WHAT IS A PRIVATE CLINIC?
A private clinic is a facility where a doctor, general physician, or, in some countries, a surgeon (for minor surgeries), or groups of healthcare providers, offer medical services or advice to patients for a fee. It is not run by the government or state and carries out all its functions independently.
Private clinics have become an essential part of healthcare systems, especially in developing countries like Pakistan, where public healthcare infrastructure is often overburdened. However, their growing role comes with both benefits and challenges.
ADVANTAGES OF PRIVATE CLINICS OVER PUBLIC HEALTHCARE FACILITIES
To begin with, private clinics provide several advantages over public hospitals and health centers:
1. Reduction in waiting time (no need to wait in long queues).
2. Better relationships between healthcare providers and patients result in consistent and improved patient care services.
3. As clinics are usually located near homes, they reduce the time required to access medical care services.
4. Patients can easily protect their privacy in a comfortable environment.
In short, these features make private clinics an appealing option for many patients seeking quick and personalized medical care.
DISADVANTAGES OF PRIVATE CLINICS OVER PUBLIC HEALTHCARE FACILITIES
However, despite these benefits, private clinics have certain disadvantages as well.
1. They are more expensive compared to public hospitals.
2. They have limited resources or healthcare facilities.
Thus, while they offer convenience, their limitations can affect the quality and comprehensiveness of healthcare delivery.
PRIVATE CLINICS AND ANTIBIOTIC RESISTANCE
Moving forward, one of the most serious issues linked with private clinics is their contribution to antibiotic resistance. Private clinics play a significant role in delivering healthcare services in developing countries. However, their contribution to antibiotic resistance is also considerable. Antibiotic resistance is a global issue, but in developing countries like Pakistan, the problem is particularly severe.
According to The News International (2025), experts have warned that Pakistan faces an alarming rise in “superbugs” due to irrational antibiotic use, self-medication, and incentivized prescriptions a problem particularly visible in the private sector. Similarly, Dawn reported that private general practitioners prescribe antibiotics and even injections more frequently than public-sector doctors, often without culture sensitivity tests or confirmed diagnoses. This growing trend has deepened the public health crisis.
WHAT IS AMR (ANTIMICROBIAL RESISTANCE)?
To understand this better, it is important to define antimicrobial resistance. Antimicrobial resistance (AMR) is a condition in which antimicrobial drugs no longer work effectively against bacteria, viruses, or fungi because these pathogens have developed resistance.
Furthermore, a surveillance study from Lahore found that 70.3% of patients in both public and private hospitals received inappropriate antimicrobial prescriptions either wrong dose, wrong indication, or both (PMCID: PMC6873729). This finding clearly highlights how widespread irrational prescribing practices are in Pakistan’s healthcare system, especially in poorly regulated private settings.
AMR DUE TO INAPPROPRIATE DOSING AND DURATION
In big cities, nearly every street corner has at least two or three clinics. Suppose a patient visits a clinic with mild symptoms of diarrhea. The physician prescribes metronidazole syrup for one day from the clinic pharmacy (which usually keeps bulk antibiotic syrups) and advises the patient to return the next day. After taking this antibiotic syrup, the patient feels relief for 2–3 days. However, when the symptoms return, the same antibiotic is prescribed again for one day.
Consequently, this inappropriate dosing and short duration of treatment contribute to antibiotic resistance. Sometimes, this resistance can become fatal due to the emergence of Clostridium difficile-associated diarrhea. Supporting this, a 2019 Karachi study on quinolone use revealed that private hospitals prescribed antibiotics without culture sensitivity testing far more frequently than public institutions, demonstrating a serious lack of diagnostic-guided therapy (IMSEAR database).
WHAT IS CLOSTRIDIUM DIFFICILE INFECTION?
Improper use of antibiotics either in high doses for a prolonged period or for an insufficient duration alters the gut microbiota. As a result, Clostridium difficile bacteria can cause inflammation of the colon by releasing toxins, leading to mild to severe diarrhea, sometimes accompanied by fever and abdominal pain. In severe cases, it may become life-threatening and even result in death.
CASE HISTORY OF A YOUNG GIRL
For instance, as mentioned above, dispensing metronidazole syrup irrationally in private clinics can provoke fatal Clostridium difficile diarrhea. A young 10-year-old girl in my area became a victim of this unethical and irrational practice in a private clinic. This tragic example shows how seemingly small errors in antibiotic use can have devastating outcomes.
LOW CONCENTRATION OF ACTIVE INGREDIENTS IN BULK SYRUPS AND AMR
In addition to irrational prescribing, another reason behind antibiotic resistance is the use of bulk syrups in private clinics, which often contain a lower concentration of the active ingredient. This leads to reduced bioavailability and, consequently, less effective treatment against infectious organisms. Over time, this inadequate exposure allows bacteria to adapt and develop resistance.
LACK OF PHARMACISTS AT CLINICS AND AMR
Moreover, private clinics often hire less educated staff or technicians for dispensing medicines to reduce expenses and increase revenue. As a result, education about antibiotic stewardship in the community is neglected. The absence of pharmacists in clinics is also a significant risk factor for AMR.
A situational analysis of antimicrobial stewardship programs (ASPs) in Karachi found that over two-thirds of private hospitals lacked any structured ASP interventions or monitoring systems (Cambridge University Press, 2023). This same lack of stewardship extends to private clinics, where there are often no pharmacists to review prescriptions or counsel patients. Pharmacists, if present, can play a vital role in reviewing antibiotic selection, dosage, and duration greatly improving patient outcomes and reducing AMR.
WHAT IS ANTIBIOTIC STEWARDSHIP?
