Islamabad: Pakistan is edging towards a post-antibiotic era where routine infections may no longer respond to treatment, the latest GLASS surveillance indicates, as drug resistance levels in South Asia surge to some of the highest in the world and nearly one in three common infections no longer respond to standard antibiotics.
WHO’s new data in ‘Global antibiotic resistance surveillance report 2025’ released official on Monday warns that resistance to essential drugs is rising faster than new treatments are being developed, with more than 40 percent of E. coli and over 55 percent of Klebsiella pneumoniae samples worldwide now resistant to third-generation cephalosporins, the same antibiotics relied upon in Pakistani hospitals.
Health officials say South-East Asian and Eastern Mediterranean countries are reporting the fastest rise in antimicrobial resistance, with WHO cautioning that nations with weak diagnostic systems and unregulated antibiotic access may face the worst consequences. Global infectious disease experts warn that if resistance to carbapenems and fluoroquinolones continues unchecked, routine childbirth, appendicitis and chest infections could once again become fatal, mirroring the pre-antibiotic era.
Tertiary care hospitals in Karachi, Lahore and Peshawar are already reporting failure of ceftriaxone and ciprofloxacin in treating typhoid, urinary tract infections and pneumonia. More than half of Klebsiella pneumoniae and E. coli isolates linked to abdominal and urinary infections are now resistant to third-generation cephalosporins, forcing a shift to last-line injectable drugs meant only for critical care.
Neonatal wards in Rawalpindi and Karachi report that premature babies admitted with sepsis are now being started on meropenem and colistin as first-line therapy because routine antibiotics no longer work. Post-delivery infections among women are also taking longer to respond, increasing both recovery time and treatment cost.
Dr Syed Faisal Mahmood, Infectious Diseases consultant at AKUH, said the crisis is being fuelled by unrestricted over-the-counter sales. “This is the main problem. Legislation exists but is not enforced. These medicines should be available, but only when prescribed by someone who understands the risks and long-term consequences,” he said.
Antibiotics are also being routinely used in poultry and livestock feed to promote faster growth. Public health experts say residues from these drugs pass through meat, milk and water and quietly contribute to resistance in the wider population.
Officials in the National Institute of Health (NIH) Islamabad said the fight against resistance begins before hospital admission. “If clean water, sanitation and hygiene are ignored, people will keep acquiring infections and demanding antibiotics even when they are not needed. Improving WASH and infection prevention is essential to reduce antibiotic demand,” an Infectious Diseases expert at NIH said.
Renowned Infectious diseases expert and former federal health minister Dr Faisal Sultan warned that banning antibiotics outright is not the answer. “Fluoroquinolones can be life-saving in specific situations, so their availability is important. The solution is not to halt production but to make prescribing and dispensing more controlled,” he said.
He maintained that sudden restrictions without clinical judgment are blunt instruments. “Appropriate prescribing is a fine instrument. Systems must be sensitised so these drugs are used with full understanding of their toxicities, especially in children and elderly patients.”
Surgeons in Lahore say appendix and gallbladder surgeries are now leading to resistant post-operative infections despite antibiotic prophylaxis. In government hospitals, nearly one in three urinary infections no longer responds to oral treatment and requires intravenous therapy.
Pakistan’s laboratory capacity to track resistance remains limited. Most district hospitals lack culture testing facilities, leaving physicians to prescribe blindly. WHO has warned that resistance is spreading fastest in places where diagnosis is weakest.
NIH official maintained antimicrobial stewardship must be integrated across sectors. “Hospitals must enforce infection control protocols, pharmacies must be regulated, livestock use monitored and the public educated. Unless DRAP and provincial authorities enforce rules on antibiotic sales and misuse, resistance will keep spreading silently,” they added.
With more than 40 percent of Acinetobacter and Klebsiella isolates in ICU settings now resistant even to carbapenems, infectious disease specialists fear that Pakistan may soon face deaths not because medicines do not exist, but because the drugs that exist no longer work.
Ends