Trends in Antimicrobial Consumption in Pakistan (2016–2028): Retrospective Observational Study with Forecasting

Background: Antimicrobial resistance (AMR) is a global public health crisis, exacerbated by the irrational use of antibiotics particularly in low- and middle-income countries (LMICs). Pakistan, one of the highest consumers of antibiotics globally, faces unique challenges, including unregulated sales, overuse of broad-spectrum antibiotics, and inadequate stewardship programs. Objective: This study aims to analyze antibiotic consumption trends in Pakistan from 2016 to 2023, project future usage through 2028, and evaluate the subsequent implications for AMR and antimicrobial stewardship programs (ASPs). Methods: Antibiotic sales data were retrieved for Pakistan from a IQVIA MIDAS database spanning 2016–2023. Data were converted to Defined Daily Doses (DDD) per 1,000 inhabitants per day (DID) using World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) Classification System. Data cleaning, statistical analyses, and data visualization were performed using R software (version 4.3.2) and Microsoft Excel. Trends were analyzed using linear regression, while future projections (2024–2028) were developed using trend-based models. Descriptive analysis were done and visualizations were used to illustrate findings. Results: The total antibiotic consumption in Pakistan from 2016 to 2023 was 12.88 billion DDDs. Broad-spectrum penicillins and fluoroquinolones, each accounting for 37.7 DID, were the most consumed classes.The analysis revealed significant increases in the consumption of macrolides ( +76%; 2.26 to 3.99 DID) and cephalosporins (+36% ; 2.87 to 3.89 DID) from 2016 to 2023, with macrolides projected to reach 5.79 DID by 2028. Reserve antibiotics, including oxazolidinones (+354%; 0.03 to 0.014 DID) and glycylcycline (+236%; 0.001 to 0.0003 DID), also showed appreciable increases, reflecting greater reliance on last-line therapies. In contrast, aminoglycosides (-36%; 0.013 to 0.14 DID) and narrow-spectrum penicillins (-30%; 0.008 to 0.005 DID ) experienced notable decline. Conclusion: The study highlights a concerning overreliance on broad-spectrum and reserve antibiotics in Pakistan, thus, underscore the urgent need for robust ASPs and stricter regulation of over-the-counter antibiotic sales to rationalize antibiotic use. Future efforts should focus on addressing gaps in prescribing practices, improving diagnostic capacity, and monitoring stewardship program outcomes to mitigate resistance development and preserve antibiotic efficacy.