{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T06:03:50Z","timestamp":1780985030438,"version":"3.54.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Antimicrobial resistance (AMR) is an increasing public health and economic threat, with substantial consequences for low- and middle-income countries such as Pakistan. This review critically synthesizes peer-reviewed evidence on the socioeconomic impact of AMR in Pakistan and examines policy and implementation challenges linked to the National Action Plan on AMR. A structured PubMed search was conducted for studies published between January 2025 and April 2026, with the final search completed on 28 April 2026. Search terms included \u201cantimicrobial resistance AND Pakistan,\u201d \u201cAMR AND Pakistan AND National Action Plan,\u201d \u201cantimicrobial resistance AND socioeconomic impact AND Pakistan,\u201d \u201cantibiotic resistance AND healthcare costs AND Pakistan,\u201d and \u201cAMR AND surveillance AND Pakistan.\u201d Following PRISMA-guided screening, 29 studies were included in the qualitative synthesis. The findings indicate rising resistance across multiple pathogens and settings, including enteric pathogens, respiratory organisms, multidrug-resistant Gram-negative bacteria, and resistant infections in hospital, community, and environmental contexts. Evidence from genomic and epidemiological studies shows persistent fluoroquinolone resistance and emerging azithromycin resistance, suggesting narrowing therapeutic options. The socioeconomic burden includes prolonged illness, increased diagnostic and treatment costs, longer hospital stays, productivity loss, and household financial strain. However, national cost-of-illness evidence remains limited, and available estimates are mainly derived from single-center studies. Policy gaps include fragmented surveillance, weak enforcement of prescription regulations, inconsistent antimicrobial stewardship, and limited public awareness. Strengthening integrated surveillance, improving regulatory enforcement, expanding vaccination strategies, and embedding AMR within health financing and public health planning are essential to reduce the long-term socioeconomic burden of AMR in Pakistan.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1809327","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:42:29Z","timestamp":1780983749000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Socio-economic impact of antimicrobial resistance in Pakistan: a comprehensive review"],"prefix":"10.3389","volume":"14","author":[{"given":"Zernila","family":"Zaheer","sequence":"first","affiliation":[{"name":"Faculty of Life Sciences, Hamburg University of Applied Sciences","place":["Hamburg, Germany"]},{"name":"Department of Food, Nutrition and Health, University of Bayreuth","place":["Bayreuth, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"001561","DOI":"10.1099\/mgen.0.001561","article-title":"A contemporary genomic snapshot of Salmonella Paratyphi A in Pakistan","volume":"11","author":"Mylona","year":"2025","journal-title":"Microb Genom."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e003699","DOI":"10.1136\/bmjresp-2025-003699","article-title":"Adapting global guidelines to local contexts: optimising community-acquired pneumonia specific prescribing in Pakistan to counter antimicrobial resistance","volume":"12","author":"Jamil","year":"2025","journal-title":"BMJ Open Respir Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e5663","DOI":"10.7759\/cureus.5663","article-title":"An overview of extensively drug-resistant Salmonella Typhi from a tertiary care hospital in Pakistan","volume":"11","author":"Saeed","year":"2019","journal-title":"Cureus."},{"key":"B4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.3390\/pathogens15010039","article-title":"Whole genome sequencing of drug-resistant Vibrio cholerae serotype Ogawa from an outbreak in Khyber Pakhtunkhwa","volume":"15","author":"Ali","year":"2026","journal-title":"Pathogens"},{"key":"B5","doi-asserted-by":"publisher","first-page":"27122","DOI":"10.1038\/s41598-025-27122-6","article-title":"Comparative genomic insights into multidrug resistance in classical and hypervirulent Klebsiella pneumoniae clinical isolates","volume":"15","author":"Azra","year":"2025","journal-title":"Sci Rep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"dkaf288","DOI":"10.1093\/jac\/dkaf288","article-title":"Results from the Survey of Antibiotic Resistance (SOAR) 2018\u201321 in Pakistan: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic\/pharmacodynamic (PK\/PD) breakpoints","volume":"81","author":"Torumkuney","year":"2025","journal-title":"J