Antibiotic Resistance in the Arab World: Why It Matters and What You Can Do

What is antibiotic resistance and why does it matter now?

When you take an antibiotic for two days and then stop because you feel better, or when you buy one at a pharmacy for a cold you thought might be bacterial, you are contributing without knowing it to one of the most serious health crises of our time. Antibiotic resistance means that bacteria have developed mechanisms that make specific drugs ineffective against them, so that an infection which was once straightforward to treat can no longer be cured with standard medicines.

Bacteria reproduce rapidly and evolve. When an antibiotic kills most bacteria in an infection but a few survive by chance because they carry a genetic mutation that makes them slightly less sensitive to the drug, those survivors reproduce and pass on their resistance. The more we use antibiotics unnecessarily, the faster we accelerate this natural selection process, and the more drug-resistant bacteria we create in our environment and in our bodies.

This is not theoretical. A major analysis published in The Lancet in 2022 estimated that antibiotic-resistant bacterial infections were directly responsible for 1.27 million deaths globally in 2019, placing antimicrobial resistance among the leading causes of death worldwide. Infections that were reliably treatable two decades ago are now becoming difficult or impossible to manage in intensive care units across the region.

Why is the Arab world at higher risk?

In most Arab countries, the majority of antibiotic types can be purchased at a pharmacy without a prescription. This was documented in a 2024 cross-sectional study published in Antimicrobial Resistance and Infection Control that surveyed pharmacies across 19 Arab countries and found that dispensing antibiotics without a prescription is widespread across the region. In practice, the pharmacist often becomes the de facto prescriber, sometimes without the training to determine whether an infection is bacterial or viral.

A 2023 study published in IJID Regions analysed antibiotic prescription patterns for upper respiratory tract infections among insured outpatients in Syria and found that antibiotics were frequently prescribed for viral illnesses where they provide no benefit. Similar patterns have been documented in Kuwait, Saudi Arabia, Egypt, and Iraq. A 2022 study from Arar, Saudi Arabia, found that a large proportion of people self-medicating with antibiotics did not complete the full prescribed course, which means the more resistant bacteria survive and are free to reproduce.

Structural factors compound the problem: weak pharmaceutical regulation in some countries, the presence of substandard or counterfeit medicines in informal markets, patient pressure on doctors and pharmacists to prescribe something when they feel unwell, and in conflict settings such as Syria, Yemen and Libya, disrupted supply chains, poor storage conditions and reduced access to medical assessment all push people towards self-medication as the only available option.

When do you actually need an antibiotic?

This is the question most people answer incorrectly. Antibiotics kill bacteria and have absolutely no effect on viruses. The common cold, influenza, most viral sore throats, viral gastroenteritis and the majority of upper respiratory tract infections are all caused by viruses. They resolve on their own with rest and hydration in most cases, typically within seven to ten days. Giving an antibiotic for these conditions does not speed recovery, does not relieve symptoms, but does expose you to side effects and contributes to building resistance.

Conditions that genuinely need an antibiotic are those caused by bacteria: most urinary tract infections, bacterial strep throat confirmed by a throat swab rather than symptoms alone, bacterial pneumonia, infected wounds with signs of spreading cellulitis, and certain other bacterial infections. Even in these cases, the correct antibiotic type and dose depends on the specific bacterium and local resistance patterns, and that determination requires a doctor rather than a pharmacy shelf.

The key rule is straightforward: if your doctor has not examined you and confirmed a bacterial cause, you should not be taking an antibiotic. A pharmacist dispensing antibiotics for a runny nose is not helping you, even if it feels like action is being taken.

How to take an antibiotic correctly when your doctor prescribes one

First rule: only start an antibiotic when a doctor has assessed you, confirmed or strongly suspected a bacterial infection, and selected the appropriate type for your situation. Different antibiotics work against different bacteria, and your doctor chooses based on what is most likely causing your infection and what resistance patterns are common in your area.

Second rule, and the most important: complete the full course even if you feel significantly better after two or three days. Improvement in symptoms does not mean the bacteria have been eliminated. The bacteria still alive in your body at day three are the ones most likely to carry resistance, and stopping early gives them the chance to multiply with no competition from the rest of the killed bacterial population.

Third rule: do not share your leftover antibiotic with another person in your household, even if their symptoms seem similar to yours. Their illness may be viral, they may need a different antibiotic for a different bacterial cause, and the dose required depends on their weight and age and medical history. Antibiotics also carry real side effects that can be serious in people with liver or kidney disease, in pregnancy, and in young children.

What happens when bacteria in your body become resistant?

Carrying resistant bacteria does not necessarily mean you are sick right now. Many people carry resistant bacteria in their gut or on their skin without any symptoms. The danger appears when those bacteria move to an abnormal site in the body, such as the bladder, a wound, the lungs or the bloodstream. At that point, the doctor cannot treat the infection with standard drugs and is forced to use reserve antibiotics that are more expensive, have more serious side effects, and may only be available in hospital.

