Colistin use, resistance, and the international pharmaceutical trade of colistin: The unfolding crisis in Pakistan. Colistin use, resistance, and the international pharmaceutical trade of colistin: The unfolding crisis in Pakistan

Antimicrobial resistance is a global threat to human and animal health. In 2015, World Health Organization adapted a Global Action Plan to mitigate AMR threat. The emergence of multidrug-resistant Gram-negative bacteria, especially those producing carbapenemases, led to a resurgence in the use colistin as a last resort antibiotic for the treatment of severe infections in human. In contrast to its limited use in humans medicine, colistin is widely used in food-producing animals not only for treatment, but also for prophylactic and growth promotion purposes. The ongoing spread of plasmid-mediated colistin resistance mechanisms (mcr-1 and other mcr variants) in Enterobacteriaceae from food animals, human and environment sectors has raised serious public health concerns about the use/misuse of colistin in the farming sector.