Trends in Antimicrobial Consumption in Pakistan (2016-2028): Retrospective Observational Study With Forecasting.

Area of Science:

• Public Health
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobial resistance (AMR) is a global crisis, worsened by antibiotic misuse, especially in low- and middle-income countries.
• Pakistan, a high antibiotic consumer, struggles with unregulated sales and inadequate antimicrobial stewardship.
• This context necessitates an analysis of antibiotic consumption patterns in Pakistan.

Purpose of the Study:

• To analyze antibiotic consumption trends in Pakistan from 2016 to 2023.
• To project future antibiotic use up to 2028.
• To evaluate the implications for AMR and antimicrobial stewardship programs.

Main Methods:

• Utilized IQVIA MIDAS database for antibiotic sales data (2016-2023).
• Converted sales to Defined Daily Doses (DDDs) and DDD per 1000 inhabitants per day (DID).
• Employed linear regression for trend analysis and trend-based models for future projections (2024-2028).

Main Results:

• Total consumption reached 12.88 billion DDDs (2016-2023).
• Macrolides (+76%) and cephalosporins (+36%) consumption significantly increased; macrolides projected to reach 5.79 DID by 2028.
• Reserve antibiotics (oxazolidinones, glycylcycline) showed substantial increases, alongside declines in aminoglycosides and narrow-spectrum penicillins.

Conclusions:

• Pakistan exhibits concerning overreliance on broad-spectrum and reserve antibiotics.
• There is an urgent need for robust antimicrobial stewardship programs and stricter regulation of antibiotic sales.
• Addressing prescribing practices and improving diagnostics are crucial for mitigating AMR and preserving antibiotic efficacy.