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Introduction: The emergence and spread of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in World Health Assembly. Pakistan’s national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan. Methodology: A narrative review of the five components of the Pakistan NAP has been taken based on the publications known to the co-authors. The suggestions have been made on the basis of that to reduce the burden of the AMR. Areas Covered: This review discusses some of the challenges in implementation of the NAP for AMR including different opinions and views of key stakeholders, concerns with lack of diagnostic facilities and financial resources and continued wide and suboptimal use of antimicrobials in human and animal health as well as food production. Expert Opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan.

Background: Chronic myelogenous leukemia (CML) is potentially curable disease of white blood cells (WBCs) especially granulocytes. Our objective was to evaluate comparative efficacy and safety of two chemotherapy protocols i.e. hyper-CVAD and MEC in patients with CML who were unresponsive to conventional therapies. Methods: A retrospective study was performed among 60 patients with blast crisis phase of myelogenous leukemia (CML) who are the candidates of allogeneic stem cell transplant (ASCT) where half of the patients were treated with hyper-CVAD and half with MEC chemotherapy protocol. Data was analyzed using SPSS (Statistical program for social sciences). Results: Both hyper-CVAD and MEC chemotherapy protocols produced a decrease in neutrophil and platelet count. Blast crisis is also associated with thrombocytopenia. So, these regimens further decrease the platelet count in blast crisis and their efficacy is questionable. Allogenic stem cell transplant is a better option and assessment of its effectiveness may be studied. In case of SGOT and SGPT, hyper-CVAD produced significant elevation whereas MEC effect was variable showing statistically insignificant elevation. Both protocols showed increase in the level of blood urea nitrogen and serum creatinine. In case of efficacy parameters hyper-CVAD showed greater response than MEC protocol. Higher molecular response of 70% was found with hyper-CVAD as compared to 60% of MEC protocol. Cytogenetic response was also higher in hyper-CVAD group. Conclusion: Due to higher efficacy and tolerable toxicity profile of hyper-CVAD chemotherapy protocol, it can be considered as standard therapeutic option whereas MEC chemotherapy protocol can be reserved as an effective alternative in cases where the disease is less aggressive or less tolerable to hyper-CVAD. However, hepatic parameters must not be overlooked while considering any of these protocols and possible adjustments should be made accordingly.

Objective The purpose of this cross-sectional study conducted in different private and public sector hospitals of the major cities of Nepal and Pakistan was to compare and evaluate the antibiotic prescribing patterns. Methodology The data was collected based on prescriptions received from different hospitals of Lahore, Pakistan and Kathmandu, Nepal without much interaction with the patients. Results Out of a total of 272 patients, 111 (40.8%) patients from Nepal and 161 (59.19%) patients from Pakistan were prescribed with 447 antibiotics. In both countries, out of total antibiotics prescribed, 42.30% were 3rd generation cephalosporins. Also, in Pakistan and Nepal, out of all the indications, 49.2% of the antibiotics were given in medical prophylaxis. Conclusion In Pakistan, the antimicrobial prescription rate is comparatively higher than Nepal, and in both countries, there is a need of proper implementation of antibiotic prescribing guidelines for the prescription of antibiotics and the administration of antibiotics in medical prophylaxis.