The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan
Abstract Background Consistent and timely access to antibiotics is a hallmark of an antimicrobial stewardship program (ASP) and can be achieved through good procurement practices. However, flawed procurement modules result in poor antibiotic supply management within health facilities of low- and mid...
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| Format: | Article |
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BMC
2025-02-01
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| Series: | Antimicrobial Resistance and Infection Control |
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| Online Access: | https://doi.org/10.1186/s13756-025-01521-w |
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| author | Shairyar Afzal Mishal Bajwa Nabeel Ahmed Jawaria Jabeen Mian Shahzeb Haroon Rana Muhammad Zahid Mushtaq Zikria Saleem |
| author_facet | Shairyar Afzal Mishal Bajwa Nabeel Ahmed Jawaria Jabeen Mian Shahzeb Haroon Rana Muhammad Zahid Mushtaq Zikria Saleem |
| author_sort | Shairyar Afzal |
| collection | DOAJ |
| description | Abstract Background Consistent and timely access to antibiotics is a hallmark of an antimicrobial stewardship program (ASP) and can be achieved through good procurement practices. However, flawed procurement modules result in poor antibiotic supply management within health facilities of low- and middle-income countries (LMICs), including Pakistan, exacerbating antimicrobial resistance (AMR). This study seeks to understand hospital pharmacists’ perspectives on the antibiotic procurement process, its efficiency in ensuring consistent access to antibiotics, and the role of clinical pharmacists in rational procurement. Methods Semi-structured interviews with 24 purposively selected hospital pharmacists from secondary healthcare facilities in Punjab, Pakistan, were conducted utilizing a qualitative case study methodology. Data analysis was conducted using MAXQDA 2024 software, following a thematic analysis technique using a codebook approach to thematic analysis. Results The study identified five central themes: (1) The state of antibiotic use in hospitals is characterized by a lack of antibiotic use policy, resulting in mostly empirical and irrational prescribing practices. (2) Medicine availability significantly influences prescribing decisions, often taking precedence over clinical needs. (3) The procurement process, although structured, is flawed owing to rigid adherence to the Standard Medicine List (SML). (4) Rationality in procurement is compromised by disregard for AMR, with decisions driven more by cost and demand than clinical evidence. (5) The clinical acumen of pharmacists is underutilized in procurement due to multifarious barriers. Conclusion Antibiotic procurement is the mainstay of implementing an ASP in hospitals. This study elucidates significant policy, practice, and education gaps regarding antibiotic use and procurement in Pakistan. There is a critical need for comprehensive antibiotic policies, including a revision in SML, enhancing pharmacist authority in procurement decisions, more rational prescribing, and ensuring access to antibiotics through more informed and data-driven processes to combat AMR effectively. |
| format | Article |
| id | doaj-art-dce7e525ca5545f9a9693a4860892722 |
| institution | Kabale University |
| issn | 2047-2994 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj-art-dce7e525ca5545f9a9693a48608927222025-02-09T12:54:46ZengBMCAntimicrobial Resistance and Infection Control2047-29942025-02-0114111410.1186/s13756-025-01521-wThe antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in PakistanShairyar Afzal0Mishal Bajwa1Nabeel Ahmed2Jawaria Jabeen3Mian Shahzeb Haroon4Rana Muhammad Zahid Mushtaq5Zikria Saleem6Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard UniversityDepartment of Pharmacy, Quaid-i-Azam UniversityCollege of Pharmacy, University of SargodhaCollege of Pharmacy, University of SargodhaDepartment of Pharmacology and Toxicology, University of Veterinary and Animal SciencesInstitute for Regeneration and Repair (IRR), Edinburgh Medical School, The University of EdinburghFaculty of Pharmacy, Bahauddin Zakariya UniversityAbstract Background Consistent and timely access to antibiotics is a hallmark of an antimicrobial stewardship program (ASP) and can be achieved through good procurement practices. However, flawed procurement modules result in poor antibiotic supply management within health facilities of low- and middle-income countries (LMICs), including Pakistan, exacerbating antimicrobial resistance (AMR). This study seeks to understand hospital pharmacists’ perspectives on the antibiotic procurement process, its efficiency in ensuring consistent access to antibiotics, and the role of clinical pharmacists in rational procurement. Methods Semi-structured interviews with 24 purposively selected hospital pharmacists from secondary healthcare facilities in Punjab, Pakistan, were conducted utilizing a qualitative case study methodology. Data analysis was conducted using MAXQDA 2024 software, following a thematic analysis technique using a codebook approach to thematic analysis. Results The study identified five central themes: (1) The state of antibiotic use in hospitals is characterized by a lack of antibiotic use policy, resulting in mostly empirical and irrational prescribing practices. (2) Medicine availability significantly influences prescribing decisions, often taking precedence over clinical needs. (3) The procurement process, although structured, is flawed owing to rigid adherence to the Standard Medicine List (SML). (4) Rationality in procurement is compromised by disregard for AMR, with decisions driven more by cost and demand than clinical evidence. (5) The clinical acumen of pharmacists is underutilized in procurement due to multifarious barriers. Conclusion Antibiotic procurement is the mainstay of implementing an ASP in hospitals. This study elucidates significant policy, practice, and education gaps regarding antibiotic use and procurement in Pakistan. There is a critical need for comprehensive antibiotic policies, including a revision in SML, enhancing pharmacist authority in procurement decisions, more rational prescribing, and ensuring access to antibiotics through more informed and data-driven processes to combat AMR effectively.https://doi.org/10.1186/s13756-025-01521-wAntibiotic procurementAntimicrobial stewardship program (ASP)Antimicrobial resistance (AMR)Antibiotic accessAntibiotic use policyClinical pharmacist |
| spellingShingle | Shairyar Afzal Mishal Bajwa Nabeel Ahmed Jawaria Jabeen Mian Shahzeb Haroon Rana Muhammad Zahid Mushtaq Zikria Saleem The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan Antimicrobial Resistance and Infection Control Antibiotic procurement Antimicrobial stewardship program (ASP) Antimicrobial resistance (AMR) Antibiotic access Antibiotic use policy Clinical pharmacist |
| title | The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan |
| title_full | The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan |
| title_fullStr | The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan |
| title_full_unstemmed | The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan |
| title_short | The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan |
| title_sort | antibiotic procurement saga a long neglected stewardship target to combat antimicrobial resistance in pakistan |
| topic | Antibiotic procurement Antimicrobial stewardship program (ASP) Antimicrobial resistance (AMR) Antibiotic access Antibiotic use policy Clinical pharmacist |
| url | https://doi.org/10.1186/s13756-025-01521-w |
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