Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
J Infect Public Health. 2023 Dec;16 Suppl 1:97-110. doi: 10.1016/j.jiph.2023.10.046. Epub 2023 Nov 2.
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.
抗生素在全球范围内对细菌的疗效逐渐减弱，这一问题在巴基斯坦等经济发达国家尤为令人关注。我们进行了范围界定审查，以审查有关巴基斯坦初级保健（PC）环境中抗菌药物使用、处方、配药以及与抗菌药物耐药性相关挑战的文献。此外，本综述旨在确定促进巴基斯坦合理使用抗菌药物的潜在解决方案。根据系统评价和荟萃分析扩展的首选报告项目（PRISMA-ScR）清单，我们对巴基斯坦 PC 环境中使用、处方和配药的抗菌药物文献进行了全面的范围界定审查。在 2000 年至 2023 年期间，我们在 Google Scholar 和 Pub-Med 上进行了搜索。根据资格标准分析论文，即包括家庭中普通人群、医院门诊部门的医生和社区药房的药剂师/发药员分别使用、处方和配药的抗菌药物。两名研究人员对文章进行了深入分析，并通过与第三名审稿人讨论解决了分歧。合格的研究包括定量和定性研究。此外，还将选定的论文分为不同的主题。我们从 4070 篇论文中筛选出符合我们资格标准的 46 项研究。研究结果表明，医生和社区药剂师对抗菌药物耐药性（AMR）的了解有限，处方和配药方面的做法也不恰当。此外，普通人群中普遍存在自行使用抗生素的现象，这表明他们缺乏有关正确使用抗生素的意识和知识。鉴于 AMR 的临床和公共卫生影响，巴基斯坦必须在 PC 环境中优先制定政策。医疗保健专业人员（HCPs）需要减少不合理的抗生素处方和配药，提高对抗生素 AWaRe（获取、观察和储备抗生素）分类和指导的理解，监测当前的使用和耐药趋势，并在目标地点实施抗菌药物管理（ASP）活动。
