Qualitative study reveals structural and commercial drivers of unregulated antibiotic use among healthcare providers, highlighting systemic barriers to combating antimicrobial resistance.
Antimicrobial resistance (AMR) is a serious global health concern. In Pakistan, the unregulated sale of antibiotics and socioeconomic challenges compound the issue, driving high rates of drug-resistant infections. This study examines the perspectives of healthcare providers regarding unregulated antibiotic use in the Khairpur Mirs district of Sindh, Pakistan. A qualitative exploratory study was conducted using purposive sampling. Nearly twenty respondents were selected, and qualitative data were collected through semi-structured interviews and field notes with doctors, pharmacists, and informal healthcare providers. Five significant themes in healthcare system that propel antibiotic abuse were revealed through thematic analysis. The first theme is on administrative and structural vulnerabilities, including political influence, weak regulation, and a lack of monitoring and audit. The second theme identifies the unrestricted power of pharmaceutical businesses and drug stores, which promotes non-prescriptive sale of antibiotics and money-motivated recommendations. The third theme reveals critical shortages in competent and skilled health practitioners and diagnostic services, leading to dependence on unqualified practitioners and the application of practical antibiotics. The fourth theme reveals gaps in healthcare providers' knowledge, professional attitudes, ethical practices, and training related to rational antibiotic use and antimicrobial stewardship. The final theme documents financial limitations that hinder diagnostic testing of infections and drive patient pressure for quick antibiotic interventions. The findings show that healthcare providers' perspectives regarding unregulated antibiotic use are shaped by several factors such as structural, political, regulatory, economic, and healthcare systems. The study advocates for a more effective and comprehensive approach to mitigating AMR by addressing these structural inequalities. Not applicable.
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Ahmed et al. (2026) studied this question.
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