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Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study.

ABSTRACT: It is well known that the emergence of antibiotic resistance is linked to the misuse and overuse of antibiotics. Misuse includes self-medication and the inappropriate use of antibiotics because of improper dosage or improper duration than recommended. This study investigated three patterns of dispensing antibiotics in a sample of community pharmacies in Jordan. This included dispensing antibiotics by prescription or over-the-counter either by direct request or upon a pharmacist's recommendation. The antibiotics dispensed were evaluated in terms of indication, appropriateness of dose, and duration of treatment based on the empirical treatment suggested by selected references: Lexicomp (2017) and UptoDate (2017) and the manufacturer's recommendations. Of the 457 antibiotics dispensed, almost one third were without prescription. Of the antibiotics dispensed with prescription or without prescription, 31.5% and 24.6% respectively were appropriate dosage and duration (p = 0.002). In the three patterns of dispensing, beta lactam antibiotics were the most commonly dispensed. In addition, it was noticed that there was a tendency to prescribe or dispense higher generations of antibiotics to cases that could have been treated with lower generation or safer antibiotics. Furthermore, 12.2% of the antibiotics were dispensed to treat infections that are not indicated for them. In conclusion, a significant proportion of antibiotics are dispensed without prescription in Jordan. Moreover, a considerable proportion of prescribed antibiotics were inappropriate for the conditions concerned. This indicates the importance of enforcing the Jordanian regulations prohibiting the dispensing of nonprescription antibiotics and the implementation of continuous education to physicians and pharmacists to increase awareness about the emergence of antibiotic resistance.

SUBMITTER: Haddadin RN

PROVIDER: S-EPMC6488076 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study.

Haddadin Randa N RN Alsous Mervat M Wazaify Mayyada M Tahaineh Linda L

PloS one 20190429 4

It is well known that the emergence of antibiotic resistance is linked to the misuse and overuse of antibiotics. Misuse includes self-medication and the inappropriate use of antibiotics because of improper dosage or improper duration than recommended. This study investigated three patterns of dispensing antibiotics in a sample of community pharmacies in Jordan. This included dispensing antibiotics by prescription or over-the-counter either by direct request or upon a pharmacist's recommendation. ...[more]

PMID: 31034528

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Project description:BackgroundIndia's total antibiotic use is the highest of any country. Patients often receive prescription-only drugs directly from pharmacies. Here we aimed to assess the medical advice and drug dispensing practices of pharmacies for standardised patients with presumed and confirmed tuberculosis in India.MethodsIn this cross-sectional study in the three Indian cities Delhi, Mumbai, and Patna, we developed two standardised patient cases: first, a patient presenting with 2-3 weeks of pulmonary tuberculosis symptoms (Case 1); and second, a patient with microbiologically confirmed pulmonary tuberculosis (Case 2). Standardised patients were scheduled to present each case once to sampled pharmacies. We defined ideal management for both cases a priori as referral to a health-care provider without dispensing antibiotics or steroids or both.FindingsBetween April 1, 2014, and Nov 29, 2015, we sampled 622 pharmacies in Delhi, Mumbai, and Patna. Standardised patients completed 1200 (96%) of 1244 interactions. We recorded ideal management (defined as referrals without the use of antibiotics or steroids) in 80 (13%) of 599 Case 1 interactions (95% CI 11-16) and 372 (62%) of 601 Case 2 interactions (95% CI 58-66). Antibiotic use was significantly lower in Case 2 interactions (98 [16%] of 601, 95% CI 13-19) than in Case 1 (221 [37%] of 599, 95% CI 33-41). First-line anti-tuberculosis drugs were not dispensed in any city. The differences in antibiotic or steroid use and number of medicines dispensed between Case 1 and Case 2 were almost entirely attributable to the difference in referral behaviour.InterpretationOnly some urban Indian pharmacies correctly managed patients with presumed tuberculosis, but most correctly managed a case of confirmed tuberculosis. No pharmacy dispensed anti-tuberculosis drugs for either case. Absence of a confirmed diagnosis is a key driver of antibiotic misuse and could inform antimicrobial stewardship interventions.FundingGrand Challenges Canada, Bill & Melinda Gates Foundation, Knowledge for Change Program, and World Bank Development Research Group.

