Anti Infectives

As per present analysis of the antimicrobials available in the Pakistan market is apparently the excessive number of brands per active ingredient, which can be worrying in the particular case of some “Watch” and “Reserve” antimicrobials not included in the WHO Essential Medicines List. This is the case of lincomycin or the combination cefoperazone + sulbactam (with 31 different brand-names each), or the “Reserve” 4th generation cephalosporin cefepime, with 24 different brand names.

On the one hand, more available brand names of a single active ingredient mean more market pressure and, hence, more chances to be prescribed irrationally. On the other hand, the high presence of “Watch” antibiotics in a market already saturated with countless combinations (rational and irrational) bears serious thought for policymakers and regulators.

Pakistan has become a fertile ground for promoting antibiotics, as the market regulations for medicines are weak, and the growth potential for generics (sold under brand names) is very high. There is an increasing need to identify the potential for harm or other interventions that can take place due to the high use of medicines in countries with lower socioeconomic status.

Interestingly, despite reports of antibiotics being regularly out of stock in many of the Pakistani public healthcare facilities, their sales are high in different pharmacies and regions. These primary healthcare facilities lack proper standard treatment guidelines for prescribers, with the result that almost 80% of the prescriptions in both outpatient and inpatient departments were found to be improper, and the most commonly prescribed antibiotics included fluoroquinolones, cephalosporins, and penicillins.

Due to misinformation amongst doctors as well as the public, there is widespread use and buying behavior towards broad-spectrum antibiotics that are not followed through, leaving the antibiotic course in the middle, which poses a challenge in collating results, and may require more robust surveillance controls. Many solutions are being proposed to address concerns on medication safety, particularly the growing use of antibiotics. Alongside the need for systems that ensure the safety of medication use, there is a concurrent need for ensuring that guidelines developed must be aligned to international treatment standards.

The role of microbiologists should also be promoted as a way to improve the selection of the most appropriate antimicrobials for the patients, and this is especially relevant for “Reserve” AM.

In a recent effort to control antibiotic use, pharmacies in the capital, Islamabad, have been directed to keep a check on the number of antibiotics sold and that they should not be dispensed without prescription. Despite this, dispensing without prescription is high in the country, and an excessive number of brands help to increase the irrationality of the decisions also at the pharmacy level.