{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:08:33Z","timestamp":1783098513117,"version":"3.54.6"},"reference-count":75,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Deanship of Graduate Studies and Scientific Research at Qassim University, Saudi Arabia","award":["QU-APC-2025"],"award-info":[{"award-number":["QU-APC-2025"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,11,3]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/objectives<\/jats:title>\n                    <jats:p>Community-acquired pneumonia (CAP) imposes a significant health burden among low- and middle-income countries. The burden is exacerbated by antimicrobial resistance (AMR), often due to inappropriate antibiotic agent use and gaps in antimicrobial stewardship activities. This study aimed to explore physicians\u2019 perspectives on the diagnosis, treatment and prevention of CAP in Pakistan, with a focus on how international guidelines are interpreted and adapted to local clinical realities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study was conducted using semistructured interviews with 33 purposively selected physicians from various specialties, followed by a focus group discussion with 19 of them. Data were analysed through thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four cross-cutting themes were identified: (1) selective use of diagnostic agents based on severity and access; (2) pragmatic empiric prescribing influenced by resistance trends and antibiotic availability; (3) stewardship intentions constrained by delayed diagnostics and limited infrastructure and (4) underutilisation of preventive strategies including adult vaccinations due to cost and policy gaps. Physicians were aware of Infectious Diseases Society of America\/American Thoracic Society guidelines but adapted them to local challenges and AMR concerns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most physicians were unaware of the exact prevalence of causative pathogens and their resistance patterns in Pakistan due to the unavailability of robust local data. Consequently, international guidelines were adapted to local challenges including resistance patterns, limited diagnostics and resource constraints. Physicians prioritised beta-lactam antibiotics use and restricted moxifloxacin and azithromycin to mitigate resistance propagation linked to multidrug-resistant tuberculosis and extensively drug-resistant typhoid. Efforts to improve antimicrobial utilisation for CAP in Pakistan need to address implementation barriers and focus on enhancing diagnostic access, vaccine coverage and funding for treatment optimisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003699","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T05:56:07Z","timestamp":1765173367000},"page":"e003699","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Adapting global guidelines to local contexts: optimising community-acquired pneumonia (CAP) specific prescribing in Pakistan to counter antimicrobial resistance"],"prefix":"10.1136","volume":"12","author":[{"given":"Emmama","family":"Jamil","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Bahauddin Zakariya University, Multan, Pakistan"},{"name":"Department of Pharmacy Practice, Hamdard University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Majid","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Bahauddin Zakariya University, Multan, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afreenish","family":"Amir","sequence":"additional","affiliation":[{"name":"National Institute of Health (NIH), Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Godman","sequence":"additional","affiliation":[{"name":"Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa"},{"name":"City St George\u2019s University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M","family":"Campbell","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK"},{"name":"The University of Manchester School of Health Sciences, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matti","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Hamdard University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda","family":"Arooj","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Bahauddin Zakariya University, Multan, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed M","family":"Altowayan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Qassim University, 52571, Buraydah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-6347","authenticated-orcid":false,"given":"Zikria","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Qassim University, 52571, Buraydah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"key":"2026030412000700000_12.1.e003699.