Healthcare providers’ knowledge, attitude, and practice of antibiotic use and antimicrobial resistance in Southern Pakistan: a qualitative study

Background: Antimicrobial resistance (AMR) is a serious global health concern. In Pakistan, the unregulated sale of antibiotics and socioeconomic challenges compound the issue, driving high rates of drug-resistant infections. This study examines the knowledge, attitudes, and practices of healthcare providers regarding unregulated antibiotic use in Pakistan. Methods: Using purposive sampling, nearly 20 respondents were selected, and qualitative data were collected through semi-structured interviews and field notes with doctors, quacks, and pharmacists. Results: Five significant themes in Pakistan's healthcare system that propel antibiotic abuse were revealed through thematic analysis. The first theme is on administrative and structural vulnerabilities, including political influence, weak regulation, and a lack of monitoring and audit. The second theme identifies the unrestricted power of pharmaceutical businesses and drug stores, which promotes non-prescriptive sale of antibiotics and money-motivated recommending. The third theme reveals critical shortages in competent and skilled health practitioners and diagnostic services, leading to dependence on unqualified practitioners and the application of practical antibiotics. Theme four reveals practitioners' ethical practices and restricted information and skills in rational prescribing. The final theme documents financial limitations that hinder diagnostic testing of infections and drive patient pressure for quick antibiotic interventions. Conclusion: All these themes collectively represent the entrenched systemic, economic, and professional issues that lead to antibiotic abuse. The study advocates for a more effective and comprehensive approach to mitigating AMR by addressing these structural inequalities.