Antibiotics are among humanity’s most remarkable discoveries, emerging unexpectedly over the past century.
The credit for this groundbreaking development goes to the Scottish physician and microbiologist, Alexander Fleming, who was studying fungi in 1928 when he inadvertently discovered what we now know as antibiotics. Following the discovery of penicillin, the first antibiotic, a continuous cycle of antibiotic discoveries began, which is still ongoing.
One might ask what antibiotics are. Antibiotics are powerful medicines used to treat bacterial infections, such as pneumonia and urinary tract infections. However, contrary to popular belief, they are ineffective against viral illnesses, including the flu, common cold, and Covid-19. These viral infections are caused by viruses, a distinct class of pathogens from bacteria. A growing threat linked to widespread and unregulated antibiotic use is known as ‘antibiotic resistance’, which occurs when bacteria evolve and become resistant to antibiotics, rendering these medicines ineffective. As a result, infections that were once easily treated by these meds become difficult to treat.
In less than a century since antibiotics were discovered, Pakistan has witnessed an alarming rise in antibiotic resistance, which could easily reverse decades of medical progress. This crisis stems largely from unregulated antibiotic use, with WHO’s GLASS (Global Antimicrobial Resistance and Use Surveillance System) reporting that over 85 per cent of E coli bloodstream infections in Pakistan are resistant to Ciprofloxacin (a frontline antibiotic).
In layman’s terms, this medicine is no longer effective in fighting against this particular type of bacteria. Resistance has grown rapidly due to easy availability, access, widespread self-medication, and a lack of diagnostic testing, factors enabled by weak enforcement of DRAP’s prescription-only regulations.
In a 2022 study, titled ‘Self-Medication with Antibiotics: Prevalence, Practices, and Related Factors among the Pakistani Public’, it was found that 62.5 per cent of Pakistani participants believe antibiotics can effectively treat colds and flu. This reflects a common misconception in Pakistan. In a country where antibiotics are often taken without prescriptions, stopped midway, or shared among friends and family members, resistance was not just likely, it was inevitable.
Imagine this: You are down with a common cold or flu. You walk into the nearest pharmacy, ask for antibiotics, and start taking them without knowing whether they will help you cure the flu or harm. This is a common scenario across Pakistan that poses a serious threat to their well-being.
But how does this happen? Let’s take a closer look.
In the context of Pakistan, the easy availability of antibiotics without a doctor’s prescription and self-medication, especially in areas where medical care is expensive or unavailable, are among the many issues to which we subtly contribute. What’s worse is that people often stop taking antibiotics midway when they start to feel a bit better or save leftover pills for next time. Others pass them on to relatives or neighbours, assuming what worked once will work again. Because of these and many other reasons, people unknowingly contribute to antibiotic resistance through their daily habits.
If this trend continues, common infections may become untreatable one day and minor injuries could lead to life-threatening complications due to antibiotic resistance.
What steps has the government of Pakistan taken so far? Through the National Action Plan on Anti-Microbial Resistance (AMR) in 2017, and DRAP’s Guidelines on the Responsible Use of Antimicrobials (2021), Pakistan took its policy steps to combat this situation. These policies emphasise the prescription-only sale of antibiotics, the establishment of antimicrobial stewardship programmes in hospitals and the integration of public awareness into the national response. However, implementation remains patchy and under-enforced, especially in community settings where over-the-counter sales persist.
Urgent action is now needed to translate these policies from paper to practice through stricter pharmacy regulation, national awareness campaigns and mandatory stewardship systems in all healthcare tiers.
Several countries in Asia with healthcare systems and demographics similar to Pakistan have implemented comprehensive strategies to curb antibiotic misuse and antimicrobial resistance. India enforced the Schedule H1 rule in 2014, requiring high-risk antibiotics to be sold only on prescription and marked with a red warning label; this was backed by the nationwide ‘Red Line Campaign’ to raise public awareness.
Thailand developed the National Strategic Plan on Antimicrobial Resistance, a plan that included mandatory stewardship programmes in hospitals, community education, and reduced antibiotic use in livestock, resulting in a significant decrease in human antibiotic consumption.
China launched a National Action Plan on AMR (2016–2020), imposed tight controls on hospital antibiotic prescriptions, and implemented antimicrobial use surveillance across its provinces. These countries also invested in public education and digital prescribing systems to monitor consumption and compliance. While challenges remain, these targeted interventions have led to measurable progress in slowing resistance trends, demonstrating that multi-sectoral commitment, policy enforcement and public engagement can produce real change.
Pakistan can draw directly from these examples to translate its own AMR policies into action and curb the unchecked misuse of antibiotics. This can be achieved through awareness campaigns utilising television, radio, and social media in various regional languages. This method will effectively engage diverse communities while ensuring the widest possible reach of this critical information.
Antibiotics, a limited and invaluable resource, are at risk of losing their effectiveness due to misuse. Despite the urgency of the matter, the government’s response remains largely passive, treating antibiotic resistance as an afterthought rather than the national health emergency it is. If concrete steps are not taken today to regulate antibiotic use, promote stewardship and educate the public, we risk raising a generation with weakened immunity, one that is far more vulnerable to infections and less likely to benefit from treatments that were once considered routine.
The window to act is closing, and the consequences of inaction will be borne not by policymakers of today but by the generations of tomorrow.
The writer is a public health expert. She can be reached at: bbzainab1400@gmail.com