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2018.12.008"},{"key":"2026030412000700000_12.1.e003699.2","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/crj.13137","article-title":"Factors predicting in-hospital mortality among patients admitted with community acquired pneumonia at a tertiary care hospital Karachi, Pakistan","volume":"14","author":"Iqbal","year":"2020","journal-title":"Clin Respir J"},{"key":"2026030412000700000_12.1.e003699.3","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-204247"},{"key":"2026030412000700000_12.1.e003699.4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00987-2019"},{"key":"2026030412000700000_12.1.e003699.5","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1111\/resp.13112","article-title":"Pneumonia in the developing world: Characteristic features and approach to management","volume":"22","author":"Aston","year":"2017","journal-title":"Respirology"},{"key":"2026030412000700000_12.1.e003699.6","article-title":"Childhood pneumonia in low-and middle-income countries: a systematic review of prevalence, risk factors, and healthcare-seeking behaviors","volume":"16","author":"Selvi","year":"2024","journal-title":"Cureus"},{"key":"2026030412000700000_12.1.e003699.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31593-8"},{"key":"2026030412000700000_12.1.e003699.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2019.06.001"},{"key":"2026030412000700000_12.1.e003699.9","doi-asserted-by":"crossref","first-page":"287","DOI":"10.4103\/ijmr.IJMR_1678_19","article-title":"Community-acquired bacterial pneumonia in adults: An update","volume":"151","author":"Eshwara","year":"2020","journal-title":"Indian J Med Res"},{"key":"2026030412000700000_12.1.e003699.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-019-0649-5","article-title":"Pattern of inappropriate antibiotic use among hospitalized patients in Pakistan: a longitudinal surveillance and implications","volume":"8","author":"Saleem","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026030412000700000_12.1.e003699.11","first-page":"15","article-title":"Identification of novel bacteriocin against Staphylococcus and Bacillus species","volume":"17","author":"Aldarhami","year":"2023","journal-title":"Int J Health Sci (Qassim)"},{"key":"2026030412000700000_12.1.e003699.12","first-page":"29","article-title":"Prescription practices of physicians, quality of care, and patients\u2019 safety: A mixed methods comprehensive study","volume":"18","author":"Abdullah","year":"2024","journal-title":"Int J Health Sci (Qassim)"},{"key":"2026030412000700000_12.1.e003699.13","first-page":"91","article-title":"A prospective study of inpatients to determine microbial etiology and therapeutic outcome of antibiotics for community-acquired pneumonia in pakistan","volume":"3","author":"Rehman","year":"2013","journal-title":"Bioimpacts"},{"key":"2026030412000700000_12.1.e003699.14","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-50657-5","article-title":"Viral and bacterial microorganisms in Vietnamese children with severe and non-severe pneumonia","volume":"14","author":"Tran","year":"2024","journal-title":"Sci Rep"},{"key":"2026030412000700000_12.1.e003699.15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijid.2020.01.038","article-title":"Inappropriate treatment of community-acquired pneumonia among children under five years of age in Tanzania","volume":"93","author":"Ngocho","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2026030412000700000_12.1.e003699.16","doi-asserted-by":"crossref","first-page":"709","DOI":"10.3390\/antibiotics14070709","article-title":"Barriers to Compliance with National Guidelines Among Children Hospitalized with Community-Acquired Pneumonia in Vietnam and the Implications","volume":"14","author":"Nguyen","year":"2025","journal-title":"Antibiotics (Basel)"},{"key":"2026030412000700000_12.1.e003699.17","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1186\/s12879-021-05906-1","article-title":"Antibiotic resistance in Pakistan: a systematic review of past decade","volume":"21","author":"Bilal","year":"2021","journal-title":"BMC Infect Dis"},{"key":"2026030412000700000_12.1.e003699.18","first-page":"24","article-title":"A comparable risk of extensively drug-resistant typhoid fever in the pediatric cohort during the COVID-19 pandemic","volume":"18","author":"Khan","year":"2024","journal-title":"Int J Health Sci (Qassim)"},{"key":"2026030412000700000_12.1.e003699.