Project description:BackgroundIn South Korea, community pharmacy experiential practice (CPEP) is very important because most pharmacists (71.8%) work in community pharmacies, which also employ the majority of students after graduation. The present study investigated student responses to the current CPEP status, suggestions for improvement, and advancement in their competency after practice based on evaluation of Community Pharmacy Experiential Practice Model (CPEPM) outcomes.MethodsA nationwide cross-sectional, self-administered online survey was conducted in 2017 for the sixth-year pharmacy students who completed CPEP, using 50 item questionnaire. The answers were evaluated using the 4-point Likert scale, used a scoring system from 1 (strongly disagree) to 4 (strongly agree). Responses of 1 and 2 were considered negative, and 3 and 4 were considered positive. To identify factors affecting CPEPM outcomes, multivariate linear regression analysis was performed.ResultsInitially, 1138 students participated in the survey. Of these, responses from 492 students were excluded due to missing data and eventually, data from 646 students were included in the analysis. In total, 95% of students responded in the affirmative that practical training influenced their future career decision. In addition, 78.5% of students were satisfied with the training. Further, they responded that their ability improved based on CPEPM outcomes. The most positive capability change was in the subdomain "personal and professional development", followed by "inter professional collaboration".ConclusionsStudents responded with the higher rating for satisfaction factor, who regarded CPEP as helpful in future career decision making, and those who wanted to practice elective Advanced Pharmacy Practice Education at a community pharmacy had a positive CPEPM outcome, while age was found to be a negative factor in terms of the regression analysis. These are valuable findings as they represent the current student perception of CPEP nationwide. They provide a basis to improve the quality of CPEP-based education not only in Korea, but in other countries as well.

Project description:BACKGROUND:Antibiotics have been used for decades against Cutibacterium acnes (previously known as Propionibacterium acnes; C. acnes). Alarmingly, antibiotic resistance to this bacterium has become a worldwide problem in recent years. No studies are available on the antibiotic susceptibility patterns of C. acnes among Jordanian acne patients and how that is influenced by antibiotic use. This study aims to assess antibiotic resistance patterns of C. acnes clinical isolates and neighboring Gram-positive normal flora of the skin obtained from acne patients attending dermatology clinics in Amman -Jordan appraising the role of antibiotic consumption. METHODS:This is a cross-sectional study of acne patients presenting to selected dermatology outpatient clinics over a 6-month study period. Swabs obtained from inflamed lesions were cultured aerobically and anaerobically. Isolates were identified and screened for antibiotic susceptibility. In addition, all patients were asked to fill in a questionnaire that included questions about the history of antibiotic treatment. RESULTS:C. acnes was isolated from lesions of 100 patients out of 115 participants included in this study. 73% of the isolates were resistant to erythromycin and 59% to clindamycin 37% to doxycycline, 36% to tetracycline, 31% to trimethoprim / sulfamethoxazole, 15% to levofloxacin, and 3% to minocycline. Multi drug resistance (MDR) in C. acnes isolates as well as Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) with a similar pattern of resistance were detected from the same patient in most cases. A pattern of higher resistance towards variable antibiotic was observed in patients previously treated with antibiotics for acne management. CONCLUSIONS:The findings of this study demonstrate the distribution of antibiotic resistance of C. acnes towards used antibiotics and emphasizes the influence of antibiotic consumption on development of antibiotic resistance. The similar pattern of resistance between skin bacteria tested in this study highlights the genetic transfer of resistance between skin commensals including S. aureus and S. epidermidis hence promoting its circulation in the community.

Dataset Information

Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study.

Publications

Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study.

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