Physicians’ perspectives on the perceived increase in respiratory infections post-COVID-19 in Pakistan: a qualitative study

BACKGROUND: The COVID-19 pandemic has significantly affected global respiratory health, with a notable rise in severe and recurrent respiratory infections. Irrational antibiotic use and limited public health measures during the pandemic were perceived by Physicians to have worsened post-COVID respiratory morbidity and to have contributed to the emergence of antimicrobial resistance (AMR). OBJECTIVE: To explore physicians' experiences and perspectives on the rise in post-COVID respiratory infections in Pakistan, with a focus on contributing factors, treatment challenges, and the impact of irrational antibiotic use and antimicrobial resistance on respiratory disease management. METHOD: A qualitative explorative study was conducted from September to December 2025 with 20 physicians in public and private healthcare settings in Islamabad and Rawalpindi. In-depth interviews using a semi-structured guide explored post-COVID respiratory trends, contributing factors, treatment challenges, and AMR. Data were transcribed, translated, and analyzed through inductive thematic analysis until saturation, following the COREQ reporting guidelines. RESULT: Physicians reported increased frequency and severity of upper and lower respiratory tract infections including asthma, COPD, and pneumonia, physicians characterized them as often severe, recurrent, and prolonged. Key contributing factors cited by physicians included perceived post-viral immune compromise, comorbidities, environmental factors, behavioral changes, and reduced adherence to preventive measures. Challenges such as irrational antibiotic prescribing, over-the-counter use, and self-medication were cited by physicians as drivers of AMR. Respondents emphasized the need for strengthened diagnostics, antimicrobial stewardship, vaccination, public awareness, and systemic interventions. CONCLUSION: The increase and severity of post-COVID respiratory infections in Pakistan is due to a combination of factors including lack of immune compromise, socio-environmental and behavioral factors, and irrational antibiotics prescriptions fueling the rising antimicrobial resistance (AMR) perceived by Physicians. It is crucial to integrate public health measures, vaccination, and antimicrobial stewardship to strengthen diagnostics and mitigate the long-term respiratory morbidity and potential future crises of infectious disease. CLINICAL TRAIL REGISTRATION: Not applicable.