Antibiotic misuse driving deadly resistance in Pakistan

Pakistan is facing a growing public health crisis due to the unnecessary use or incomplete doses of antibiotics, with medical experts warning that antimicrobial resistance (AMR) is claiming between 200,000 and 300,000 lives in the country every year — either directly or indirectly.

Doctors say there has been a sharp rise in the number of critically ill patients whose infections are caused by multidrug-resistant organisms, particularly in ICUs. They warn, if the current trend continues, AMR could emerge as one of the leading causes of death.

According to the World Health Organisation (WHO), AMR occurs when bacteria, viruses, fungi or parasites evolve over time and become resistant to medicines, rendering standard treatments ineffective and making infections increasingly difficult — and in some cases impossible — to treat.

“AMR has become a global threat as it prolongs illness, significantly increases treatment costs, raises the risk of complications and leads to higher mortality,” Professor Dr Saeed Khan, Head of the Molecular Pathology Laboratory at Dow University of Health Sciences, told The Express Tribune.

He warned that AMR is also undermining modern medical care, posing serious risks to surgeries, chemotherapy and critical care services. Citing WHO estimates, he said, if effective control measures are not implemented, antibiotic resistance could cause up to 10 million deaths annually worldwide by 2050.

Dr Khan said Pakistan is among the countries at particularly high risk of AMR due to the widespread use of antibiotics without prescriptions, incomplete or unnecessary medication, poor infection control practices in hospitals, excessive use of antibiotics in livestock and poultry, and weak surveillance and reporting systems.

He added that the most drug-resistant bacteria commonly identified in major hospitals in Karachi include Escherichia coli, Klebsiella pneumonia, Acinetobacter baumannii, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), and extensively drug-resistant (XDR) Salmonella typhi. These pathogens pose serious risks in urinary tract infections, ICUs and diseases such as typhoid.

Dr Khan added that bacterial pneumonia following influenza has become more lethal as first-line antibiotics are often ineffective, resulting in delays in appropriate treatment and more severe illness. Children, the elderly and immunocompromised people are particularly vulnerable to drug-resistant infections.

He further said that multidrug-resistant gram-negative infections and XDR typhoid have emerged as major challenges in the city’s hospitals, especially in ICUs, neonatal wards, surgical wards, tuberculosis wards and infectious disease units.

Dr Khan said Pakistan remains among the countries with the highest number of TB cases, while multidrug-resistant (MDR) and XDR TB have reached alarming levels. Such patients require prolonged and costly treatment lasting 18 to 24 months and face higher risks of treatment failure and death.

According to various studies, he said, between 40 and 70 per cent of patients admitted to ICUs in major public and private hospitals across the country suffer from infections caused by multidrug-resistant organisms, most of them gram-negative bacteria, making treatment increasingly complex.

Meanwhile, microbiologist Dr Syeda Sadaf Akbar said Pakistan ranks 29th among 204 countries in terms of antibiotic resistance. She said available data indicate that 200,000 to 300,000 people die each year in Pakistan due to AMR, either directly or indirectly, and warned that the resistance rate continues to rise annually, with global data showing an increase of 5 to 15 per cent.