Socio-economic impact of antimicrobial resistance in Pakistan: a comprehensive review

Antimicrobial resistance (AMR) is an increasing public health and economic threat, with substantial consequences for low- and middle-income countries such as Pakistan. This review critically synthesizes peer-reviewed evidence on the socioeconomic impact of AMR in Pakistan and examines policy and implementation challenges linked to the National Action Plan on AMR. A structured PubMed search was conducted for studies published between January 2025 and April 2026, with the final search completed on 28 April 2026. Search terms included “antimicrobial resistance AND Pakistan,” “AMR AND Pakistan AND National Action Plan,” “antimicrobial resistance AND socioeconomic impact AND Pakistan,” “antibiotic resistance AND healthcare costs AND Pakistan,” and “AMR AND surveillance AND Pakistan.” Following PRISMA-guided screening, 29 studies were included in the qualitative synthesis. The findings indicate rising resistance across multiple pathogens and settings, including enteric pathogens, respiratory organisms, multidrug-resistant Gram-negative bacteria, and resistant infections in hospital, community, and environmental contexts. Evidence from genomic and epidemiological studies shows persistent fluoroquinolone resistance and emerging azithromycin resistance, suggesting narrowing therapeutic options. The socioeconomic burden includes prolonged illness, increased diagnostic and treatment costs, longer hospital stays, productivity loss, and household financial strain. However, national cost-of-illness evidence remains limited, and available estimates are mainly derived from single-center studies. Policy gaps include fragmented surveillance, weak enforcement of prescription regulations, inconsistent antimicrobial stewardship, and limited public awareness. Strengthening integrated surveillance, improving regulatory enforcement, expanding vaccination strategies, and embedding AMR within health financing and public health planning are essential to reduce the long-term socioeconomic burden of AMR in Pakistan.