Drug Inspector as an antibiotic Steward: challenges and recommendations to implement national action plan of Pakistan on antimicrobial resistance

ABSTRACT

Background

Despite significant measures, low- and middle-income countries (LMICs), including Pakistan, struggle to curtail non-prescription antibiotic sales, enforce regulations, and implement National Action Plan (NAP) against antimicrobial resistance (AMR). NAP Pakistan entails drug inspectors (DIs) to ensure prescription-based sales of antibiotics. This study seeks to understand the perspective of DIs regarding antimicrobial sales without prescription, underlying factors, and policy implementation status.

Methods

A qualitative study employing a semi-structured interview guide using in-depth interviews with purposively selected 17 DIs was conducted. Interviews were transcribed verbatim, and data were analyzed following a thematic analysis framework utilizing MAXQDA 2022 software.

Results

Five main themes emerged after data analysis: (1) drug inspector – the regulator of the antimicrobial armamentarium, (2) the policy context, (3) awareness regarding AMR, (4) barriers to combatting AMR, and (5) the way forward: strategies and recommendations.

Conclusion

A weak regulatory framework, low level of awareness, quackery, vested interests, and socio-economic factors augment inappropriate antibiotic utilization. Opting for better policies and strengthening the DI fraternity as outlined in NAP Pakistan is recommended. Recognizing drug inspectors as effective surveilling units and mobilizing field force against irrational antibiotic utilization is the need of the hour and requires policy reformation.

KEYWORDS:

• Antimicrobial resistance (AMR)
• Antibiotic Steward
• Antibiotic use surveillance
• Drug inspector (DI)
• National action plan (NAP)
• Non-prescription sale
• Rational utilization

Disclaimer

As a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Shairyar Afzal, Sadaf Areej Sheikh and Zikria Saleem were involved in the conception and design of the study. Shairyar Afzal collected the data. Mishal Bajwa, Shairyar Afzal, and Sadaf Areej Sheikh were involved in the data analysis and result interpretation. Mishal Bajwa and Shairyar Afzal wrote the original draft of the manuscript. Zikria Saleem reviewed and edited the final draft of the manuscript. All authors read and approved the final version of the manuscript.

Acknowledgment

The authors would like to express their sincere gratitude to Ms. Qindeel Bajwa for evaluating transcripts. We are very grateful to Mr. Waseem Mehmood and Mr. Waqar Haider for facilitating data collection. We would like to say our sincere thanks to all the participants for taking time out of their busy schedules and participating in the study.

Data availability statement

The data that support the findings of this study are available on reasonable request from the corresponding author.

Ethical approval

Ethical approval for the study was solicited from the Human Ethical Committee of the Faculty of Pharmacy, Department of Pharmacy Practice, Bahauddin Zakariya University – Multan vide no. BZUDEPP228301005DI.

Table 1 – Participant Demographics

Table 2 - Summary Findings

Table 3 - Contradictory points noted by the study corresponding to the NAP operational plan

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Additional information

Funding

This paper was not funded.