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2022.08.009"},{"key":"2026030412000700000_12.1.e003699.20","doi-asserted-by":"crossref","first-page":"i18","DOI":"10.1093\/jac\/dkac213","article-title":"Country data on AMR in Pakistan in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome","volume":"77","author":"Torumkuney","year":"2022","journal-title":"J Antimicrob Chemother"},{"key":"2026030412000700000_12.1.e003699.21","doi-asserted-by":"crossref","first-page":"00048","DOI":"10.1128\/CMR.00048-19","article-title":"Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries","volume":"33","author":"Gandra","year":"2020","journal-title":"Clin Microbiol Rev"},{"key":"2026030412000700000_12.1.e003699.22","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s13756-019-0471-0","article-title":"Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review","volume":"8","author":"Nathwani","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026030412000700000_12.1.e003699.23","unstructured":"World Health Organization . Antimicrobial stewardship programmes in health-care facilities in low-and middle-income countries: a WHO practical toolkit. Antimicrobial stewardship programmes in health-care facilities in low-and middle-income countries: a WHO practical toolkit. 2019."},{"key":"2026030412000700000_12.1.e003699.24","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/cid\/cix407","article-title":"Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions","volume":"65","author":"Stenehjem","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2026030412000700000_12.1.e003699.25","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzw055"},{"key":"2026030412000700000_12.1.e003699.26","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2019.e02159","article-title":"Snapshot of antimicrobial stewardship programs in the hospitals of Pakistan: findings and implications","volume":"5","author":"Saleem","year":"2019","journal-title":"Heliyon"},{"key":"2026030412000700000_12.1.e003699.27","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics11121824","article-title":"Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future","volume":"11","author":"Saleem","year":"2022","journal-title":"Antibiotics (Basel)"},{"key":"2026030412000700000_12.1.e003699.28","doi-asserted-by":"crossref","first-page":"743","DOI":"10.12788\/jhm.3444","article-title":"Clinical Guideline Highlights for the Hospitalist: 2019 American Thoracic Society\/Infectious Diseases Society of America Update on Community-Acquired Pneumonia","volume":"15","author":"Jackson","year":"2020","journal-title":"J Hosp Med"},{"key":"2026030412000700000_12.1.e003699.29","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.22.288614"},{"key":"2026030412000700000_12.1.e003699.30","doi-asserted-by":"crossref","DOI":"10.3390\/medicina59071215","article-title":"Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications","volume":"59","author":"Saleem","year":"2023","journal-title":"Medicina (Kaunas)"},{"key":"2026030412000700000_12.1.e003699.31","doi-asserted-by":"publisher","DOI":"10.3201\/EID2003.121157"},{"key":"2026030412000700000_12.1.e003699.32","doi-asserted-by":"crossref","first-page":"001","DOI":"10.17352\/2455-5479.000215","article-title":"Bacterial Etiology of Adult Community-Acquired Pneumonia in Pakistan: A Systematic Review and Meta-Analysis","volume":"11","author":"Rahil","year":"2025","journal-title":"Arch Community Med Public Health"},{"key":"2026030412000700000_12.1.e003699.33","article-title":"Antibiogram and Antibiotic Resistance Patterns in Bacterial Isolates from Hayatabad Medical Complex, Peshawar","volume":"16","author":"Iftikhar","year":"2024","journal-title":"Cureus"},{"key":"2026030412000700000_12.1.e003699.34","unstructured":"World Health Organization . Antimicrobial stewardship programmes in health-care facilities in Low-and middle- income countries: a WHO practical tool kit. 2019. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/329404\/9789241515481-eng.pdf"},{"key":"2026030412000700000_12.1.e003699.35","unstructured":"World Health Organization . Antimicrobial stewardship interventions: a practical guide. n.d. Available: https:\/\/iris.who.int\/bitstream\/handle\/10665\/340709\/9789289054980-eng.pdf"},{"key":"2026030412000700000_12.1.e003699.36","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1007\/s00134-023-07220-7","article-title":"Implementing the severe community-acquired pneumonia guidelines in low- and middle-income countries","volume":"49","author":"Salluh","year":"2023","journal-title":"Intensive Care Med"},{"key":"2026030412000700000_12.1.e003699.37","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-089535","article-title":"Facilitators and barriers to use of clinical practice guidelines among physicians in Nigeria: a cross-sectional study","volume":"15","author":"Adejumo","year":"2025","journal-title":"BMJ Open"},{"key":"2026030412000700000_12.1.e003699.38","doi-asserted-by":"crossref","DOI":"10.1093\/jacamr\/dlab080","article-title":"Assessment of adherence to pneumonia guidelines and its determinants in an ambulatory care clinic in Ghana: findings and implications for the future","volume":"3","author":"Sefah","year":"2021","journal-title":"JAC Antimicrob