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Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR.

Introduction Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies. Aims Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan. Methodology A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit. Results Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history. Conclusion Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.

BackgroundAntimicrobial resistance (AMR) is an appreciable public health threat, exacerbated by considerable inappropriate use of antibiotics including for upper respiratory tract infections (URTIs). Whilst there have been high levels of inappropriate prescribing of antibiotics in primary care in South Africa, study findings vary regarding the extent of dispensing of antibiotics without a prescription. Where this occurs, this is typically for patients with urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to update knowledge regarding antibiotic dispensing patterns in primary care in South Africa alongside key factors influencing this. The findings can provide future direction to key stakeholders in South Africa grappling with high AMR rates.MethodsA previously piloted questionnaire was administered to patients leaving community pharmacies in a rural province using their preferred language. The questionnaire collected data on current antibiotic utilisation patterns alongside their knowledge and attitudes towards AMR.Results465 patients were interviewed exiting community pharmacies with a medicine. 78.7% of patients who were dispensed antibiotics were dispensed these without a prescription. Perceived STIs were the most common infectious disease where this occurred, with 99.1% of antibiotics issued for this condition dispensed without a prescription. Only 1 out of 116 patients with a perceived STI, received an antibiotic from a prescription issued by an authorized prescriber. The reverse was seen with patients with URTIs where there was very little dispensing of antibiotics without a prescription for these patients. This may be because surveyed patients were prepared to take advice from community pharmacists, who typically offered symptomatic relief to patients with suspected URTIs. This situation contrasts with antibiotics from prescriptions where URTIs were the most common infection where antibiotics were prescribed (59.3%). Questioning patients in their own language enhanced their understanding of key issues.ConclusionThere is an urgent need to re-consider community pharmacist activities in South Africa with some countries allowing them to prescribe antibiotics for UTIs. Trained community pharmacists can also potentially engage with patients to help prevent and manage STIs with patients appearing to preferentially seek assistance from community pharmacists for their perceived STIs. Community pharmacists can also potentially work with prescribers to improve their antibiotic use especially for URTIs.

The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis.

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

To analyze the clinico-radiological characteristics and neurosurgical management of spinal space-occupying lesions (SOLs). A retrospective observational study involving patients with spinal cord SOLs who underwent surgical management at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, between 2022 and 2024, was conducted after approval from the institute's review board. Patient profiles, clinical and radiological features, tumor location, and surgical outcomes were analyzed for comparative assessment. With a mean age of 36.78 ± 16.57 years, a clear male preponderance of 62.5% (35) was noted for spinal SOLs in a Pakistani cohort of 56 patients. Among all spinal SOLs, 46.4% (26) were intradural intramedullary (IDIM) lesions, 25% (14) were intradural extramedullary (IDEM), and 28.6% (16) were extradural (ED) lesions. The most common symptoms were lower back pain in 65.4% (17) in IDIM, 68.8% (11) in ED, and 64.3% (9) in IDEM lesions. Post-operatively, Karnofsky Performance Scale (KPS) score was improved in all patients. The most common histopathology was meningioma in 76.9% (20) of IDIM patients, astrocytoma in 71.4%(10) of IDEM patients, and hemangioma in 62.5% (10) of ED patients. Patients with spinal lesions significantly improved clinically post-operatively, regardless of the anatomical location of the lesion. Surgical intervention remained the primary treatment for majority patients with spinal cord SOLs..

This study aimed to explore the determinants of quality, quantity, impact, and excellence of the research produced by the most productive and the highly cited researchers of Pakistan. The study also presented the profile of these impactful and the most prolific researchers of Pakistan. 134 highly cited and the most productive researchers constitute a group of PERs (Pakistani elite researchers). This group of elite researchers produced one-fourth of the country’s scholarly research and received 40% citations’ share over the period of study, from 2009 to 2018. Based on its findings the study provided multiple policy recommendations for researchers, research institutes, policy-makers, the government of Pakistan, and the administrators of universities. The study recommended the researchers to collaborate internationally and publish their research in good quality and open access journals for greater visibility and impact. The study further recommended enhancing the academic-corporate collaboration for user insight-based research. The study found that Islamabad based academic institutions have employed almost half of the elite researchers while the rest half of these researchers are affiliated with the institutions of the rest of the whole country. The majority of the journals publishing scholarly output of Pakistani elite researchers are based in the USA and European countries. Only 12 (0.32%) journals belonged to Pakistan. Besides international collaboration, industry collaboration was in place for this group of elite researchers. The key determinants of research quantity/quality, impact, and excellence were publications published in 1st and 2nd journals quartiles, journals having impact factor/citescore, open access publications, and international collaborations.