Apni Marzi Se Dawai: Antibiotics, Self-Medication and Resistance in Pakistan

In most of Pakistan you can describe a symptom at a medical store counter and walk out with an antibiotic in under two minutes. A simulated-client study across community pharmacies in Hazara Division found 96% dispensed antibiotics without any prescription; other work puts non-prescribed supply lower but still substantial (PLOS ONE). The most commonly dispensed indications were respiratory (34.3%) and gastrointestinal (16.8%) infections — both usually self-limiting, i.e. conditions that mostly get better on their own.

At a glance

• 96% of pharmacies in one study dispensed antibiotics with no prescription
• The commonest reasons — coughs, colds, sore throats, ordinary diarrhoea — are mostly viral, and antibiotics do nothing for viruses
• Every unnecessary course makes the next infection harder to treat
• Pakistan already has XDR typhoid resistant to almost every oral option — see our typhoid guide
• Stopping a course early because "I feel fine" actively selects for resistant bacteria
• A pharmacist is a genuine clinical professional — ask them properly rather than treating the counter as a vending machine

Antibiotic kis cheez par kaam karta hai — aur kis par nahi

Antibiotic sirf bacteria ko marta hai. Virus par is ka koi asar nahi. Aur yeh cheezein zyada tar virus se hoti hain:

• Aam zukam aur naak behna — hamesha virus
• Zyada tar khansi — virus, aur do se teen haftay lag sakte hain khud theek hone mein
• Gala kharab — zyada tar virus. Sirf kuch soorton mein (strep throat) antibiotic chahiye hota hai, aur us ka faisla test ya doctor karta hai
• Flu / mausami bukhar — virus
• Bachon mein dast — zyada tar virus; ilaj ORS hai, antibiotic nahi. Dekhen bachon ke dast

Antibiotics genuinely are needed for things like bacterial pneumonia, urinary tract infections, typhoid, tuberculosis, wound infections, and bacterial meningitis. The point is not that antibiotics are bad — they are one of medicine's great achievements — it is that using them when they cannot help costs you the times they could.

Why resistance is not an abstract problem here

Bacteria that survive a partial or unnecessary course multiply, and their resistance spreads. This is not a distant future risk in Pakistan: extensively drug-resistant (XDR) typhoid emerged here and is resistant to nearly all oral antibiotics, so treatment that once meant a course of tablets at home now often means injections in hospital. The same trajectory is visible in urinary and wound infections, where cultures increasingly come back resistant to first-line drugs.

The practical consequence is simple: the more often you take antibiotics you didn't need, the fewer options exist on the day you genuinely need one.

Sahih tarika — using antibiotics properly

• Sirf doctor ke kehne par lein. Padosi ki bachi hui dawai, ya pichli baar wali parchi, aap ki bimari ke liye nahi hai
• Poora course mukammal karen — jab tak doctor na kahe. Do din mein aaram aa jane ka matlab bacteria khatam hona nahi
• Waqt par lein, mukarrar wafqe se
• Khane ke sath ya khali pet — jo hidayat ho, us par amal karen; kuch antibiotics doodh ya calcium ke sath jazb nahi hote
• Bachi hui dawai sambhal kar na rakhen agle bukhar ke liye
• Allergy batayen — khas taur par penicillin
• Doosri dawaiyan batayen, khas taur par blood thinner, mirgi ki dawai aur mane'-e-hamal goliyan, jin par asar parta hai
• Bachon ki khuraak wazan se tay hoti hai — bare ki dawai aadhi kar ke bache ko dena mahfooz nahi

Beyond antibiotics: the wider self-medication problem

• Steroids — sold freely for aches and "kamzori"; long use causes diabetes, hypertension, bone loss, ulcers and adrenal suppression
• Painkillers — regular NSAIDs damage the kidneys and stomach, and daily use causes medication-overuse headache
• Injections on demand — no faster for most conditions, and unsafe injection practice spreads hepatitis B and C. This is one of Pakistan's major hepatitis drivers
• Unlabelled herbal and "desi" mixtures — some contain undeclared steroids or heavy metals
• Cough syrups for young children — little benefit and real risk

What a pharmacist is actually for

A qualified pharmacist can tell you whether your symptoms need a doctor at all, check interactions with what you already take, explain how and when to take a medicine, flag a dose that looks wrong for a child's weight, and advise on side effects. That is a clinical service, and it is under-used because the counter is treated as a shop. You can find pharmacists on DoctorOS and ask properly.

Find care: browse pharmacists near you on DoctorOS — filter by city, distance and rating, and book without a phone call.

Frequently asked questions

Bukhar hai — kya antibiotic le lena chahiye?

Nahi, pehle wajah samajhni chahiye. Zyada tar bukhar virus se hota hai aur khud theek ho jata hai. Pakistan mein bukhar ki kuch wajuhat — typhoid, malaria, dengue — bilkul mukhtalif ilaj mangti hain, aur dengue mein to ghalat dawai khatarnak hai. Agar bukhar teen din se zyada rahe, bohat tez ho, ya sath mein saans ki takleef ya be-hoshi ho, to doctor ko dikhayen — medical store ko nahi.

Doctor ne 7 din ka course diya, main 3 din mein theek ho gaya. Baqi chhor dun?

Nahi, poora karen — jab tak doctor khud na kahe. Teen din mein alamat khatam hone ka matlab yeh nahi ke bacteria khatam ho gaye. Jo bache rehte hain woh sab se zyada mazboot hote hain, aur agli baar wohi dawai kaam nahi karti.

Is a "stronger" antibiotic better?

No. The right antibiotic is the narrowest one that covers the organism you actually have — ideally guided by a culture. Broad-spectrum drugs used casually wipe out protective gut bacteria and breed resistance faster, which is why they are held in reserve.

My child is prescribed antibiotics for every cold. Should I question that?

Yes, politely. Ask: "Do you think this is bacterial, and what would change if we waited 48 hours?" A good clinician will welcome the question. Some will also offer a delayed prescription — fill it only if things worsen — which is a well-established, evidence-backed compromise.

Sources

• "Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study," PLOS ONE — 96% dispensed without prescription
• "Self-Medication with Antibiotics: Prevalence, Practices and Related Factors among the Pakistani Public" (PMC)
• "Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan" (PMC)
• World Health Organization — Antimicrobial resistance

For practitioners: if you're a pharmacist, general physician or infectious disease specialist in Pakistan, list your practice free on DoctorOS and start taking bookings from patients who are searching for exactly this kind of care.

Cover image: Fall Coloured Pills by Martin Cathrae, licensed under CC BY-SA 2.0.