Resist"},{"key":"2026030412000700000_12.1.e003699.39","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.ijmyco.2014.10.046","article-title":"Fluoroquinolone resistance in Mycobacterium tuberculosis isolates from Pakistan 2010-2014: Implications for disease control","volume":"4 Suppl 1","author":"Jabeen","year":"2015","journal-title":"Int J Mycobacteriol"},{"key":"2026030412000700000_12.1.e003699.40","doi-asserted-by":"publisher","DOI":"10.3201\/eid1703.100957"},{"key":"2026030412000700000_12.1.e003699.41","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008682","article-title":"Response of extensively drug resistant Salmonella Typhi to treatment with meropenem and azithromycin, in Pakistan","volume":"14","author":"Qureshi","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2026030412000700000_12.1.e003699.42","doi-asserted-by":"crossref","DOI":"10.1128\/msphere.00215-20","article-title":"A Race against Time: Reduced Azithromycin Susceptibility in Salmonella enterica Serovar Typhi in Pakistan","volume":"5","author":"Iqbal","year":"2020","journal-title":"mSphere"},{"key":"2026030412000700000_12.1.e003699.43","doi-asserted-by":"crossref","first-page":"546","DOI":"10.48036\/apims.v20iSUPPL-1.1142","article-title":"Fighting XDR Typhoid: A Hospital Based Study on Clinical Aspects and Treatment Outcome in Tertiary Care Hospital","volume":"20","author":"Adnan, Riaz","year":"2024","journal-title":"Ann Pak Inst Med Sci"},{"key":"2026030412000700000_12.1.e003699.44","unstructured":"United Nations . Political declaration of the high-level meeting on antimicrobial resistance. 2024. Available: https:\/\/www.un.org\/pga\/wp-content\/uploads\/sites\/108\/2024\/09\/FINAL-Text-AMR-to-PGA.pdf"},{"key":"2026030412000700000_12.1.e003699.45","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1581ST"},{"key":"2026030412000700000_12.1.e003699.46","unstructured":"Baker SE , Edwards R . How many qualitative interviews is enough. 2012."},{"key":"2026030412000700000_12.1.e003699.47","doi-asserted-by":"publisher","DOI":"10.1177\/15586898221126816"},{"key":"2026030412000700000_12.1.e003699.48","doi-asserted-by":"crossref","DOI":"10.3389\/fphar.2025.1600787","article-title":"Global variation in antibiotic prescribing guidelines and the implications for decreasing AMR in the future","volume":"16","author":"Jamil","year":"2025","journal-title":"Front Pharmacol"},{"key":"2026030412000700000_12.1.e003699.49","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.j2291","article-title":"Antibiotic use in South East Asia and policies to promote appropriate use: reports from country situational analyses","volume":"358","author":"Holloway","year":"2017","journal-title":"BMJ"},{"key":"2026030412000700000_12.1.e003699.50","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1186\/s13756-019-0649-5","article-title":"Pattern of inappropriate antibiotic use among hospitalized patients in Pakistan: a longitudinal surveillance and implications","volume":"8","author":"Saleem","year":"2019","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026030412000700000_12.1.e003699.51","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2021-013565"},{"key":"2026030412000700000_12.1.e003699.52","doi-asserted-by":"publisher","DOI":"10.1017\/ICE.2023.5"},{"key":"2026030412000700000_12.1.e003699.53","doi-asserted-by":"crossref","first-page":"5","DOI":"10.62541\/jaspi036","article-title":"Diagnostic Stewardship in LMICs: The Way Forward","volume":"2","author":"Gupta","year":"2024","journal-title":"JASPI"},{"key":"2026030412000700000_12.1.e003699.54","doi-asserted-by":"crossref","DOI":"10.1016\/j.infpip.2023.100315","article-title":"Challenges of implementing antimicrobial stewardship tools in Low to Middle Income Countries (LMICs)","volume":"5","author":"Shamas","year":"2023","journal-title":"Infect Prev Pract"},{"key":"2026030412000700000_12.1.e003699.55","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.6136","article-title":"Effect of Gram Stain\u2013Guided Initial Antibiotic Therapy on Clinical Response in Patients With Ventilator-Associated Pneumonia","volume":"5","author":"Yoshimura","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026030412000700000_12.1.e003699.56","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/cid\/ciz876","article-title":"Sputum Gram Stain for Bacterial Pathogen Diagnosis in Community-acquired Pneumonia: A Systematic Review and Bayesian Meta-analysis of Diagnostic Accuracy and Yield","volume":"71","author":"Ogawa","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2026030412000700000_12.1.e003699.57","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.5.1486"},{"key":"2026030412000700000_12.1.e003699.58","doi-asserted-by":"crossref","first-page":"792","DOI":"10.26719\/2009.15.4.792","article-title":"Does sputum culture affect the