Antimicrob Chemotherapy"},{"key":"B7","doi-asserted-by":"publisher","first-page":"11601","DOI":"10.1007\/s10661-025-13989-5","article-title":"Assessment of water quality and occurrence of multidrug-resistant clinically relevant bacteria in drinking water in the twin cities of Pakistan","volume":"25","author":"Nadeem","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2762","DOI":"10.1186\/s12866-025-03930-8","article-title":"Antimicrobial-resistant Brucella spp. prevail in raw milk and animal feces of different livestock farms","volume":"13","author":"Zeb","year":"2025","journal-title":"Microorganisms"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1481212","DOI":"10.3389\/fpubh.2025.1481212","article-title":"Economic burden of antimicrobial resistance on patients in Pakistan","volume":"13","author":"Safdar","year":"2025","journal-title":"Front Public Health."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1568","DOI":"10.1186\/s13690-025-01568-6","article-title":"AMR battle in Pakistan: from national action plans to local failures","volume":"18","author":"Saleem","year":"2025","journal-title":"J Pharm Policy Pract."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2437223","DOI":"10.3390\/medicina61030481","article-title":"Antibiotic utilization and resistance according to the WHO AWaRe classification in intensive care units after COVID-19 third wave in Pakistan: findings and implications","volume":"18","author":"Iqbal","year":"2025","journal-title":"J Pharm Policy Pract."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0012963","DOI":"10.2147\/IDR.S531874","article-title":"Progress on the global research agenda for antimicrobial resistance in human health in Pakistan: findings and implications","volume":"19","author":"Maryam","year":"2025","journal-title":"PLoS Negl Trop Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0013067","DOI":"10.1371\/journal.pntd.0013067","article-title":"XDR typhoid in Pakistan: a threat to global health security and a wake-up call for antimicrobial stewardship","volume":"19","author":"Abdullah","year":"2025","journal-title":"PLoS Negl Trop Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"dkaf425","DOI":"10.1093\/jac\/dkaf425","article-title":"Notable transmitted HIV drug resistance among people who inject drugs in Pakistan","volume":"81","author":"Melnychuk","year":"2026","journal-title":"J Antimicrob Chemotherapy."},{"key":"B15","doi-asserted-by":"publisher","first-page":"13989","DOI":"10.1186\/s12879-025-10535-z","article-title":"Regional insights on the prevalence and antimicrobial susceptibility pattern of carbapenem- and colistin-resistant Gram-negative bacteria: an observational cross-sectional study from Karachi, Pakistan","volume":"197","author":"Khursheed","year":"2025","journal-title":"Environ Monit Assess."},{"key":"B16","doi-asserted-by":"publisher","first-page":"10535","DOI":"10.1371\/journal.pntd.0012963","article-title":"Detection of Salmonella Typhi and blaCTX-M genes in drinking water, wastewater, and environmental biofilms in Sindh Province, Pakistan","volume":"25","author":"Tajammul","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B17","first-page":"11588","article-title":"Antimicrobial resistance profiling and molecular characterization of Salmonella enterica from retail meat and poultry products in Punjab, Pakistan","volume":"25","author":"Khan","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"3930","DOI":"10.1038\/s41598-025-14853-9","article-title":"Utilization of clove and cinnamon essential oils as an alternative to inhibit MDR and biofilm-producing Escherichia coli from raw chicken meat","volume":"25","author":"Rafique","year":"2025","journal-title":"BMC Microbiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"e57","DOI":"10.3390\/pathogens14101040","article-title":"Genetic diversity and antibiotic resistance paradigm of Enterobacterales in animal-derived food sources: a One Health disquiet","volume":"153","author":"Sarwar","year":"2025","journal-title":"Epidemiol Infection."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2762","DOI":"10.3390\/microorganisms13122762","article-title":"Patients and surfaces: integrated clinical\u2013environmental surveillance of MDR Gram-negative bacteria in critical-care units (Karachi, 2024\u20132025)","volume":"13","author":"Hussain","year":"2025","journal-title":"Microorganisms."