Typhoid disaster we created ourselves

AS a family physician, I am increasingly confronted by a disturbing reality that should alarm every Pakistani. Children and adults are arriving in clinics with high-grade fevers that simply refuse to respond to treatment. Patients have already swallowed multiple courses of antibiotics. Many have received injections. Some have been treated by several doctors. Yet the fever persists. What we are witnessing is not merely another seasonal outbreak. It is the consequence of years of neglect, poor policy and reckless antibiotic use. Pakistan is now facing a growing epidemic of multidrug-resistant and extensively drug-resistant typhoid and far too few people are talking about it. There was a time when typhoid fever was a disease doctors knew how to treat. The diagnosis was straightforward and effective antibiotics usually brought recovery. Today, however, we are increasingly encountering strains that resist many of the medicines that once worked reliably. In some cases, treatment options have become alarmingly limited. The tragedy is that this crisis did not appear overnight. We created it ourselves. For decades, antibiotics in Pakistan have been treated as harmless commodities rather than precious medical resources. They have been prescribed unnecessarily, sold freely without prescriptions and consumed by patients as if they were painkillers. During the COVID-19 pandemic, antibiotics such as azithromycin were prescribed on a massive scale despite limited evidence of benefit. Many of us warned that indiscriminate antibiotic use would have consequences. Those consequences are now arriving in our clinics and hospitals. The usual narrative places all the blame on general practitioners, unqualified practitioners and self-medication. While these are certainly major contributors, the uncomfortable truth is that antibiotic misuse extends far beyond them. Specialists, consultants, pediatricians, intensivists, pulmonologists, gynecologists, dentists and many others must also examin