Frequent use of antibiotics causing antimicrobial resistance: DRAP

ISLAMABAD: Six of the top 11 best-selling medicines in Pakistan in 2024 are antibiotics, collectively valued at over Rs 41.86 billion, raising serious concerns about the country’s over-reliance on these drugs and their contribution to antimicrobial resistance (AMR), officials and experts said on Monday.

According to data from IQVIA, a global provider of healthcare analytics, antibiotics such as Augmentin (Rs 10.64 billion), Oxidil (Rs 7.065 billion), Flagyl (Rs 5.71 billion), Novidat (Rs 5.68 billion), Calamox (Rs 5.58 billion), and Velosef (Rs 5.03 billion) are among the top-selling pharmaceuticals in Pakistan, reflecting the rampant use of antibiotics in the country. A total of 11 pharmaceutical products in Pakistan each surpassed Rs 5 billion in sales in 2024, collectively generating a market value of Rs 85.4 billion, according to IQVIA data. Leading the list is Panadol, a widely used painkiller, with sales exceeding Rs 14.55 billion, driven by rising viral infections and climate-related health challenges.

Among antibiotics, Augmentin, Oxidil, Flagyl, Novidat, Calamox, and Velosef dominate, reflecting the high reliance on antibiotics in the country, which poses serious concerns about antimicrobial resistance (AMR). The sales of Brufen (Rs 8.62 billion), a non-steroidal anti-inflammatory drug, and Methycobal (Rs 7.16 billion), a vitamin B12 supplement, highlight the demand for pain management and nutritional products. Additionally, CAC 1000 Plus (Rs 6.16 billion), a calcium supplement, shows growth in the health and wellness segment. The overall growth for these products stands at 26.08 percent, with Panadol seeing the highest growth rate of 36.21 per cent, underscoring significant shifts in healthcare needs across Pakistan.

Officials in the Drug Regulatory Authority of Pakistan (DRAP) attribute the unchecked sale of antibiotics in the provinces and their over-prescription as key contributing factors to the rapid development of AMR, which poses a significant global threat to public health. Infectious disease experts attribute Pakistan’s high antibiotic consumption to self-medication, over-the-counter availability, and a healthcare system that fails to regulate prescriptions adequately. “Antimicrobial resistance has been declared a global threat by the World Health Organization (WHO) since 2014, and misuse of antibiotics is one of the main causes of this crisis,” said an official from DRAP. “In Pakistan, 70 to 80 percent of antibiotic prescriptions are unnecessary, prescribed for self-limiting conditions, which exacerbates resistance and diminishes the effectiveness of these drugs,” the official added.

Beyond antibiotics, other major pharmaceutical products dominating the market include Panadol (Rs 14.55 billion), a common painkiller, whose sales surged by over 36 percent in 2024. Panadol’s popularity is attributed to Pakistan’s climate-related challenges, including a spike in waterborne diseases, high levels of viral infections, and lack of access to medical care. Painkillers such as Brufen (Rs 8.62 billion) and nutritional supplements like Methycobal (Rs 7.17 billion) and CAC 1000 Plus (Rs 6.16 billion) also rank among the top-selling products.

Public health experts believe that the surge in these medications is partly driven by the frequency of climate-related illnesses and the overall lack of accessible healthcare, pushing individuals to self-medicate. In response to this growing crisis, DRAP has issued a directive to provincial health departments across Pakistan, urging them to enforce the sale of antibiotics only through prescriptions by registered medical practitioners. “We have no choice but to restrict antibiotic sales to counter the dangerous rise in self-medication,” DRAP’s Chief Executive Officer Asim Rauf told The News. “Antibiotics and antibacterials are controlled substances globally, and we need to adopt similar measures to prevent their overuse here.”

DRAP’s directive seeks to curb self-medication and address the ethical concerns surrounding incentivized prescriptions. In a stern warning, Rauf indicated that the Pakistan Medical and Dental Council (PMDC) and healthcare commissions nationwide would be approached to crack down on healthcare professionals involved in irrational antibiotic prescriptions. “Moreover, the pharmaceutical industry will also face penalties if it is found offering incentives to promote unnecessary antibiotic use,” he warned. These measures are part of a larger national effort to combat AMR, which continues to threaten public health and compromise medical advancements.

An advisory issued by DRAP’s Director of Pharmacy Services, Dr. Obaidullah, highlighted that DRAP is the national focal point for Antimicrobial Consumption Surveillance (AMCS) and is responsible for ensuring the responsible use of antibiotics nationwide.

Yet despite these efforts, experts caution that without a more rigorous public health campaign and better access to alternative treatments, Pakistan may continue to struggle with an unchecked rise in antimicrobial resistance. The rising sales of antibiotics in Pakistan—alongside the rampant self-medication—paint a troubling picture. If stringent regulations are not effectively enforced, the consequences of AMR could lead to a public health catastrophe soon, impacting not only Pakistan but also the broader global community.