In simple terms, antibiotic stewardship refers to the programs and practices that guide healthcare providers to prescribe antibiotics only when necessary, and for the correct duration and dose, to prevent antimicrobial resistance in pathogens. Implementing stewardship programs is therefore an essential step in controlling antibiotic misuse at all levels of healthcare.
IRRATIONAL ANTIBIOTIC PRESCRIBING FOR PATIENT SATISFACTION AND AMR
Additionally, physicians in private clinics often avoid diagnostic tests to reduce treatment costs. They may not determine whether the infection is viral or bacterial. In viral infections, antibiotics are unnecessary symptomatic treatment is usually enough, and recovery occurs within 4–5 days. However, to satisfy patients, antibiotics are often prescribed irrationally, which is a major factor in the emergence of antibiotic resistance.
Supporting this, a study conducted in Sindh (Journal of Pharmaceutical Research International, 2021) revealed that many individuals buy antibiotics directly from pharmacies or clinics without a prescription, particularly drugs like ciprofloxacin and cotrimoxazole. This culture of self-medication and patient pressure fuels unnecessary antibiotic use and accelerates resistance.
OVERUSE OF ANTIBIOTICS AND AMR
Furthermore, when patients do not recover, they often visit another clinic, where they may be prescribed stronger antibiotics. This repeated switching and overuse of antibiotics further contribute to AMR. As Dawn highlighted, many patients frequently consult multiple private practitioners, each escalating antibiotic strength without laboratory evidence further compounding the resistance problem.
COMMISSION FROM PHARMACEUTICAL COMPANIES AND AMR
Adding to this, pharmaceutical companies sometimes offer commissions to physicians to promote their brands. This unethical practice can lead to irrational prescribing of broad-spectrum antibiotics, ultimately worsening antibiotic resistance. The Dawn editorial (2024) emphasized that Pakistan ranks among the world’s top consumers of antibiotics, partly driven by aggressive marketing and commission-based incentives in the private sector.
HOW CAN WE OVERCOME THE PROBLEM?
To address this challenge, collective action is needed at every stage from prescribing and dispensing to patient education. Dispensing antibiotics from bulk containers in clinics should be stopped immediately. Moreover, a strong government body must enforce antibiotic prescribing guidelines in private clinics.
Pharmacists should be appointed in clinics to educate patients about proper dosage, frequency, duration, and the dangers of irrational antibiotic use. Likewise, broad spectrum antibiotics should not be prescribed for commission purposes. Differential diagnosis between viral and bacterial infections must be carefully performed before starting antibiotics.
In addition, promoting vaccination can also help reduce AMR by preventing infections and decreasing unnecessary antibiotic prescriptions. As a result, the gut microbiota will remain balanced, protecting patients from antibiotic associated complications.
CONCLUSION
In conclusion, private clinics though vital for community healthcare have become a major driver of antibiotic resistance due to irrational prescribing, lack of stewardship, and weak regulation. To reverse this trend, Pakistan must urgently implement strong antibiotic stewardship programs, enforce prescription monitoring, and increase public awareness.
Ultimately, owning the concept of antibiotic stewardship today will protect future generations from the devastating impact of drug-resistant microorganisms.
FREQUENTLY ASKED QUESTIONS (FAQs)
1. Why is antibiotic resistance such a serious problem in Pakistan?
Antibiotic resistance in Pakistan is rising rapidly due to over the counter sales of antibiotics, self-medication, lack of diagnostic testing, and irrational prescribing in private clinics. Studies have shown that more than 70% of patients receive antibiotics unnecessarily or in incorrect doses.
2. Can private clinics really cause antimicrobial resistance (AMR)?
Yes. Many private clinics in Pakistan prescribe antibiotics without proper indication or laboratory testing. They also use bulk syrups with substandard concentrations and lack pharmacists to monitor dosing both of which accelerate resistance.
3. What are the most misused antibiotics in Pakistan?
According to several studies, ciprofloxacin, amoxicillin, metronidazole, and ceftriaxone are among the most commonly misused antibiotics in both urban and rural private clinics.
4. How can patients help reduce antibiotic resistance?
Patients can help by:
• Avoiding self-medication.
• Completing prescribed antibiotic courses fully.
• Not pressuring doctors for antibiotics when not needed.
• Consulting qualified pharmacists or doctors before taking any antibiotic.
5. What is antibiotic stewardship and why is it important?
Antibiotic stewardship ensures antibiotics are prescribed only when necessary and in the correct dose, duration, and route. It helps prevent the spread of resistant bacteria, protecting both individuals and the community.
DISCLAIMER
This article is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider or pharmacist before starting or stopping any medication. The views expressed here are based on current scientific evidence and reputable news sources from Pakistan and international health authorities.
CALL TO ACTION
Join the fight against antibiotic resistance!
• Share this article to raise awareness about the responsible use of antibiotics in Pakistan.
• If you’re a healthcare provider, commit to antibiotic stewardship today.
• Patients ask before you take any antibiotic. Together, we can stop the rise of drug resistant infections.
Stay informed. Stay responsible. Save lives.
REFERENCES
1. The News International (2025). “Superbugs on the rise due to irrational antibiotic use in Pakistan.”
2. Dawn News (2024). “Commission driven prescriptions fueling antibiotic resistance.”
3. Cambridge University Press (2023). Situational Analysis of Antimicrobial Stewardship Programs in Karachi, Pakistan.
4. Journal of Pharmaceutical Research International (2021). “Pattern of antibiotic use and self-medication trends in Sindh, Pakistan.”
5. PMCID: PMC6873729 – “Assessment of antimicrobial prescribing in public and private healthcare settings in Lahore.”
6. World Health Organization (WHO). “Antimicrobial Resistance: Global Report on Surveillance.” 7. IMSEAR Database (2019). “Evaluation of antibiotic prescribing practices in Karachi hospitals.”