Resistant bacteria spread between people the same way regular bacteria do: through unwashed hands, contaminated food, and direct contact. This means the resistance crisis does not only affect people who personally misuse antibiotics. It threatens everyone who may one day need these drugs to work, including cancer patients, surgical patients and premature babies for whom effective antibiotics can be the difference between life and death.

A 2024 review of antibiotic misuse and resistance in Iraq published in the Eastern Mediterranean Health Journal documented a worrying rise in resistance among common bacteria including Escherichia coli, the bacterium most often responsible for urinary tract infections, to several important antibiotic classes. This progressively narrows the treatment options available to doctors dealing with what should be a routine infection.

What actually helps when the infection is viral?

Your immune system is built to handle most viral infections without any drug. The common cold and mild influenza and most viral sore throats resolve within seven to ten days regardless of what you take. What genuinely helps during this time is getting adequate rest, drinking enough fluids to prevent dehydration, and managing fever and pain with a safe analgesic such as paracetamol at the correct dose for your weight and age.

For confirmed influenza in high-risk individuals including older adults, people with heart or lung disease, and pregnant women, an antiviral called oseltamivir (Tamiflu) can shorten the illness if taken within the first 48 hours of symptoms. It must be prescribed by a doctor and is not the same as an antibiotic. It has no effect on bacteria and an antibiotic has no effect on influenza.

Signs that mean you should see a doctor promptly even during what started as a viral illness include: fever above 39 degrees Celsius that does not come down with paracetamol, fever lasting more than five days, significant difficulty breathing, confusion or extreme drowsiness, or severe dehydration with very little urination. These may indicate a secondary bacterial complication that does warrant an antibiotic prescribed after proper assessment.

What can you do personally to be part of the solution?

Individual decisions drive this crisis and individual decisions can slow it. The most important things you can do are: do not request antibiotics when your doctor has not found a bacterial reason to prescribe one, and if an antibiotic is prescribed, complete the full course on time every day. These two habits together make a significant difference when adopted across a community.

Do not keep leftover antibiotics at home for a future occasion, and do not give yours to a family member without a doctor's assessment of their situation. Flush or safely dispose of unused courses rather than stockpiling them. Teach children to wash their hands regularly with soap and water, because handwashing is one of the most effective ways to interrupt the community spread of resistant bacteria before they reach someone whose immune system cannot fight them.

If you have a chronic condition and develop what seems like a bacterial infection, tell your doctor about every medicine you are already taking, because some antibiotics interact significantly with blood thinners, heart medicines and diabetes drugs. Sharing this information helps the doctor choose the safest antibiotic for your individual situation rather than a default choice that may cause problems you were not warned about.

What the region is doing and what you can expect going forward

The WHO and health ministries across the Arab world have launched national action plans on antimicrobial resistance, and some countries have tightened regulations on antibiotic dispensing in recent years. Saudi Arabia has introduced stricter controls on pharmacy sales. Jordan and Egypt have increased focus on hospital antibiotic stewardship programmes. These are real steps, but enforcement in resource-limited and conflict-affected settings remains a major challenge.

The most important shift is cultural: moving away from the expectation that any illness warrants an antibiotic, and building trust that a doctor who does not prescribe one is making the right call, not withholding treatment. This takes time and consistent public education, but the evidence from countries that have made this shift shows that antibiotic consumption can fall substantially without any increase in serious infections when people have access to clear, accurate information about when these drugs are and are not needed.

Use Sihtak to keep a daily record of your symptoms when you are unwell, track how they are progressing, and log what medications you are taking. This gives you and your doctor a clear picture of your illness trajectory and helps inform whether a bacterial cause is likely, rather than making a guess at a pharmacy counter.

Sources

• Antimicrobial Resistance Collaborators: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis, Lancet, 2022
• Hafez H, Rakab MS, Elshehaby A et al: Pharmacies and use of antibiotics: a cross sectional study in 19 Arab countries, Antimicrobial resistance and infection control, 2024
• Al-Jumaili AA, Ahmed KK: A review of antibiotic misuse and bacterial resistance in Iraq, Eastern Mediterranean health journal, 2024
• Eltom EH, Alanazi AL, Alenezi JF et al: Self-medication with antibiotics and awareness of antibiotic resistance among population in Arar city, Saudi Arabia, Journal of infection in developing countries, 2022
• Sous MMJA, Houri HNA, Safiah MH et al: Antibiotic prescription patterns for acute upper respiratory tract infections in an outpatient population with health insurance in Syria, IJID regions, 2023
• Awad AI, Aboud EA: Knowledge, attitude and practice towards antibiotic use among the public in Kuwait, PloS one, 2015
• World Health Organization: Antimicrobial resistance fact sheet