Unprecedented increase: Rs120bn antibiotics consumed in Pakistan in 2021

KARACHI: An unprecedented increase in the usage of antibiotics was observed in Pakistan in 2021 when bactericidal drugs worth Rs120 billion were consumed in the country, officials and experts said, claiming that over 70 per cent of the antibiotics consumed by patients were unnecessary.

According to the official data available to The News, oral and injectable antibiotic medicines worth Rs119,745,122,879 were consumed in Pakistan in the year 2021 alone, which is around 10 per cent of the total expenditure on health in Pakistan. As per the Drug Regulatory Authority of Pakistan (DRAP), there are around 333 manufacturers of antibiotic medicines, both oral and injectable, in Pakistan, manufacturing different brands of 87 molecules (generic antibiotic medicines). These 333 drug manufacturers have 2013 antibiotic medicines registered with the DRAP, of which 1,604 are active products, which means that they are available in the local market.

“Last year (2021) was a unique year when an unprecedented increase in the consumption of antibiotics was observed all over the world, including Pakistan. For instance, over 95 per cent of Covid-19 patients in Pakistan consumed antibiotic medicines despite having absolutely no role in the treatment of this disease,” Dr Faisal Mehmood, an infectious diseases expert associated with the Aga Khan University Hospital (AKUH), Karachi, said while talking to The News. He said that during the last two years of Covid-19 pandemic, most of the people having even minor fever used antibiotics either on their own or on the advice of medical practitioners, relatives or family friends and added that azythromycin remained the most frequently used medicine by Covid-19 patients, although it had no role in the treatment of the disease.

The expert claimed that due to abuse of antibiotics, most of the gram negative bacteria, which cause deadly infections, were now resistant to almost all the antibiotics available in the country, adding that new antibiotics which are effective against these drug-resistant bacteria are highly expensive and even not available in the country. “At the moment, we are faced with the problem of drug-resistant bacteria against whom we either have no or limited options available. This is because of extreme misuse of antibiotics in our society,” Dr Mehmood said, deploring that antibiotics are more easily available in Pakistan than in any other country.

Claiming that the majority of people are consuming antibiotics unnecessarily in the country, he called for an immediate end to over-the-counter availability of bactericidal drugs, ensuring presence of pharmacists at medical stores and in hospitals and rational prescription of antibiotic medicines by physicians in the country.

Pakistan Society of Health System Pharmacists (PSHP) President Abdul Latif Shaikh said that according to Pakistan’s drug laws, only a qualified pharmacist is authorized to provide antibiotics to a person at a pharmacy, but, unfortunately, hardly one or two per cent pharmacies in the country have trained and qualified pharmacists available during their business timings. “Nowhere in the world, pharmacies and medical stores operate in the way they are doing in our country. We have uneducated and untrained people at pharmacies, who sell all kinds of medicines including antibiotics without even asking for a prescription. Similarly, our physicians are also misusing their authority and prescribing antibiotics without any justification, which is leading to antimicrobial resistance,” Shaikh, who is a former head of Pharmacy Services at the AKUH, added.

On the other hand, some of the pharmacists who tried to prevent the irrational use of medicines including antibiotics claimed that they were cursed and criticized when they tried to advise patients not to use antibiotics, steroids or other medicines not recommended for the treatment of their diseases.

“Our pharmacists working at different branches of the Ehad Medical Centre in Karachi are often criticized for preventing self-medication or advising against the use of antibiotics for the treatment of viral ailments, especially common cold and flu. We didn’t sell medicines without a prescription and offer telemedicine consultation with a pulmonologist or infectious diseases experts in case of suspected or even confirmed cases of Covid-19 during the peak of the pandemic,” said Umaima Muzammil, a pharmacist associated with the Ehad Medical Centre in Karachi.

Being a member of the Pakistan Society of Health System Pharmacists (PSHP), Muzammil said they have introduced the concept of consultation with pharmacists at the Ehad Medical Centre where medicines are not sold to patients without prescription and if there is a discrepancy in the prescription, it is referred to the pharmacist or the physician.

When approached, DRAP Chief Executive Officer (CEO) Asim Rauf said they are trying to introduce a Common Quality Management System (CQMS) in the country in consultation with the provinces to prevent the misuse and abuse of antibiotics as well as other prescription medicines, adding that they already have the first meeting with provincial representatives in this regard.

“To set a minimum standard for pharmacies throughout the country, we are planning to develop Standard Operating Procedures (SOPs) for pharmacies all over the country and want to introduce good distribution, storage and disbursement practices of medicines to the end users,” Rauf said, adding that the presence of trained and qualified pharmacists at every pharmacy in the country will be ensured to prevent self-medication and abuse of prescription drugs.

He maintained that with the presence of trained and qualified pharmacists at medical stores and pharmacies, not only the issue of misuse of antibiotics and other prescription drugs can be prevented but the patients can also be guided properly by pharmacists regarding proper dosage and duration of medicines they should take.