Factors Leading to Acquired Bacterial Resistance Due to Antibiotics in Pakistan

This resistance is due to the change in nature of the bacteria and becomes severe due to several multiplications of bacterial generations which cause destruction in human body [1]. Another most common cause of antibiotic resistance in Pakistan is that the patients get antibiotics from medical stores without the physician’s |description [2]. Antibiotic consumption in Pakistan between 2000 and 2015 increased 65% from 800 million defined daily doses (DDD) to 1.3 billion DDD. The antibiotic consumption rate in the country witnessed a surge from 16.2 DDD to 19.6 DDD per 1,000 inhabitants per day [3]. Multidrug resistance (MDR) is increasing day by day in Pakistan [1]. A study found that Pakistan was the third highest consumer of antibiotics after India and China among the 76 lowand middle-income countries it surveyed [4] (Figure 1). Abstract Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Bacteria, not humans or animals, become antibiotic-resistant. Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth. Antibiotic resistance is a major concern of overuse of antibiotics. In other words bacteria are resistant and are able to multiply in the presence of therapeutic levels of an antibiotic. Antibiotic resistance has become a major issue in the 21st century and is posing as a major blip on the danger radar. Pakistan being one of only three polio-suffering countries is also suffering from bacterial resistance caused by poor use of Antibiotics. Being a third world country, Pakistan suffers from avoidable causes of antibiotic resistance but lacks the basic necessities which provides favorable environment to bacteria and produce resistance to its killer/inhibitor. Following article focuses primarily on the factors leading to acquired bacterial resistance to Antibiotics in Pakistan.

Due to the poor economic and lack of basic health facilities Fast relive is the only main concern [8].   (9.5%). Erythromycin and Ampicillin/cloxacillin were used by 6.7% and 6.2% of the sample population respectively and other antibiotics were amongst the less frequently used antibiotics [12,5] ( Figure 3).

Antibiotic Use Other than Humans
Pakistan is an agricultural country and It is seen in Pakistan that use of antibiotic use is not only restricted to humans only. Sprays of antibiotics used on plants and livestock to increase their mass and yields is increasing the antibiotic resistance among the population.
Antibiotics are essential for control of bacterial diseases of plants, especially fire blight of pear and apple and bacterial spot of peach.
Streptomycin is used in several countries; the use of oxytetracycline, oxalinic acid and gentamicin is limited to only a few countries.

Springtime antibiotic sprays suppress pathogen growth on flowers
and leaf surfaces before infection; after infection, antibiotics are ineffective. Antibiotics are applied when disease risk is high but in Pakistan it is used to obtain high yield and faster harvest to sale of fruits and vegetables ignoring the fact that these antibiotics are producing resistant in bodies of those who intake these produce.
Livestock are also victims of misuse antibiotics to relieve of even non-serious diseases for fast recovery [13] ( Figure 4).

Antibiotics Resistance Due to poor quality of Drugs
It is important to note that poor quality medicine can be critically damaging to public health in many ways beyond

Causes of Antimicrobial Resistance
To better appreciate the causes of AMR, we need to understand the various sequential steps involved for a drug to get to a patient and the eventual use, which include; production, distribution, prescription, dispensing, and finally consumption of the drug by the patient or use in animal production. Consequently, any imprudent practice along this flow may result in the emergence of resistance [15].

Drug dispensers and drug quality
the lack of appropriate regulations in the sales of antimicrobials is also a driving factor in the access and misuse of antimicrobials.
In most developing countries, antimicrobials can be purchased

Veterinary Medicine
Main Another guideline is to implement methodologies that help to establish associated risk factors and assess the risk of antibiotic resistance [22].

Water, Sanitation, Hygiene
Infectious disease control through improved water, sanitation and hygiene (WASH) infrastructure needs to be placed at the center of the antimicrobial resistance (AMR) agenda. The spread of infectious diseases caused by inadequate WASH standards is a major driver of antibiotic demand in developing countries [23].
Growing usage of antibiotics together with persistent infectious disease levels have led to a dangerous cycle in which reliance on antimicrobials increases while the efficacy of drugs diminishes [23].

Water Pollution
An increase in hand washing compliance by hospital staff results in decreased rates of resistant organisms. Antibiotic resistance is a growing problem among humans and wildlife in terrestrial or aquatic environments. In this respect, the spread and contamination of the environment, especially through water pollution "hot spots" such as hospital wastewater and untreated urban wastewater, is a growing and serious public health problem [24,25]. Antibiotics have been polluting the environment since their introduction through human waste (medication, farming), animals, and the pharmaceutical industry [26]. The contribution of the pharmaceutical industry is so significant that parallels can be drawn between countries with highest rate of increasing antibiotic resistance and countries with largest footprint of pharmaceutical industry. As bacteria replicate quickly, the resistant bacteria that enter water bodies through wastewater replicate their resistance genes as they continue to divide. In addition, bacteria carrying resistance genes have the ability to spread those genes to other species via horizontal gene transfer. Therefore, even if the specific antibiotic is no longer introduced into the environment, antibioticresistance genes will persist through the bacteria that have since

Transmission of Antibiotic Resistance
It has been noted and observed by many experts that overuse