AMR in Pakistan: A One Health Call for Prescription-Only Antibiotics Across Human and Veterinary Medicine

Antibiotics have transformed modern medicine and veterinary medicine. They have saved countless human and animal lives and remain essential for treating bacterial infections.

However, inappropriate and unnecessary antimicrobial use contributes to the development and spread of resistant organisms.

The discussion in Pakistan must therefore move beyond the question of how much antibiotics are used in poultry, livestock or hospitals.

The more important policy question is:

“How are antibiotics being accessed, prescribed, dispensed and used across Pakistan's entire health system?”

A genuine One Health response cannot apply strict stewardship principles to one sector while allowing uncontrolled access in another.

Human health and animal health are interconnected. Resistant organisms and resistance genes can move between people, animals, food and the environment. Consequently, antimicrobial stewardship must also be interconnected.

Pakistan should progressively strengthen and enforce a national system under which antibiotics classified as prescription medicines are dispensed only against a valid prescription from an appropriately registered healthcare professional.

This principle should apply consistently to:

• Human medicine
• Veterinary medicine
• Community pharmacies
• Veterinary pharmacies and retailers
• Wholesale distribution
• Online and digital sales channels
• Other commercial routes through which antibiotics reach end users

The objective is not to deny patients or animals access to essential treatment.

The objective is to prevent self-medication, inappropriate prescribing, unnecessary treatment and uncontrolled antimicrobial access.

Any serious national AMR strategy must address antimicrobial use in human medicine with the same seriousness applied to veterinary medicine.

Antibiotics should not be treated as ordinary consumer products.

Patients should not routinely be able to purchase antibiotics simply by requesting them from a pharmacy without appropriate clinical assessment.

A prescription-based system can help establish professional accountability by recording:

• The prescribing professional
• Patient information
• The antimicrobial prescribed
• Strength and dosage
• Frequency of administration
• Duration of treatment
• Relevant clinical indication where appropriate

This creates an opportunity to improve antimicrobial stewardship while generating useful data for national surveillance.

The veterinary sector also has a responsibility to ensure prudent antimicrobial use.

Veterinary antimicrobial treatment should be based on professional assessment, with appropriate consideration of:

• Diagnosis
• Disease prevention
• Vaccination
• Biosecurity
• Farm management
• Diagnostic testing
• Antimicrobial susceptibility testing where appropriate
• Correct antimicrobial selection
• Correct dosage
• Appropriate treatment duration
• Withdrawal periods for food-producing animals

Veterinarians should be recognised as an essential part of the solution, not treated simply as a source of the problem.

The poultry and livestock sectors have strong incentives to reduce disease, improve biosecurity and minimise unnecessary medication. Better prevention reduces disease pressure and consequently reduces the need for antimicrobial intervention.

The concept of One Health should not remain a slogan.

If antimicrobial resistance is a One Health problem, then antimicrobial stewardship must also be implemented through a One Health framework.

This means that:

“Doctors, veterinarians, pharmacists, farmers, pharmaceutical companies, regulators, patients and consumers all have responsibilities.”

No single sector can solve AMR independently.

Equally, no single sector should carry disproportionate responsibility for a problem that crosses biological and regulatory boundaries.

Prescription-only legislation will have limited effect if antibiotics continue to move through poorly controlled distribution channels.

Pakistan therefore needs stronger monitoring across the complete supply chain:

Manufacturer / Importer → Distributor → Wholesaler → Pharmacy / Retailer → Prescriber → Patient / Animal

The regulatory system should progressively become more traceable and data-driven.

Particular attention should be given to:

• OTC antibiotic sales
• Unauthorised dispensing
• Unregulated online sales
• Unlicensed distribution
• Prescription compliance
• Professional prescribing practices
• Antimicrobial sales data
• Veterinary antimicrobial use
• Human antimicrobial use

Enforcement should be risk-based and proportionate, with education and compliance support accompanying regulatory action.

Prescription control alone will not solve AMR.

Pakistan must simultaneously invest in disease prevention.

In human health, this includes vaccination, infection prevention, sanitation and appropriate clinical diagnosis.

