Azithromycin Misuse in Upper Respiratory Tract Infections in Pakistan: An Emerging Concern for Drug-Induced Liver Injury and Antimicrobial Resistance

Abstract

Upper Respiratory Tract Infections are among the most common conditions encountered in primary care and community healthcare settings particularly in developing countries such as Pakistan. Most URTIs are of viral origin and are self-limiting requiring only symptomatic management rather than antibiotic therapy. Despite this, antibiotics, particularly Azithromycin, are frequently used inappropriately for URTIs in Pakistan. Easy access to antibiotics through community pharmacies and drug stores, the practice of purchasing antibiotics mostly Azithromycin without a prescription or pharmacist advice, coupled with limited public awareness regarding their appropriate use, has contributed to the growing practice of self-medication. Patients often purchase Azithromycin from community pharmacies without prior medical consultation especially for mild symptoms such as pharyngitis, low-grade fever or cough. Such irrational use not only accelerates antimicrobial resistance but also increases the risk of adverse drug reactions including drug-induced liver injury. Therefore, there is an urgent need to educate both the public and healthcare professionals regarding the consequences of inappropriate Azithromycin use and to implement effective regulatory and stewardship measures to promote rational antibiotic use in Pakistan.