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Ayenew W, Tessema TA, Anagaw YK, Siraj EA, Zewdie S, Simegn W, Limenh LW, Tafere C, Yayehrad AT. Prevalence and predictors of self-medication with antibiotics in Ethiopia: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2024; 13:61. [PMID: 38853267 PMCID: PMC11163721 DOI: 10.1186/s13756-024-01417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/29/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION Antibiotic self-medication is a global public health concern contributing to antibiotic resistance. This systematic review and meta-analysis aim to assess the prevalence of antibiotic self-medication and its associated factors in Ethiopia. METHODS A comprehensive search of electronic databases was conducted from MEDLINE (PubMed), Scopus, Google Scholar and Web of Science to identify relevant studies published between 2000 and 2024. Adult households, undergraduate university students and health care professionals who had taken antibiotics without a prescription in the household setting were included in this review. The primary outcome of this review is antibiotic self- medication. The random-effects model was used to estimate pooled prevalence rates. The outcome measure was analyzed with STATA version 17 software. RESULTS A total of nine studies were included in the Meta-analysis, comprising a sample size of 5908 participants. The pooled prevalence of antibiotic self-medication among Ethiopians was found to be 46.14 with 95% Confidence Interval [35.71, 56.57]. The most frequently used classes of self-medicated antibiotics were penicillins, followed by tetracyclines. Community pharmacies were the source of information that individuals utilized. The most common reported reasons for antibiotic self-medication include previous experience of treating a similar illness, to save cost, lack of time and avoiding waiting time for medical services. Participants having less than high school educational level was the most commonly reported factor associated with self-medication antibiotics. CONCLUSION Antibiotic self-medication is a prevalent practice in Ethiopia. This underscores the need for targeted interventions such as educating people about the risks associated with using antibiotics without medical guidance, which results in a reduction in antibiotic resistance.
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Affiliation(s)
- Wondim Ayenew
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Ayalew Tessema
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yeniewa Kerie Anagaw
- Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ebrahim Abdela Siraj
- Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Segenet Zewdie
- Department of Social and Administrative Pharmacy, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Liknaw Workie Limenh
- Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chernet Tafere
- Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashagrachew Tewabe Yayehrad
- Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Darakhvelidze M, Kalandadze I, Mirzikashvili N, Tsereteli D, Zakareishvili N, Ketchakmadze I. Self-medication with antibiotics in Georgian population. Front Pharmacol 2024; 15:1254817. [PMID: 38449805 PMCID: PMC10915006 DOI: 10.3389/fphar.2024.1254817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Background: Self-medication with antibiotics is a global phenomenon and a potential contributor to human pathogen resistance to antibiotics. It involves obtaining medication without a prescription, taking medicines based on the advice of friends and relatives, or previous treatment experience. Self-medication is common in both developed and developing countries; however, the prevalence of self-medication is higher in developing countries. The aim of this study was to determine the characteristics of antimicrobial self-medication in Georgia and its potential to influence the overall situation regarding antimicrobial consumption in the country. Methods: We conducted a cross-sectional study using a random sampling method and developed a self-administered questionnaire to collect the data. The survey was conducted via the Internet using the Google Forms platform. Results: The overall number of respondents was 742 adults living in Georgia. The results showed that 23.8% (n = 177) of adults had consumed antibiotics without a doctor's prescription, and 12.7% (n = 94) confirmed the use of antibiotics by their own decision to treat minor family members. The total prevalence of self-medication was 32.6%. The data analysis revealed a correlation between factor F1 ("personal experience") and gender (p = 0.042, F = 2.6), and between age and factor F2 ("lack of trust in medical practitioners") (p = 0.047, F = 2.691). The correlation was stronger among young adults (aged 18-24) and senior adults (aged 60+). The correlation between the level of education and factor F2 was stronger (p = 0.00; F1 = 7.9) than with factor F1 (p = 0.04; F = 2.2). Conclusion: Self-medication is prevalent in Georgia; pharmacies are the main sources of antimicrobials. No correlation was found between factor F2, pertaining to "lack of trust in medical practitioners" and gender, between age and factor F1, linked to "personal experience." The study uncovered a lack of knowledge about self-medication with antibiotics and emphasized the importance of public awareness campaigns and implementing effective interventions to regulate the sales of antibiotics without a doctor's prescription.
