 20th, 2025