Can Pakistan achieve the UNGA 70% antibiotic access target? A scoping review of susceptibility data

BackgroundAntimicrobial resistance (AMR) poses a major public health challenge in Pakistan due to irrational antibiotic use and weak surveillance. The WHO AWaRe framework and United Nations General Assembly (UNGA) declaration urge a 70% global use of Access antibiotics. This scoping review aims to assess whether current susceptibility patterns in Pakistan (2020–2024) support achieving or maintaining the 70% Access target.MethodsA PRISMA-ScR–based scoping review identified 2020–2024 studies reporting susceptibility of WHO Access antibiotics in Pakistan. Eligible studies included human clinical isolates tested by standardized antimicrobial susceptibility methods. Weighted pathogen-antibiotic-year-wise susceptibilities were analyzed, along with pathogen-and WHO ATC (anatomical therapeutic chemical classification) class–wise temporal trends.ResultsA total of 74 studies published between 2020 and 2024 were included. Most studies were conducted in Punjab. Overall, the susceptibility of WHO Access antibiotics remained low across major pathogens. S. aureus and Pseudomonas spp showed notable declines, while E. coli has shown variable susceptibility. Among WHO ATC classes, aminoglycosides, beta lactams, and cephalosporins demonstrated low susceptibility.ConclusionThis scoping review revealed that persistently low susceptibility to Access antibiotics in Pakistan challenges the feasibility of the WHO's 70% utilization target. Strengthening surveillance programs is essential to curb AMR and align national efforts with global antibiotic use targets.