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Affiliation(s)
- Marina Darakhvelidze
- Faculty of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
| | - Iagor Kalandadze
- Faculty of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
| | - Nino Mirzikashvili
- Faculty of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
| | - David Tsereteli
- National Centre of decease Control and Public Health, Tbilisi, Georgia
| | | | - Ivane Ketchakmadze
- Faculty of Natural Sciences and Medicine, Ilia State University, Tbilisi, Georgia
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Akande-Sholabi W, Oyesiji E. Antimicrobial stewardship: knowledge, perceptions, and factors associated with antibiotics misuse among consumer's visiting the community pharmacies in a Nigeria Southwestern State. J Pharm Policy Pract 2023; 16:120. [PMID: 37821920 PMCID: PMC10566051 DOI: 10.1186/s40545-023-00629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND In middle-income countries like Nigeria, the misuse of antibiotics by consumers is posing serious threats to public health. This is contributing to the alarming increase in antimicrobial resistance, which is reducing the effectiveness of antibiotics against common infections. This study therefore aimed to assess the knowledge, perceptions, and factors associated with antibiotics misuse among consumers visiting selected community pharmacies. METHODS This cross-sectional study conducted in Ibadan, Nigeria, aimed at determining factors influencing antibiotics misuse among consumers. The questionnaires were completed by 509 consumers. The analysis was done using SPSS version 26 and the results were presented using descriptive statistics. The associations between categorical variables were analysed using Pearson's Chi-square with statistical significance set at p < 0.05. RESULTS Results showed that 95.9% of the consumers believed that antibiotics prevent bacterial growth, and 60.7% thought they treat all infections. However, 57.4% were unaware of antibiotic resistance, while only 14.7% had adequate knowledge about antibiotics. Most of the consumers, 72.5% had used antibiotics in the last 12 months and, amoxicillin 42.4% was the most commonly used with, malaria 38.9% as the primary condition for which antibiotics were used. Some of the significant factors influencing antibiotics misuse included delays in test reports (p-value = 0.007), the belief in antibiotics' quick relief (p-value = 0.001), proximity of the pharmacy to their house or workplace (p-value = 0.028), amongst others. CONCLUSION Most of the consumers had inadequate knowledge about rational antibiotic use which contributed to their misuse of antibiotics. Thus, targeted educational interventions are needed to improve knowledge and promote appropriate antibiotic use among consumers. Policies regulating the dispensing and selling of antibiotics with adequate counselling should be further enforced.
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Affiliation(s)
- Wuraola Akande-Sholabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Eunice Oyesiji
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Brisley A, Lambert H, Rodrigues C. Antibiotics in Catalan Primary Care: Prescription, Use and Remedies for a Crisis of Care. Med Anthropol 2023; 42:682-696. [PMID: 37747451 PMCID: PMC10561602 DOI: 10.1080/01459740.2023.2256451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Antimicrobial resistance is one of the twenty-first century's major health challenges. Linked to the extensive use of antibiotics and other antimicrobials, resistance occurs when microbes stop responding to medications. Rates of antibiotic consumption in Spain are among the highest in Europe. Drawing on research conducted in Catalonia, in this article we present findings from ethnographic fieldwork and semi-structured interviews with general practitioners, residents of Barcelona, and professionals who have worked in antibiotic stewardship. We argue that the circulation of antibiotics should be understood in relation to broader historical processes and the deficient systems of health and social care provision they have produced.
