Malik Farrukh, Figueras Albert
Eu2P European Programme in Pharmacovigilance & Pharmacoepidemiology, Université de Bordeaux, Bordeaux, France.
Fundació Institut Català de Farmacologia; Department of Pharmacology, Therapeutics, & Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
JAC Antimicrob Resist. 2019 Nov 13;1(3):dlz063. doi: 10.1093/jacamr/dlz063. eCollection 2019 Dec.
Pakistan was third on the list of the highest antibiotic-consuming countries among low- and middle-income countries in 2015. Studies have suggested that areas with higher consumption of antibiotics are likely to have higher antibiotic resistance rates.
With limited surveillance data on consumption and resistance in Pakistan, this study investigated the 5 year trends (April 2014 to March 2019) in consumption of the two highest-sold antibiotic classes, cephalosporins [Anatomical Therapeutic Chemical (ATC) group J01D] and fluoroquinolones (ATC group J01MA).
IQVIA Pakistan data (retail) on antibiotic sales presented in units were used. These data were standardized and a DDD was assigned to all formulations, based on WHO's ATC/DDD index, and the data expressed as DIDs (DDDs per 1000 inhabitants per day). WHO's AWaRe classification of antimicrobials was used for the analyses, especially of those categorized as 'Watch'.
The findings showed a significant increase in consumption trends for 'Watch' cephalosporins (61.5%) while the use of 'Reserve' cephalosporins doubled during the studied period. In 2018, combined consumption of second- and third-generation cephalosporins (both in the 'Watch' group) was nearly five times higher than that of the first-generation cephalosporins. For fluoroquinolones, the total consumption only showed a major increase for ciprofloxacin, with 127 820 more persons per day. The consumption of cephalosporins and fluoroquinolones in Pakistan increased by 1.86 DIDs in just 5 years.
It is urgent to establish a National Antimicrobial Commission in Pakistan, to critically analyse the pharmaceutical market offerings and implement surveillance systems and antimicrobial stewardship.
在2015年低收入和中等收入国家中，巴基斯坦是抗生素消费最高的国家之一，位列第三。研究表明，抗生素消费量较高的地区可能具有更高的抗生素耐药率。
鉴于巴基斯坦关于抗生素消费和耐药性的监测数据有限，本研究调查了2014年4月至2019年3月期间销量最高的两类抗生素——头孢菌素（解剖治疗化学分类系统（ATC）J01D组）和氟喹诺酮类（ATC J01MA组）的5年消费趋势。
使用IQVIA巴基斯坦提供的抗生素零售销量数据（以单位计）。这些数据经过标准化处理，并根据世界卫生组织的ATC/限定日剂量（DDD）索引为所有制剂分配一个DDD，数据以每日每千居民限定日剂量数（DIDs）表示。分析采用了世界卫生组织对抗微生物药物的AWaRe分类，特别是对那些被归类为“观察类”的药物。
研究结果显示，“观察类”头孢菌素的消费趋势显著增加（61.5%），而在研究期间，“储备类”头孢菌素的使用量翻了一番。2018年，第二代和第三代头孢菌素（均在“观察类”组）的联合消费量几乎是第一代头孢菌素的五倍。对于氟喹诺酮类药物，仅环丙沙星的总消费量有大幅增加，每天增加127820人。巴基斯坦的头孢菌素和氟喹诺酮类药物消费量在短短5年内增加了1.86 DIDs。
巴基斯坦迫切需要建立一个国家抗菌药物委员会，以严格分析药品市场供应情况，并实施监测系统和抗菌药物管理措施。
