Antibiotic Stewardship in Pakistan: A solution to Antibiotic Resistance

Abstract

Antibiotic resistance is rising at a high rate in all regions of the world, with the main cause of it being the irrational use of the antibiotics. Today it is one of the biggest health threats to the populations globally, and researchers have consistently raised their voices, which is based on sound evidence.¹ As described, overuse of antibiotics is one of the causes of antibiotic resistance, however it can occur naturally occasionally. The underlying factor is that standard treatment guidelines are not mostly followed to treat infections. Additionally, incorrect diagnosis, wrong dose, lack of source control, poor qualities of the drugs, extended hospital stay, increasing prevalence of resistant organisms along with co-infections are other important causes of antibiotic failure.²

Many studies have reinforced these findings and found that inappropriate prescription practices, frequent over-the-counter sale of antibiotics, widespread use of antibiotics in veterinary medicine, poorly functioning drug regulatory authority, and inefficient patient education system about antibiotic use are other causes of antimicrobial resistance in developing countries.^1,2 Considering this grave situation of the prevalence and factors associated with antibiotic resistance, stewardship regarding antibiotic use is an important strategy to overcome the bacterial resistance, irrational use of antibiotics, and prolonged hospital stay.

Another important factor related to antibiotic resistance is that although the topic of antibiotics is usually taught in all medical colleges during undergraduate education in Pakistan, unfortunately components of antibiotic stewardship are missing in the curriculum of MBBS and allied health sciences. Whereas, in comparison with the developed countries like the United States and the United Kingdom, medical schools emphasize various components of antibiotic stewardship to their medical undergraduates. However even in their medical schools, the content of antibiotic stewardship is usually taught by lectures, and only a few medical schools teach antibiotic stewardship principles and make it part of the interprofessional curriculum. Antibiotic Stewardship practice is a very vast subject indeed and for undergraduate students, it needs to be tailored to the requirements of the community where it is going to be practiced. The core elements of antibiotic stewardship mainly emphasize seven important areas such as leadership, commitment, accountability, drug expertise, action, tracking, reporting, and education. Moreover, it's a multidisciplinary approach to implementing policies and interventions to improve antibiotic use for optimal patients.²

Pakistan is facing many drug-resistance diseases like typhoid fever, and multidrug resistance Tuberculosis.  The strains of the microorganisms which are having increasing resistance include Staphylococcus aureus, Klebsiella pneumoniae, Salmonella typhi, Enterobacter species, and Pseudomonas Aeruginosa among others. There is a dire need to incorporate the principles and practices of antibiotic stewardship in Pakistan, to encounter an alarmingly high-paced increase in antibiotic resistance.