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Affiliation(s)
- Adam Brisley
- Business and Technology Department, La Salle, Universitat Ramon Llull, Barcelona, Spain
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carla Rodrigues
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
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Wang Q, Wu Y, Wang D, Lai X, Tan L, Zhou Q, Duan L, Lin R, Wang X, Zheng F, Yu T, Wang L, Fan S, Wang Y, Zhang X, Liu C. The impacts of knowledge and attitude on behavior of antibiotic use for the common cold among the public and identifying the critical behavioral stage: based on an expanding KAP model. BMC Public Health 2023; 23:1683. [PMID: 37653367 PMCID: PMC10472573 DOI: 10.1186/s12889-023-16595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This study aims to explore the impacts of knowledge and attitude on the behavior of antibiotic use during the treatment of the common cold based on the expanding KAP model, and then identify the critical behavioral stage. METHODS A cross-sectional study was conducted on 815 public from 21 community health centers (CHCs) in Chongqing, China. Based on the expanding KAP model, a self-administered questionnaire was designed to measure knowledge, attitude, multi-stage behavior, and perceived threat, in which multi-stage behavior was divided into pre-use antibiotic behavior, during-use antibiotic behavior, and post-use antibiotic behavior. A structural equation model was used to examine the model fit and the direct, indirect, mediating effects, and moderating effect of the variables. RESULTS The expanding KAP showed good model fit indices with χ²/df = 0.537, RMSEA = 0.033, CFI = 0.973, GFI = 0.971, NFI = 0.934, TLI = 0.979. Knowledge had a positive effect on attitude (β = 0.503, p < 0.05), pre-use antibiotic behavior (β = 0.348, p < 0.05), during-use antibiotic behavior (β = 0.461, p < 0.001), and post-use antibiotic behavior (β = 0.547, p < 0.001). Attitude had a positive effect on during-use antibiotic behavior (β = 0.296, p < 0.001), and post-use antibiotic behavior (β = 0.747, p < 0.001). The mediating effect of attitude was positive among knowledge, during-use antibiotic behavior (β = 0.149, p < 0.05), and post-use antibiotic behavior (β = 0.376, p < 0.001). Perceived threat also had a positive moderating effect between knowledge and post-use antibiotic behavior (β = 0.021, p < 0.001). CONCLUSIONS Knowledge, attitude and perceived threat had different effects on different stages of antibiotic behavior. The critical behavioral stage prioritized the post-use antibiotic behavior and during-use antibiotic behavior over pre-use antibiotic behavior.
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Affiliation(s)
- Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yuanyang Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Dan Wang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei China
| | - Xiaoquan Lai
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Li Tan
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Qian Zhou
- Department of Hospital Infection Management, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Lixia Duan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Rujiao Lin
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Tiantian Yu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Lu Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Si Fan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yanting Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
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Farooqui M, Iqbal Z, Sadiq A, Raziq A, Alshammari MS, Iqbal Q, Haider S, Saleem F. Hospital Pharmacists' Viewpoint on Quality Use of Antibiotics and Resistance: A Qualitative Exploration from a Tertiary Care Hospital of Quetta City, Pakistan. Antibiotics (Basel) 2023; 12:1343. [PMID: 37627763 PMCID: PMC10451787 DOI: 10.3390/antibiotics12081343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023] Open
Abstract
Suboptimal antibiotics use and the development of antibiotic resistance is a universal calamity. The theoretical model of therapeutic efficacy correlates quality use of antibiotics with healthcare practitioners' understanding of antibiotic use and resistance. Keeping this phenomenon in mind, we aimed to evaluate hospital pharmacists' understanding of antibiotic use and resistance at a public healthcare institute in Quetta city, Pakistan. This was a qualitative study that employed a semi-structured interview guide for data extraction. The phenomenology-based approach commissioned in-depth, face-to-face interviews with hospital pharmacists stationed at the surgical unit of Sandeman Provincial Hospital, Quetta. The interviews were audio taped followed by transcribed verbatim and were then analyzed for thematic contents by the standard content analysis framework. Although the saturation was reached after the 10th interview, we conducted two additional interviews for definite validation. Content analysis revealed five major themes: (1) Defining antibiotics, quality use of antibiotics and resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. The knowledge of quality use of antibiotics and resistance was promising, and the respondents were eager to address the drastic situation. The respondents were aware of the critical situation and provided valuable insights that can offer valued input while promoting the quality use of antibiotics in a developing country. The current study managed to identify an adequate understanding of antibiotic use and resistance among hospital pharmacists. Additionally, prospective concerns and possible predictors of antibiotic resistance were also highlighted. The current findings must be disseminated to the policymakers and prescribers to take prompt restorative actions to address antibiotic use and the development of antibiotic resistance in a developing country like Pakistan.