management and\/or outcome of community-acquired pneumonia?","volume":"15","author":"Shariatzadeh","year":"2009","journal-title":"East Mediterr Health J"},{"key":"2026030412000700000_12.1.e003699.59","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.16.1807"},{"key":"2026030412000700000_12.1.e003699.60","first-page":"CR171","article-title":"Assessment of the usefulness of sputum Gram stain and culture for diagnosis of community-acquired pneumonia requiring hospitalization","volume":"14","author":"Miyashita","year":"2008","journal-title":"Med Sci Monit"},{"key":"2026030412000700000_12.1.e003699.61","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06081-4"},{"key":"2026030412000700000_12.1.e003699.62","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00789-11"},{"key":"2026030412000700000_12.1.e003699.63","doi-asserted-by":"crossref","first-page":"S296","DOI":"10.1093\/cid\/cir045","article-title":"Diagnostic tests for agents of community-acquired pneumonia","volume":"52 Suppl 4","author":"Bartlett","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026030412000700000_12.1.e003699.64","doi-asserted-by":"crossref","first-page":"5411","DOI":"10.2147\/IDR.S491454","article-title":"Antimicrobial Use Among Hospitalized Neonates and Children; Findings and Implications from a Comprehensive Point Prevalence Survey Among General Tertiary Hospitals in Pakistan","volume":"17","author":"Mustafa","year":"2024","journal-title":"Infect Drug Resist"},{"key":"2026030412000700000_12.1.e003699.65","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piu014"},{"key":"2026030412000700000_12.1.e003699.66","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics12101504","article-title":"RETRACTED: Empowering Low- and Middle-Income Countries to Combat AMR by Minimal Use of Antibiotics: A Way Forward","volume":"12","author":"Kanan","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"2026030412000700000_12.1.e003699.67","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2021.1951705"},{"key":"2026030412000700000_12.1.e003699.68","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-017-0260-6","article-title":"Readiness for antimicrobial resistance (AMR) surveillance in Pakistan; a model for laboratory strengthening","volume":"6","author":"Saeed","year":"2017","journal-title":"Antimicrob Resist Infect Control"},{"key":"2026030412000700000_12.1.e003699.69","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2017.07.010"},{"key":"2026030412000700000_12.1.e003699.70","doi-asserted-by":"crossref","DOI":"10.1093\/jacamr\/dlae193","article-title":"Paediatricians\u2019 knowledge, perceptions, preparedness and involvement towards paediatric antimicrobial stewardship in Pakistan: findings and the implications","volume":"6","author":"Mustafa","year":"2024","journal-title":"JAC-Antimicrobial Resistance"},{"key":"2026030412000700000_12.1.e003699.71","doi-asserted-by":"crossref","unstructured":"Ahmad Z , Wasif S , Bailey ES , et al . Assessment of the Prevalence and Determinants of Vaccine Hesitancy in Pakistan. TOPHJ 2024;17. doi:10.2174\/0118749445298070240319081623","DOI":"10.2174\/0118749445298070240319081623"},{"key":"2026030412000700000_12.1.e003699.72","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2020-318988"},{"key":"2026030412000700000_12.1.e003699.73","first-page":"50","article-title":"Pandemic related Perceived Stress and Vaccine Hesitancy in Pakistani Adults Aged 18\u201359 Years","volume":"5","author":"Bilal","year":"2021","journal-title":"Journal of Management Practices, Humanities and Social Sciences"},{"key":"2026030412000700000_12.1.e003699.74","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2024.1469766","article-title":"Identifying targets for antibiotic stewardship interventions in pediatric patients in Punjab, Pakistan: point prevalence surveys using AWaRe guidance","volume":"12","author":"Sheikh","year":"2024","journal-title":"Front Pediatr"},{"key":"2026030412000700000_12.1.e003699.75","doi-asserted-by":"crossref","DOI":"10.1093\/jacamr\/dlaf033","article-title":"Status and implications of the knowledge, attitudes and practices towards AWaRe antibiotic use, resistance and stewardship among low- and middle-income countries","volume":"7","author":"Saleem","year":"2025","journal-title":"JAC-Antimicrobial Resistance"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-003699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T20:00:19Z","timestamp":1772654419000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-003699"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":75,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12,7]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjresp-2025-003699"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-003699","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}