},{"key":"B21","doi-asserted-by":"publisher","first-page":"21","DOI":"10.33073\/pjm-2025-021","article-title":"Streptococcus pyogenes in neonates and postpartum women: first report on prevalence, resistance, emm typing, and risk factors in Khyber Pakhtunkhwa","volume":"74","author":"Basit","year":"2025","journal-title":"Polish J Microbiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"11171","DOI":"10.1080\/23144599.2024.2437223","article-title":"Molecular epidemiology and characterization of antibiotic resistance of Pasteurella multocida isolated from livestock population of Punjab, Pakistan","volume":"25","author":"Ali","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"531874","DOI":"10.1128\/spectrum.02181-24","article-title":"Investigation of bedaquiline heteroresistance among Mycobacterium tuberculosis isolates from Pakistan","volume":"18","author":"Rashid","year":"2025","journal-title":"Infect Drug Resist."},{"key":"B24","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1186\/s12879-025-11171-3","article-title":"Seasonal and hospital settings variations in antimicrobial resistance among clinical isolates from cardiac patients: insights from a 7-year study","volume":"25","author":"Asghar","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1186\/s12879-025-11588-w","article-title":"Bacterial profiling and antibiotic resistance patterns in urinary tract infections: a microbiological analysis from Dera Ismail Khan, Pakistan","volume":"25","author":"Ullah","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1017\/S0950268825100575","article-title":"Multiple highly resistant clones of MRSA circulating among patients with skin and soft tissue infection, Peshawar, Pakistan 2021\u20132022","volume":"74","author":"Ullah","year":"2025","journal-title":"Polish J Microbiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"4031","DOI":"10.1186\/s12866-025-04031-2","article-title":"Surveillance of AMR in environmental and food samples in Pakistan","volume":"25","author":"Rashid","year":"2025","journal-title":"BMC Microbiol."},{"key":"B28","first-page":"1040","article-title":"Detection of MDR pathogens in community and clinical isolates in Pakistan","volume":"14","author":"Hussain","year":"2025","journal-title":"Pathogens."},{"key":"B29","first-page":"14853","article-title":"Genomic epidemiology and AMR patterns of Salmonella enterica in Pakistan","volume":"15","author":"Memon","year":"2025","journal-title":"Sci Rep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1186\/s12879-025-11601-2","article-title":"Temporal and geographic trends in extended-spectrum cephalosporins resistance among Neisseria gonorrhoeae isolates worldwide: a systematic review and meta-analysis","volume":"25","author":"Alhusseini","year":"2025","journal-title":"BMC Infect Dis."},{"key":"B31","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13756-025-01521-w","article-title":"The antibiotic procurement saga: a long-neglected stewardship target to combat antimicrobial resistance in Pakistan","volume":"14","author":"Afzal","year":"2025","journal-title":"Antimicrob Resist Infect Control."},{"key":"B32","doi-asserted-by":"publisher","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":"B33","doi-asserted-by":"publisher","first-page":"3903","DOI":"10.2147\/IDR.S234610","article-title":"Antimicrobial resistance: implications and costs","volume":"12","author":"Dadgostar","year":"2019","journal-title":"Infect Drug Resist."},{"key":"B34","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s41182-022-00478-5","article-title":"How Universal Health Coverage can curb the escalating antimicrobial resistance in Pakistan: a call to action for the country's healthcare system","volume":"50","author":"Imran","year":"2022","journal-title":"Trop Med Health."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.3390\/antibiotics14111154","article-title":"Multicentric surveillance of antimicrobial resistance to generate data-driven regional antibiograms: a laboratory-based cross-sectional study in Pakistan","volume":"14","author":"Noreen","year":"2025","journal-title":"Antibiotics."},{"key":"B36","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/14787210.2021.1935238","article-title":"Progress on the national action plan of Pakistan on antimicrobial resistance: a narrative review and the implications","volume":"20","author":"Saleem","year":"2022","journal-title":"Expert Rev Anti Infect Ther."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1809327\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:42:32Z","timestamp":1780983752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1809327\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2026.1809327"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1809327","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"article-number":"1809327"}}