Islamabad: Nearly half of the patients visiting outpatient clinics for common cough, cold, sore throat and flu like illnesses are taking antibiotics such as azithromycin, levofloxacin and amoxicillin despite not needing them, a new Pakistani research study has found, drawing attention to patterns of antibiotic use with implications for public health.
The study was conducted at Alkhidmat Raazi Hospital, Rawalpindi, and led by Dr Usman Zafar, Medical Superintendent of the hospital, along with a team of Pakistani clinicians and researchers. The research has been published in the international peer reviewed journal Open Health by De Gruyter. Dr Farrukh Ansar, Medical Officer at Alkhidmat Raazi Hospital, is the corresponding author of the study.
Based on data collected between December 2024 and February 2025, the cross sectional study analysed antibiotic use among 384 patients presenting to outpatient departments with symptoms of upper respiratory tract infections. Such infections are among the most common reasons for outpatient visits and are predominantly viral in nature, for which antibiotics are generally not required.
According to the findings, 43.8 percent of patients reported using antibiotics either before or at the time of their clinic visit, while clinical assessment showed that only 9.6 percent actually required antibiotic treatment. Researchers noted a clear gap between medical need and actual consumption.
Azithromycin was the most commonly used antibiotic, accounting for more than half of all reported use. Other frequently used medicines included levofloxacin, amoxicillin, ciprofloxacin and clarithromycin. The study found that nearly 90 percent of antibiotics consumed belonged to the World Health Organization’s Watch category, which includes drugs with higher resistance potential and which are advised to be used cautiously in primary care.
The study highlights that most antibiotics were initiated without qualified medical advice. More than one third of patients reported self medication, while others relied on advice from non registered local health workers, pharmacies, friends or family members. Doctors accounted for a smaller proportion of antibiotic initiation prior to presentation at the hospital.
Despite widespread use, antibiotics provided limited benefit in most cases. Over 70 percent of patients who had taken antibiotics reported no improvement in symptoms. Clinical evaluation also showed no significant difference in outcomes between antibiotic users and non users for the majority of symptoms.
Researchers identified longer duration of fever and illness as key factors associated with self medication. Previous antibiotic use strongly predicted repeated antibiotic consumption, suggesting established behaviour patterns among patients. Clinicians, when prescribing antibiotics after assessment, were more likely to do so for older patients and those with higher temperatures or prolonged fever.
When antibiotics were prescribed based on clinical judgement, doctors most commonly used amoxicillin clavulanate, followed by levofloxacin, with azithromycin and moxifloxacin used in selected cases. The study notes that clinicians largely followed evidence based prescribing once patients were formally assessed.
Dr Usman Zafar has also presented the findings of this research at academic and scientific forums, highlighting the need for better public awareness about the appropriate use of antibiotics. The authors note that inappropriate use of antibiotics in outpatient and community settings is a recognised contributor to antimicrobial resistance, a growing challenge in Pakistan and globally.
The study recommends strengthening public awareness, improving regulation of antibiotic sales and expanding antimicrobial stewardship efforts beyond hospitals into primary care and community settings. It also underscores the role of qualified healthcare providers and pharmacists in guiding appropriate treatment for common respiratory illnesses.
Clinicians said that addressing self medication and unregulated access to antibiotics is essential to preserve the effectiveness of these medicines and to support long term public health outcomes in Pakistan.
Commenting on the study, an official of the National Institute of Health (NIH) Islamabad said that the antibiotics most frequently used in Pakistan include amoxicillin marketed as Amoxil, amoxicillin clavulanate sold as Augmentin, clarithromycin commonly known by the brand name Klaricid, metronidazole marketed as Flagyl, as well as injectable antibiotics such as ceftriaxone and cefotaxime sold under the brand name Claforan.
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