Analysis of the Antimicrobial Market in Pakistan: Is It Really Necessary Such a Vast Offering of “Watch” Antimicrobials?

Abstract

Understanding antimicrobials (AM) on offer in a pharmaceutical market, with a particular reference to drugs categorized as "Watch" active ingredients, is one of the important first steps to prevent their potentially inappropriate use. The March 2019 data of all AM containing registered brands and presentations currently being sold in the country for the J01 Anatomical Therapeutic Chemical (ATC) subgroup from IQVIA Pakistan was used. Each AM was categorized as "Access," "Watch," or "Reserve," according to the WHO AWaRe classification. There were 59 single chemical entities and 14 combinations with 1869 brands and 4648 presentations. The WHO Essential Medicines List included 35 J01 AM while an additional 38 single and combination AM with 425 brands and 977 presentations were present in the country. Looking at the whole list of marketed AM, 8 of the 10 AM with more than 60 brands were classified as "Watch", offering 962 brands and 2418 presentations. Most AM marketed in Pakistan, of which there are an excessive number of brands, belong to the "Watch" AWaRe category. The higher the number of brands, the higher the marketing pressure on prescribers and pharmacists will be which implies more potential confusion. One vital step to rationalize the use of AM lies in reviewing their market offer.

Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014–2018: Findings and Implications from ESAC-Net and WHO Europe

“…In the absence of indication-linked information on antibiotic use, the WHO AWaRe classification allows a more detailed analysis of aggregated data and opportunities for stewardship activities ( Sharland et al, 2019 ). The AWaRe classification has been applied to patterns of total antibiotic consumption globally in 2015 ( World Health Organization, 2018 ), changes over time between 2000 and 2015 ( Klein et al, 2020 ), analyses of pediatric antibiotic sales data ( Hsia et al, 2019a ), published studies of antibiotic use in low- and middle-income countries ( Sulis et al, 2020 ), analyses of national consumption estimates ( McGettigan et al, 2017 ; Malik and Figueras, 2019 ; Public Health Agency of Canada, 2020 ) and patterns of consumption in hospitals ( Schweickert et al, 2018 ; Hsia et al, 2019b ).…”

Mapping the Antimicrobial Supply Chain in Bangladesh: A Scoping-Review-Based Ecological Assessment Approach

“…This high level of market offering of Watch antibiotics as opposed to the Access group has been observed also in India and Pakistan. 77 , 78 The target of the AWaRe categorization is 3-fold: achieve an increase in the use of Access antibiotics, the group associated with the lowest potential to induce AMR, to 60% by 2023; decrease the use of Watch antibiotics; and restrict Reserve antibiotics to infections caused by drug-resistant infections. 14 This target may be challenging in contexts with a large proportion of licensed antibiotic products being of the Watch category and with unrestricted access via over-the-counter sales of antibiotics, with implications for antimicrobial stewardship programs.…”

“…14 This target may be challenging in contexts with a large proportion of licensed antibiotic products being of the Watch category and with unrestricted access via over-the-counter sales of antibiotics, with implications for antimicrobial stewardship programs. 78 …”

Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005–17: A systematic analysis of user characteristics based on 132 national surveys from 73 countries

“…Second, many countries implemented programs to extend the reach of health services to underserved populations during this period (WHO, 2019;Wehrmeister et al, 2020): for example, the integrated community case management (iCCM) program aimed at extending the coverage of essential fever-care services to remote rural areas, including antibiotics for suspected pediatric pneumonia cases (Diaz et al, 2014). Third, and importantly, there has also been increasing availability of antibiotics in these settings (McGettigan et al, 2017;Malik and Figueras, 2019), especially in South-East Asia where the most substantial increases in reported antibiotic use were seen among sick children aged <5 years in the various user groups. While this indicates improving antibiotic access even among marginalized groups, the increasing antibiotic availability in South-East Asia could also raise concern, given the ubiquity and high levels of consumption of broad-spectrum antibiotics in the region (Nguyen et al, 2020;Do et al, 2021).…”