Improving antibiotic prescribing in LMICs - Insights from an outpatient clinic in Pakistan

Sep 28, 2026

Uploaded by Stanley

Antibiotic use in outpatient settings drives antimicrobial resistance (AMR), yet patient-level prescribing data in low- and middle-income countries (LMICs) remain scarce. This study examines antibiotic consumption and prescription appropriateness in an outpatient clinic in Pakistan, a country with some of the world’s highest reported AMR prevalence. Patients were interviewed after visits and one month later; prescriptions were extracted from records. Results showed frequent, guideline-discordant prescribing favoring broad-spectrum and combination therapies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Background

Methods

Study design

Manga Mandi outpatient clinic

New Microbes and New Infections 69 (2026) 101680 Contents lists available at ScienceDirect New Microbes and New Infections journal [homepage:](homepage: www.journals.elsevier.com/new-microbes-and-new-infections)[ www.journals.elsevier.com/new-microbes-and-new-infections](homepage: www.journals.elsevier.com/new-microbes-and-new-infections) | Original Article
Improving antibiotic prescribing in LMICs: Insights from an outpatient clinic in Pakistan
Tamim Khawaja a,b,c,d, Mikael Kajova a,b,c,d, Anu Kantelea,b,c,d,*
a Department of Infectious Diseases, Inflammation Centre, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Finland
b Human Microbiome Research Program, University of Helsinki, P.O. Box 63, 00014, Finland
c Meilahti Vaccine Research Centre, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Finland d FIMAR, Multidisciplinary Centre of Excellence in Antimicrobial Resistance Research, University of Helsinki, P.O. Box 3, 00014, Finland | | | --- | --- | | A R T I C L E I N F O
Handling Editor: Patricia Schlagenhauf
Keywords:
Antimicrobial resistance (AMR) Antibiotic stewardship Outpatient prescribing
Low- and middle-income countries (LMICs) Pakistan
Guideline adherence Resource-limited settings | A B S T R A C T
Background: Most human antibiotic use occurs in outpatient care and is a key driver of antimicrobial resistance (AMR). Although sales statistics suggest that high-income countries consume more antibiotics overall, the steepest growth is seen in low- and middle-income countries. Sales data – incomplete and non-transparent – reveal little about prescriptions to individual patients. Detailed, clinic-level data are essential for identifying targets for stewardship.
We investigated antibiotic use and prescription appropriateness in an outpatient clinic in Pakistan – a country with some of the world’s highest reported AMR prevalences.
Methods: Patients attending an outpatient clinic near Lahore were interviewed immediately after their clinic visit and again one month later. Clinical data were collected through patient interviews, and antibiotic prescriptions were extracted from patient records.
Results: Of the 983 participants, 398 (40.5 %) were prescribed antibiotics at the primary visits. Metronidazole was the single most common agent, followed by first-generation cephalosporins, fluoroquinolones, and amoxicillin–clavulanate; phenoxymethylpenicillin and amoxicillin were only minimally prescribed. One-third of prescriptions (33.2 %) were combination regimens, 90.2 % of which included metronidazole. Guidelineconcordant first- or second-line choices accounted for only 23.4 % of prescriptions.
Of all patients, 493 (50.2 %) attended a one-month control visit. Of these, 233 (47.3 %) also saw a practitioner during the visit; 73 of them (31.3 %) were prescribed antibiotics.
Conclusions: Antibiotic prescribing was excessive and discordant with recommended first-line therapies, favouring broad-spectrum agents and combination treatments – practices likely influenced by the negligible time available per patient. Our findings highlight the need to adapt antimicrobial stewardship interventions to limited-resource contexts. | 1. Background Antimicrobial resistance (AMR) is a global health crisis, with most severe consequences in low- and middle-income countries (LMICs), where it is associated with millions of deaths annually [1]. The primary driver of this crisis is the overuse and misuse of antibiotics [2] exacerbated by weak policies regulating their use in human healthcare and agriculture [3,4]. One of the main targets of global AMR containment are antibiotic overprescription and inappropriate use in LMICs. However, data on antibiotic usage in LMICs remain limited. South Asia is among the regions hardest hit by the AMR crisis [1, 3–5], driven by factors such as high population density, poverty, poor hygiene

FAQs

Why is outpatient antibiotic prescribing important for AMR in LMICs?

Most antibiotic use occurs in outpatient care and acts as a key driver of antimicrobial resistance. The document notes that limited patient-level prescription data restrict identifying stewardship targets.

How was the study conducted in the outpatient clinic in Pakistan?

Patients attending an outpatient clinic near Lahore were interviewed immediately after their visit and again one month later. Antibiotic prescriptions were extracted from patient records, and follow-up attendance was tracked.

What were the main findings about antibiotic choice and guideline adherence?

A large share of participants received antibiotics at primary visits, with metronidazole being the most common agent. Guideline-concordant first- or second-line choices accounted for only a minority of prescriptions, while broad-spectrum agents and combinations were favored.

Sep 28, 2026

Uploaded by Stanley