In animal agriculture, it includes:

• Biosecurity
• Vaccination
• Farm hygiene
• Improved housing
• Water quality
• Nutrition
• Veterinary supervision
• Early disease detection
• Diagnostic capacity
• Good farming practices

The less disease Pakistan has, the less dependence there will be on antimicrobial treatment.

Therefore:

“AMR policy should be built around prevention first, responsible treatment second.”

Prescription-only access must not become a barrier to legitimate treatment.

A farmer with a sick animal must be able to obtain veterinary care.

A patient with a bacterial infection must be able to obtain appropriate medical treatment.

The policy objective should therefore be:

“Control inappropriate access, not legitimate treatment.”

Government should ensure that prescription controls are accompanied by adequate availability of qualified doctors, veterinarians, diagnostic services and essential medicines.

National AMR policy should not measure success by looking at one sector in isolation.

A comprehensive national dashboard should progressively monitor:

1. Human antimicrobial consumption
2. Veterinary antimicrobial consumption
3. Antimicrobial sales
4. Prescription compliance
5. Antimicrobial resistance patterns
6. Foodborne resistant organisms
7. Relevant antimicrobial residues
8. Hospital prescribing
9. Community prescribing
10. Veterinary prescribing
11. OTC sales
12. Online antimicrobial sales
13. Antimicrobial use in food-producing animals
14. Environmental AMR indicators

Such information would allow policymakers to identify where intervention is actually required rather than relying on assumptions or sector-specific perceptions.

PVPA recommends strengthening coordination among:

• Ministry of National Health Services, Regulations & Coordination
• Drug Regulatory Authority of Pakistan (DRAP)
• Ministry of National Food Security & Research
• Provincial Health Departments
• Provincial Livestock Departments
• Pakistan Medical & Dental Council
• Pakistan Veterinary Medical Council
• Pharmacy regulatory authorities
• Food-safety authorities
• Environmental authorities
• Medical and veterinary professional bodies
• Pharmaceutical and veterinary pharmaceutical industries
• Universities and research institutions
• Diagnostic laboratories

A national AMR response should be based on shared responsibility, shared data and coordinated enforcement.

The poultry and veterinary sectors should accept evidence-based scrutiny wherever inappropriate antimicrobial use is identified.

At the same time, policy should be based on evidence covering the entire antimicrobial-use landscape.

It is neither scientifically appropriate nor consistent with the One Health concept to discuss antimicrobial use in poultry while ignoring inappropriate access, prescribing and dispensing in human medicine.

The answer is not to shift responsibility from one sector to another.

The answer is to establish one national antimicrobial stewardship framework covering all relevant sectors.

Pakistan has an opportunity to transform the AMR debate from a sectoral controversy into a coordinated public-health programme.

A strong national policy would combine:

Prescription control + professional accountability + diagnostics + prevention + surveillance + public awareness + enforcement.

This would provide a practical framework for reducing inappropriate antimicrobial use while protecting access to essential treatment.

The Pakistan Veterinary Pharmaceuticals Association supports the development and effective enforcement of a One Health, prescription-only antimicrobial framework in Pakistan covering both human and veterinary medicine.

The Association calls upon the Government and relevant regulatory authorities to:

1. Strengthen prescription-only control of antibiotics in human medicine.
2. Strengthen and enforce prescription-based veterinary antimicrobial use.
3. Address OTC and unregulated online antimicrobial sales.
4. Establish integrated human and veterinary antimicrobial-use surveillance.
5. Strengthen diagnostic and laboratory capacity.
6. Promote vaccination, biosecurity, infection prevention and responsible husbandry.
7. Establish coordinated enforcement involving health, veterinary, pharmaceutical, food and environmental authorities.
8. Ensure that legitimate patients and animals retain timely access to essential antimicrobial treatment.

AMR does not respect the boundaries between a hospital, a veterinary clinic, a poultry farm, a livestock farm, a pharmacy or the environment.

Our response should not be divided by those boundaries either.

If AMR is a One Health challenge, antimicrobial stewardship must be a One Health responsibility.

Pakistan can protect the effectiveness of essential antibiotics for future generations by ensuring that these medicines are used responsibly wherever they are prescribed, dispensed and administered.