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Pattern of inappropriate antibiotic use among hospitalized patients in Pakistan: a longitudinal surveillance and implications

  • Saleem, Zikria1, 2
  • Saeed, Hamid3
  • Hassali, Mohamed Azmi1
  • Godman, Brian1, 4, 5, 6
  • Asif, Usama7
  • Yousaf, Mahrukh7
  • Ahmed, Zakiuddin8
  • Riaz, Humayun9
  • Raza, Syed Atif3
  • 1 Universiti Sains Malaysia, Gelugor, Malaysia , Gelugor (Malaysia)
  • 2 Hamdard University, Islamabad, Pakistan , Islamabad (Pakistan)
  • 3 University of the Punjab, Lahore, Pakistan , Lahore (Pakistan)
  • 4 Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden , Stockholm (Sweden)
  • 5 Strathclyde University, Glasgow, UK , Glasgow (United Kingdom)
  • 6 University of Liverpool Management School, Liverpool, UK , Liverpool (United Kingdom)
  • 7 Agha Khan University Hospital, Karachi, Pakistan , Karachi (Pakistan)
  • 8 Ripha University, Islamabad, Pakistan , Islamabad (Pakistan)
  • 9 Rashid Latif College of Pharmacy, Lahore, Pakistan , Lahore (Pakistan)
Published Article
Antimicrobial Resistance & Infection Control
BioMed Central
Publication Date
Nov 21, 2019
DOI: 10.1186/s13756-019-0649-5
Springer Nature


BackgroundThe inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is currently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan.MethodsLongitudinal surveillance was conducted over a period of 2 months among hospitals in Lahore, Pakistan. Antibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or both based on the British National Formulary.ResultsA total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately two-thirds of the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had respiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy. Cephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%). Penicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or dosage or both. Significant variations were also observed regarding inappropriate prescribing for several antimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides (74.6%) and other antibacterials (73.1%).ConclusionEducational interventions, institutional guidelines, and antimicrobial stewardship programs need to be developed to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and Government officials are also needed to minimize inappropriate antibiotic use.

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