Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future

Muniba Alam, Zikria Saleem*, Abdul Haseeb, Muhammad Usman Qamar, Aziz Sheikh, Safa S. Almarzoky Abuhussain, Muhammad Shahid Iqbal, Fahad Raees, Audrey Chigome, Aislinn Cook, Catrin E. Moore, Zia Ul Mustafa, Muhammad Salman, Umar Saleh, Sana Shabbir, Brian Godman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000–2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.

Original languageEnglish
Pages (from-to)97-110
Number of pages14
JournalJournal of Infection and Public Health
Publication statusPublished - Dec 2023


  • Ambulatory care
  • Antibiotic dispensing
  • Antibiotic prescribing
  • Dentist prescribing antibiotics
  • Hand hygiene
  • Outpatient departments
  • Pakistan
  • Primary healthcare center
  • Retail pharmacy dispensing


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