KARACHI: Doctors across Pakistan are prescribing more than twice the number of medicines recommended by the World Health Organization, according to a new study that also found generic drug prescribing remains rare nationwide.
The research, conducted by the Health Services Academy in Islamabad and published in the journal Discover Public Health, analyzed 15 studies on prescribing practices at hospitals and clinics in Punjab, Khyber Pakhtunkhwa, Sindh, Balochistan and Islamabad between 2013 and 2024. The goal was to measure how closely Pakistani doctors follow WHO prescribing standards.
Key findings
Patients received an average of 4.2 medicines per prescription, more than double the WHO-recommended range of 1.6 to 1.8. At one tertiary care hospital in Peshawar, the average reached 10.56 medicines per prescription, nearly six times the WHO benchmark. Even the lowest average recorded, from an emergency department in Bahawalpur, exceeded WHO limits.
Generic drugs accounted for only about 25% of prescriptions, far below the WHO's 100% target. Some hospitals reported generic prescribing rates near zero, and just two of the 15 studies found rates above 50%.
Antibiotics appeared in 45% of prescriptions on average, compared with a WHO-recommended range of 20% to 26.8%. Injections were included in more than 27% of prescriptions, also above the WHO limit of 13.4% to 24.1%, though rates varied widely by facility, from zero to 98%.
Researchers also found that only 72% of prescribed medicines came from Pakistan's essential medicines list, which is meant to guide prescribing decisions nationwide.
A nationwide pattern
Prof. Shahzad Ali Khan, vice chancellor of the Health Services Academy and a co-author of the study, said the trend held true across every type of facility examined, from small clinics to large teaching hospitals. He described the problem as systemic rather than isolated to any single institution or region.
According to Khan, doctors often prescribe antibiotics and injections without adequate testing, partly in response to patient expectations. Many patients, he said, believe injections and antibiotics work faster than other treatments, and time-pressed physicians frequently comply with those requests rather than push back.
Part of a broader resistance concern
The findings add to mounting alarm over antibiotic misuse in Pakistan. Federal health officials said earlier this year that antimicrobial resistance among priority bacteria and fungi could kill more than 262,000 people in the country over the next 25 years, according to a report. In response, Pakistan has developed a national Priority Pathogen List intended to help hospitals prioritize drug-resistant infections.
The Drug Regulatory Authority of Pakistan has also moved to restrict antibiotic sales to prescriptions from registered doctors, after data showed Pakistanis consumed roughly Rs135 billion worth of antibiotics in a single year, with 70% to 80% of that use tied to illnesses that did not require antibiotics at all.
Why generics lag behind
Khan attributed the low use of generic medicines partly to aggressive marketing by pharmaceutical companies and partly to a persistent belief among both doctors and patients that generics are less effective than branded drugs, despite no evidence supporting that view.
He noted that Pakistan already has prescribing guidelines in place but said enforcement remains virtually nonexistent. The core issue, he said, is not a lack of policy but a failure to apply existing rules in everyday practice.
Recommendations
The study calls for routine audits of prescribing practices, structured feedback for physicians, and disciplinary measures for repeat violations. It also urges coordinated action among the government, pharmaceutical companies, hospitals and medical associations.
Khan said meaningful change will require the health ministry, provincial health departments and the broader medical profession to act in concert. Without that collaboration, he warned, patients will continue receiving more medication than necessary, and antibiotics will keep losing effectiveness against disease.
