Islamabad: Pakistan’s worsening antimicrobial resistance (AMR) crisis is being driven by irrational prescribing practices of doctors, including excessive use of antibiotics and widespread inclusion of nutraceuticals in prescriptions, Pakistan Pharmacist Association (PPA) alleged on Saturday.
In a strongly worded letter to the Ministry of National Health Services, the Pakistan Pharmacists Association (PPA) has accused medical practitioners of contributing to unsafe prescribing trends, claiming that nearly half of all prescriptions contain nutraceuticals despite repeated warnings from the Drug Regulatory Authority of Pakistan (DRAP).
It also alleged that unchecked antibiotic use by physicians is accelerating AMR, one of the most serious public health threats facing the country.
The letter, which comes amid an escalating dispute between pharmacists and the Pakistan Medical and Dental Council (PMDC), highlights what pharmacists describe as a deeper structural problem: weak oversight of prescription practices and blurred professional boundaries within the healthcare system.
The row was triggered by a PMDC communication dated April 21, 2026, in which the council asked the federal health ministry to bar allied health professionals, including pharmacists, from prescribing medicines or engaging in clinical practice, insisting that such roles fall exclusively within the domain of doctors and dentists.
Pharmacists have rejected the move outright, calling it an attempt to deflect attention from poor prescribing practices and a “jurisdictional overreach” by a regulator whose mandate, they argue, does not extend beyond medical and dental practitioners.
“The real issue is not pharmacists prescribing medicines, but irrational prescribing by doctors that is going largely unchecked,” a senior pharmacist said, reflecting the sentiment within the profession.
In its formal representation, the PPA argued that core pharmaceutical functions such as procurement, dispensing, administration and monitoring of medicines legally fall within the domain of pharmacists, but are routinely performed by physicians, raising questions about accountability and professional boundaries.
The association maintained that pharmacy practice in Pakistan is governed under separate legal frameworks, including the Pharmacy Act, 1967, and the DRAP Act, 2012, which clearly define the role of pharmacists in medication management, patient safety and rational drug use. It said any attempt by PMDC to regulate pharmacists is not only legally flawed but risks creating institutional confusion.
Pharmacists also warned that the PMDC’s position could further weaken an already fragile system where prescription practices remain largely unregulated. Pakistan has long struggled with over the counter sale of antibiotics, polypharmacy and limited clinical oversight, all of which contribute to rising drug resistance.
Rather than restricting pharmacists, the PPA argued that strengthening clinical pharmacy services is essential to improving prescription quality, reducing medication errors and ensuring safer patient outcomes.
The association also took exception to what it described as the “mischaracterisation” of pharmacists as allied or subordinate personnel, saying such framing ignores their role as trained medication experts who contribute directly to patient care through clinical pharmacy services.
“This kind of broad categorisation not only undermines the profession but also weakens the healthcare system’s ability to ensure safe and effective use of medicines,” the association said.
Beyond the immediate dispute, pharmacists warned that the PMDC letter could create regulatory ambiguity by overlapping the mandates of PMDC, the Pharmacy Council of Pakistan and DRAP, potentially disrupting coordination in healthcare delivery.
They have called on the government to withdraw the April 21 directive in its current form, issue a clear clarification excluding pharmacists from its scope and ensure that future policy decisions are made in consultation with all relevant regulatory bodies.
PMDC officials, however, maintain that unauthorised clinical practice by non physician professionals poses risks to patient safety and must be curtailed, underscoring the widening gap between the two sides.
Health experts say the confrontation reflects a deeper governance failure in Pakistan’s healthcare system, where weak enforcement, fragmented regulation and lack of accountability continue to undermine patient safety.
With AMR steadily rising and prescription practices largely unchecked, the current standoff raises a more fundamental question: who is responsible for ensuring rational use of medicines in Pakistan, and why is the system failing to do so.
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