Asian Journal of Hospital Pharmacy

Comprehensive review on antimicrobial resistance: mechanisms, clinical challenges

Devivara Prasad R — 2025-10-20

Antimicrobial resistance (AMR) poses a growing global health threat, necessitating a deeper understanding of its mechanisms and clinical implications. This review investigates three critical resistance phenomena: extended-spectrum β-lactamases (ESBLs) in gram-negative bacilli, penicillin-resistant Streptococcus pneumoniae (PRSP), and vancomycin-resistant enterococci (VRE). We synthesize clinical, microbiological, and molecular data from hospital outbreaks,surveillance programs to elucidate the evolutionary and epidemiological drivers of resistance. ESBL-producing Klebsiella pneumoniae and Escherichia coli emerged through plasmid-mediated gene transfer and transposon mobility, with hospital outbreaks linked to prolonged antibiotic use and invasive procedures. PRSP strains acquired mosaic genes encoding altered penicillin-binding proteins, retaining virulence despite resistance, while VRE outbreaks were fueled by van operon dissemination via plasmids, leading to high mortality rates. The study reveals convergent resistance mechanisms across pathogens, underscoring the limitations of current therapies. Moreover, it highlights the efficacy of carbapenems and β-lactam–β-lactamase inhibitors against ESBLs, the geographic variability of PRSP serotypes, and the urgent need for infection-control measures to curb VRE transmission. Our findings emphasize the necessity of multidisciplinary interventions, including antibiotic stewardship, vaccine development, and novel therapeutic strategies, to mitigate AMR's escalating impact. This research contributes a comprehensive analysis of resistance dynamics, offering actionable insights for clinicians, policymakers, and researchers to address one of the most pressing public health challenges of our time.

A review of over the counter medication safety, affordability, and prevalence

Jahnavi Chitteti — 2025-10-28

Over-the-counter (OTC) medications have become a cornerstone of modern self-care, allowing individuals to independently treat common ailments such as headaches, colds, and digestive discomfort without medical supervision. Their widespread availability offers substantial benefits—reducing unnecessary doctor visits, cutting healthcare costs, and empowering consumers to take control of their health. Globally, 60–80% of adults report using OTC products, with even higher rates in Europe and growing adoption across India and other low- and middle-income countries. Economic analyses show that every dollar spent on OTC drugs can save up to seven dollars in healthcare expenditure, highlighting their value to both individuals and health systems. However, the convenience of OTC access is coupled with significant risks. Misuse, accidental overdose, drug interactions, and inappropriate self-diagnosis contribute to adverse outcomes, particularly among vulnerable groups such as children, pregnant women, and the elderly. The misuse of antibiotics sold as OTC in some regions further fuels antimicrobial resistance—a major global health concern. Regulatory frameworks vary widely across countries, with strong safety controls in the US and Europe but substantial enforcement gaps in India and other developing markets. Education gaps also persist, as many users fail to read labels or underestimate potential side effects. This review evaluates the prevalence, benefits, risks, and regulatory challenges of OTC medication use. A balanced approach—strengthening regulation, enhancing pharmacist involvement, and improving public awareness—is essential to ensure that OTC drugs continue to support health without compromising safety.