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Adapting global guidelines to local contexts: optimising community-acquired pneumonia (CAP) specific prescribing in
Emmama Jamil1,2, Muhammad Majid Aziz1, Afreenish Amir3
1Department of Pharmacy Practice, Bahauddin Zakariya University, Multan, Pakistan.
Background/Objectives:
Community-acquired pneumonia (CAP) imposes a significant health burden among low- and middle-income countries. The burden is exacerbated by antimicrobial resistance (AMR), often due to inappropriate antibiotic agent use and gaps in antimicrobial stewardship activities. This study aimed to explore physicians' perspectives on the diagnosis, treatment and prevention of CAP in Pakistan, with a focus on how international guidelines are interpreted and adapted to local clinical realities.
Methods:
A qualitative study was conducted using semistructured interviews with 33 purposively selected physicians from various specialties, followed by a focus group discussion with 19 of them. Data were analysed through thematic analysis.
Results:
Four cross-cutting themes were identified: (1) selective use of diagnostic agents based on severity and access; (2) pragmatic empiric prescribing influenced by resistance trends and antibiotic availability; (3) stewardship intentions constrained by delayed diagnostics and limited infrastructure and (4) underutilisation of preventive strategies including adult vaccinations due to cost and policy gaps. Physicians were aware of Infectious Diseases Society of America/American Thoracic Society guidelines but adapted them to local challenges and AMR concerns.
Conclusions:
Most physicians were unaware of the exact prevalence of causative pathogens and their resistance patterns in Pakistan due to the unavailability of robust local data. Consequently, international guidelines were adapted to local challenges including resistance patterns, limited diagnostics and resource constraints. Physicians prioritised beta-lactam antibiotics use and restricted moxifloxacin and azithromycin to mitigate resistance propagation linked to multidrug-resistant tuberculosis and extensively drug-resistant typhoid. Efforts to improve antimicrobial utilisation for CAP in Pakistan need to address implementation barriers and focus on enhancing diagnostic access, vaccine coverage and funding for treatment optimisation.
Insights
Physicians in Pakistan adapt international pneumonia guidelines due to local antimicrobial resistance and resource limits. Improving treatment requires better diagnostics, vaccine access, and funding.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Practice
Background:
- Community-acquired pneumonia (CAP) presents a substantial health challenge in low- and middle-income countries.
- Antimicrobial resistance (AMR) worsens the CAP burden, driven by improper antibiotic use and weak antimicrobial stewardship.
- Pakistan faces significant challenges in managing CAP effectively.
Purpose of the Study:
- To investigate Pakistani physicians' perspectives on diagnosing, treating, and preventing CAP.
- To understand how international CAP guidelines are interpreted and applied within local Pakistani clinical contexts.
- To identify barriers and facilitators in CAP management and antimicrobial use.
Main Methods:
- A qualitative research approach was employed.
- Semistructured interviews were conducted with 33 physicians from diverse specialties.
- A focus group discussion involving 19 physicians complemented the interview data.
- Thematic analysis was used to analyze the collected qualitative data.
Main Results:
- Physicians selectively use diagnostic tools based on disease severity and availability.
- Empirical antibiotic prescribing is pragmatic, influenced by local resistance patterns and drug availability.
- Antimicrobial stewardship efforts are hindered by diagnostic delays and inadequate infrastructure.
- Preventive measures like adult vaccinations are underutilized due to cost and policy issues.
Conclusions:
- Lack of local data on pathogen prevalence and resistance patterns impacts physician decision-making.
- International guidelines are modified to address local resistance, diagnostic limitations, and resource constraints.
- Physicians prioritize beta-lactams and restrict certain antibiotics to combat resistance to tuberculosis and typhoid.
- Enhancing CAP management in Pakistan necessitates improved diagnostic access, increased vaccine uptake, and better funding for treatment optimization.
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