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Objectives: This multicenter study, conducted from a One Health perspective, aimed to comprehensively examine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections and their biofilm-forming capabilities in Pakistan. Phylogenetic analysis of the study isolates was also performed., Methods: A total of 150 MRSA isolates were screened from various clinical samples using Cefoxitin antibiotic discs. Genotypic confirmation was conducted through mecA, S. aureus-specific nuc, and 16S rRNA genes. Biofilm formation was assessed using Congo red agar (CRA) and slime layer quantification methods. The intercellular adhesion (ica) operon genes, specifically icaA and icaD, were detected. Phylogenetic analysis utilized the 16S rRNA sequences. Statistical associations between various parameters were determined using chi-square analysis., Results: The presence of the mecA gene was observed in 131 out of 150 isolates (87.3%). CRA identified 28% and 40% of isolates as strong and moderate biofilm producers, respectively, while 9.3% were classified as non-biofilm producers. The slime layer assay exhibited higher sensitivity, classifying only 4.7% of isolates as non-biofilm producers. Biofilm-forming genes icaA and icaD were detected in 85.3% and 86.7% of the isolates, respectively. Antibiotic resistance was more prevalent among biofilm-forming isolates, particularly against ciprofloxacin, levofloxacin, erythromycin, trimethoprim-sulfamethoxazole, and fosfomycin. Ceftaroline demonstrated efficacy irrespective of biofilm-forming abilities. Conversely, non-biofilm producers exhibited complete susceptibility to clarithromycin and tigecycline., Conclusions: Clinical MRSA strains exhibit a substantial potential for biofilm formation, contributing to a resistant phenotype. Routine antibiotic testing in clinical settings that overlook the biofilm aspect may lead to the failure of empiric antibiotic therapy., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2024. Published by Elsevier B.V.)

Antibiotics in aquatic systems of developing countries are a growing concern, particularly with the potential ecological risks and emergence of antimicrobial resistance. In Pakistan, antibiotics are widely consumed and released untreated into rivers, however, there is little information on their occurrence and potential risks. In this study, the concentrations and risk assessment of three commonly consumed antibiotics, ciprofloxacin (CIP), amoxicillin (AMX), and cefixime (CFM) belonging to different classes of fluoroquinolone, penicillin, and cephalosporin respectively were investigated in the Kabul River and its two tributaries, Bara River and Shah Alam River in the northwest region of the country. Composite samples were collected in different sampling campaigns and analyzed using the LC-ESI-MS/MS technique. All three antibiotics were found in higher concentrations ranging from 410 to 1810 ng/L, 180-850 ng/L, and 120-600 ng/L for CIP, AMX, and CFM respectively. The Friedman and Wilcoxon signed-ranked tests revealed insignificant differences in average concentrations of each antibiotic in the three rivers and the Pearson Correlation showed a significant positive correlation of CIP with both AMX and CFM indicating their similar pollution sources. Ecotoxicological risk assessment showed a higher risk to algae and bacteria (P. putida) in the rivers with CIP posing a greater risk. The potential risk of antimicrobial resistance development (ARD) was higher in all the three rivers, particularly in Kabul River where maximum risk quotients (RQ ARD ) of 28.3, 9.4 and 3.4 were noted for CIP, CFM and AMX respectively. The human health (HH) risk was insignificant, though the RQ HH was higher for the lower age groups (0-3 months). In addition, the combined flux of the antibiotics in the Kabul River was estimated as 59 tons/year with CIP having a significant flux relative to the other antibiotics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations., Competing Interests: Declaration of Competing Interest The authors confirm that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Antimicrobial resistance (AMR) is a global threat that affects 700,000 lives every year and could lead to 10 million deaths every year by 2050. World Health Organization (WHO) has instituted a global action plan in 2015 to deal antimicrobial resistance in the 68th World Health Assembly. This paper aimed to review the situation analysis of current bottlenecks of the health system and provision of recommendations to improve the current regulatory mechanism for antimicrobial drugs in Pakistan. Antimicrobial Resistance (AMR) emerged as a threat practically in all nations of the world including Pakistan which is the world's sixth most populous country. This qualitative document analysis has been done by using Pakistan's National Policy on AMR. In 2004, total expenditure on pharmaceuticals was 1844 million US$ with a total pharmaceutical expenditure per capita of 11.3US$. Total number of pharmacists licensed was10,000 technician and assists were 20,000 and licensed pharmacies were 7000. There are only 0.9 pharmacists per 100000 populations are deployed. The health system and society are at risk of an emerging epidemic of AMR. This investigational analysis of AMR control, policy and regulation in Pakistan highlights some facts about misuse, availability of over the counter medicine, self-medications and low effect of existing approaches. Drug prescription monitoring law and policy investment is needed in the regulation of drugs to reduce unnecessary drug consumption and prescription, and strengthening quality parameters at several levels to control epidemic of AMR.

Background. Antibiotic resistance is mostly brought about through antibiotic self-medication, which is a common issue in impoverished countries. The most at-risk group is children, while there is no protection evidence released for them. Due to a lack of proper knowledge, parents often inappropriately administer antibiotics to their children. Objectives. The current study aims to evaluate the parents' knowledge of antibiotic use and their knowledge of the medical conditions for which self-medication is used. Material and methods. A cross-sectional descriptive study was carried out in parents. Parents' direct interviews and self-administered questionnaires were used to gather the data. Descriptive analysis and chi-square tests were performed to determine the significance of these findings using IBM SPSS Statistics version 22. Results. There were 1,034 individuals who self-medicated their children in total. Male participants outnumbered female participants by a small margin. In the past 12 months, 88.6% of parents gave antibiotics to their children. Pharmacy advice and past prescriptions were the main causes of this behaviour, whilst cough, fever and tooth discomfort were the conditions for which antibiotics were prescribed. Throughout the course, 45.5% of patients changed antibiotics on their own. Conclusions. The findings of this study underscore the urgent need to address the issue of self-medication of antibiotics in children, emphasising the potential harm it can cause. Parents often resort to self-medication without a proper understanding of the underlying causes of their children's illnesses, relying on antibiotics as a panacea. To mitigate this practice and protect the well-being of children, it is imperative to implement a multifaceted approach involving regulatory measures and educational initiatives beyond the scope of pharmacist interventions. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of conservative and operative management of diabetic foot having bone involvement. Study Design: Quasi-experimental study. Place and Duration of study: Combined Military Hospital, Rawalpindi Pakistan, from May to Dec 2022. Methodology: The study included all the patients with neuropathic diabetic foot ulcers worsened by bone involvement/osteomyelitis. All the included patients were divided randomly into two equal groups, A and B (Conservative and Operative Management Groups, respectively). They were followed up for the study period to assess the healing of the wound. All the participants of the study were given antibiotics. Outcome measures were the proportion of patients achieving primary wound healing, hospitalization time, and wound healing time. Results: In our study, we included 302 patients, amongst which 206(68.20%) were male subjects and 96(31.80%) were female subjects. The mean age was 33.89±7.57 years. The proportion of patients achieving primary wound healing in the Conservative Management-Group was 121(80.13%), and in the Operative Management-Group, it was 132(87.42%) (p=0.086). However, the difference between the duration of hospitalization and the time of wound healing was statistically insignificant (p-values of 0.199 and 0.538, respectively). Conclusion: Conservative management with antibiotics alone may be a good alternative to operative management, avoiding surgical complications and costs. [ABSTRACT FROM AUTHOR]