It isn’t every day that you hear of a hospital doing some soul-searching when it comes to the way it is operating. But The Indus Hospital in Karachi did just that. When a recent study found that many of its patients may be receiving excessive amounts of antimicrobials such as antibiotics, it decided to correct course.

Antimicrobials are medications that fight infections caused by viruses (antivirals), bacteria (antibiotics), or fungus (antifungals). Globally, the most prescribed antimicrobials are antibiotics, such as Amoxil (amoxicillin).

The eight-member research team, led by Dr Quratulain Shaikh, studied the whether antimicrobials were being appropriately prescribed at The Indus Hospital in Karachi. Dr. Shaikh’s team used a point prevalence survey, a technique adapted from the World Health Organization, to review the appropriateness of antibiotic prescriptions in their healthcare system.

The study is titled: WHO Point Prevalence Survey to Describe the Use of Antimicrobials at a Tertiary Care Center in Pakistan: A Situation Analysis for Establishing an Antimicrobial Stewardship Program. It was published Nov 2, 2022 in the journal Antibiotics.

To do this study, they selected patients who were admitted to the Korangi Campus hospital in September 2021. They then reviewed the antibiotics that these patients received.

Of the patients who received antibiotics, Dr. Shaikh’s team found that 13% received an excessively long course and 17% did not need them at all. Overall, they found that there was a 38% non-compliance rate with antibiotic use guidelines.

To date, this was the most detailed study of how hospital systems prescribe antibiotics in Pakistan. The rates they identified were similar rates to other low- and middle-income countries.

There are multiple risks of overusing antibiotics. These include risks to the individual patient, such as side-effects and damage the healthy bacteria. At the national level, overuse of antibiotics can promote growth of resistant bacteria, often referred to as “superbugs.” When these bacteria spread, many of the existing treatment options do not work for patients.

“I would like to emphasize here that it is important for a layperson to understand that this is the expected pattern of antimicrobial use all over in Pakistan,” Dr. Shaikh told me over email. “The numbers are expected to be much higher at the primary care level. We do not have robust research on this topic due to various reasons but now the clock is ticking and we are running out of most antibiotics since most bacteria are resistant to the available antibiotics. In Pakistan we do not have access to many new antibiotics and we have some of the most resistant antibiotic resistance genes in bacteria.”

Dr. Shaikh’s group was able to use their findings to change hospital guidelines and develop targeted interventions at The Indus Hospital to improve their antibiotic prescribing. Because they are the first group to do this type of study, the status of other hospitals in Pakistan with respect to antibiotic use remains unknown. Dr. Shaikh’s team concludes that, “It is important to measure the use of antimicrobials at other hospitals within the country to develop a situation analysis, after which a framework of interventions can be designed.”

Dr. Shaikh added that, “The only way forward is to use antibiotics when indicated only, avoiding overuse of antibiotics for minor ailments, controlling over the counter use of antibiotics and educating general physicians and public about this issue.”

The writer is an MD and based in the US.