International Journal of Antibiotics Review Article
Influence of Antibiotic Promotion Practices on Pharmacovigilance and Resistance Reporting Patterns
Abstract
The global escalation of antimicrobial resistance (AMR) has emerged as a critical public health crisis, undermining decades of therapeutic advancements. While inappropriate prescribing and misuse of antibiotics are widely acknowledged contributors, the role of pharmaceutical promotion practices remains underexplored in influencing prescribing behaviors and downstream pharmacovigilance systems. This review critically examines how antibiotic promotion strategies – ranging from direct physician engagement to digital marketing – affect adverse drug reaction (ADR) reporting and resistance surveillance patterns. The article integrates insights from pharmacovigilance frameworks, antimicrobial stewardship programs, and healthcare marketing ethics to evaluate the multidimensional impact of promotional activities. Evidence suggests that aggressive marketing may skew prescription trends toward newer, broad-spectrum antibiotics, potentially leading to underreporting of ADRs and delayed resistance detection. Furthermore, promotional bias may influence clinicians’ perception of drug safety, thereby affecting spontaneous reporting systems. This review also highlights systemic gaps in pharmacovigilance reporting, particularly in low- and middle-income countries, where regulatory oversight is limited and promotional influence is often stronger. Mechanistic pathways linking promotion practices to resistance reporting distortions are discussed, including cognitive bias, selective information dissemination, and economic incentives. The study concludes by emphasizing the need for stricter regulatory frameworks, enhanced transparency in pharmaceutical marketing, and integration of pharmacovigilance with antimicrobial stewardship initiatives. Strengthening these systems is essential to ensure rational antibiotic use and accurate resistance monitoring, ultimately safeguarding global health.
Keywords
References (55)
- World Health Organization. Global action plan on antimicrobial resistance. Geneva: World Health
- Organization; 2015 Apr 2.
- Paneri M, Sevta P. Overview of antimicrobial resistance: An emerging silent pandemic. Glob J Med
- Pharm Biomed Update. 2023 Jan 1;18.
- More SA, Atal S, Mishra PS. Inter-rater agreement between WHO-Uppsala Monitoring Centre
- system and Naranjo algorithm for causality assessment of adverse drug reactions. J Pharmacol
- Toxicol Methods. 2024 May 1;127:107514.
- World Health Organization. The importance of pharmacovigilance: Safety monitoring of medicinal
- products. Technical report series. Geneva: World Health Organization; 2002.
- Menebo MM. Smart advertising in prescription only medication: Aligning it with prescriber’s or
- consumer’s behavior. Int J Pharm Healthc Mark. 2022 Feb 11;16(1):55–74.
- Spurling GK, Mansfield PR, Montgomery BD, Lexchin J, Doust J, Othman N, et al. Information
- from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: A
- systematic review. PLoS Med. 2010 Oct 19;7(10):e1000352.
- O’Neill J. Tackling drug-resistant infections globally: Final report and recommendations.
- Ventola CL. The antibiotic resistance crisis: Part 1: Causes and threats. Pharm Ther. 2015
- Apr;40(4):277.
- Belleudi V, Fortinguerra F, Poggi FR, Perna S, Bortolus R, Donati S, et al. The Italian network for
- monitoring medication use during pregnancy (MoM-Net): experience and perspectives. Front
- Pharmacol. 2021 Jun 23;12:699062.
- Wazana A. Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA. 2000 Jan
- 19;283(3):373–80.
- Norris P, Herxheimer A, Lexchin J, Mansfield P. Drug promotion: What we know, what we have
- yet to learn. Reviews of materials in the WHO/HAI database on drug promotion. 2005
- Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic
- resistance—The need for global solutions. Lancet Infect Dis. 2013 Dec 1;13(12):1057–98.
- Holloway K, Van Dijk L. The world medicines situation 2011: Rational use of medicines. Geneva:
- World Health Organization; 2011 Apr 5;3.
- Fugh-Berman A, Ahari S. Following the script: How drug reps make friends and influence doctors.
- PLoS Med. 2007 Apr 24;4(4):e150.
- Moynihan R, Cassels A. Selling sickness: How the world’s biggest pharmaceutical companies are
- turning us all into patients. Greystone Books; 2008 Sep 1.
- Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: Attitudes and practices of medicine
- housestaff toward pharmaceutical industry promotions. Am J Med. 2001 May 1;110(7):551–7.
- Richter L. Prevalence and characterisation of antimicrobial resistant Enterobacteriaceae in fresh
- vegetables from farm to retail in the Gauteng Province of South Africa [doctoral dissertation].
- University of Pretoria (South Africa).
- Kumawat M, Khandelwal O, Agrawal P, Pradhan P, Sharma O. Herbal medicine and pharmacy
- practice: Roles, challenges, and future pathways. J Ayurveda Herb Sci. 2026 Mar 30;1(1):10–45.
- Haque M, Sartelli M, McKimm J, Bakar MA. Health care-associated infections–an overview. Infect
- Drug Resist. 2018 Nov 11;11:2321–33.
- Kadri SS. Key takeaways from the US CDC’s 2019 antibiotic resistance threats report for frontline
- providers. Crit Care Med. 2020 Jul 1;48(7):939–45.
- Sultana J, Zaccaria C, De Lisa R, Rossi F, Capuano A, Ferrajolo C. Good pharmacovigilance
- practice in paediatrics: An overview of the updated European Medicines Agency guidelines. Pediatr
- Drugs. 2019 Oct;21(5):317–21.
- Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, et al. Ongoing strategies to
- improve the management of upper respiratory tract infections and reduce inappropriate antibiotic
- use particularly among lower and middle-income countries: Findings and implications for the
- future. Curr Med Res Opin. 2020;36(2):301–327.
- Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care.
- Cochrane Database Syst Rev. 2005;(4).
- Van Boeckel TP, Gandra S, Ashok A, Caudron Q, Grenfell BT, Levin SA, et al. Global antibiotic
- consumption 2000 to 2010: An analysis of national pharmaceutical sales data. Lancet Infect Dis.
- 2014 Aug 1;14(8):742–50.