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Affiliation(s)
- Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia; (M.F.); (M.S.A.)
| | - Zaffar Iqbal
- Health Department, Government of Balochistan, Quetta 87100, Pakistan;
| | - Abdul Sadiq
- Jhalawan Medical College Khuzdar, Khuzdar 89100, Pakistan;
| | - Abdul Raziq
- Department of Statistics, University of Balochistan, Quetta 87300, Pakistan;
| | - Mohammed Salem Alshammari
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia; (M.F.); (M.S.A.)
| | - Qaiser Iqbal
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta 87300, Pakistan; (Q.I.); (S.H.)
| | - Sajjad Haider
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta 87300, Pakistan; (Q.I.); (S.H.)
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta 87300, Pakistan; (Q.I.); (S.H.)
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Muacevic A, Adler JR, Ukey U, Sonpimpale B, Ughade S, Narlawar U, Gaikwad S, Nair P, Masram P, Pandey S. Prevalence, Pattern, and Reasons for Self-Medication: A Community-Based Cross-Sectional Study From Central India. Cureus 2023; 15:e33917. [PMID: 36819304 PMCID: PMC9936784 DOI: 10.7759/cureus.33917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction Self-medication is an important public health problem, with varied prevalence across the world. The high prevalence of self-medication in India is one of the important factors contributing to the development of antimicrobial resistance. Self-medication without medical guidance can lead to inappropriate, incorrect, or undue therapy, missed diagnosis, delays in appropriate treatment, pathogen resistance, and increased morbidity. The growing trend of self-medication can be attributed to various factors like the urge for self-care, sympathy toward sick family members, inaccessible health services and nonavailability of drugs, time and financial constraints, ignorance, misbeliefs, extensive advertisement and availability of drugs in places other than drug shops. Methodology The present community-based descriptive cross-sectional study was conducted in an urban field practice area of a tertiary health care center (UHTC) in Central India. Individuals above 18 years of age and present at home at the time of the house-to-house survey comprised the study participants. A total of 400 participants were enrolled in the study. Data were collected using a predesigned and pretested questionnaire by the face-to-face interview technique. Results The prevalence of self-medication in the area was 60 % (240). The most widely used drugs for self-medication were analgesics (159; 66.25%) and antipyretics (142; 59.16%). Common ailments for which self-medication was used frequently were fever, body aches, common cold, and cough. It was observed that female participants were twice more likely to self-medicate as compared to male participants (Odds Ratio (OR): 2.04; Prevalence (p) = 0.014, Confidence Interval (CI) 95% = 1.15-3.62). Additionally, those having education above the high school level had more chances of self-medicating than those educated less than high school (OR: 1.25; p≤0.014, CI 95%=1.05-1.50). The commonest reasons for resorting to self-medication as per the findings of the present study are that it saves time and the condition was not serious enough to warrant a physician's consultation.
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Nazari J, Chezani-Sharahi N, Eshrati B, Yadegari A, Naghshbandi M, Movahedi H, Moradzadeh R. Prevalence and determinants of self-medication consumption of antibiotics in children in Iran: A population-based cross-sectional study, 2018-19. PLoS One 2022; 17:e0278843. [PMID: 36584040 PMCID: PMC9803171 DOI: 10.1371/journal.pone.0278843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/25/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The prevalence of self-medication of antibiotics has been revealed in various studies. The main aim of this work is to investigate the frequency of self-medication in children under 6 years and the factors affecting it. METHODS This is a population-based cross-sectional study conducted in the Arak metropolitan in the center of Iran from January 2019 to January 2020. We used stratified random sampling to determine recruitment criteria. As 1754 households were invited to the study that 1483 were approved to participate. Children's data were obtained by the interview with their mothers. In order to define self-medication consumption of antibiotics, it was adapted between annually maternal self-reported consumption of antibiotics among their children and history of received antibiotics registered in insurance services during the same time period. Logistic regression models were exploited to obtain odds ratios and 95% confidence intervals. RESULTS Mean age of mothers was 31.8 years (SD = 5.4), 52.1% of the children were boys. Annually self-medication of antibiotic consumption was estimated 61.6% (n = 914). Based on the logistic regression analysis, in the adjusted analysis, girls were associated with self-medication consumption of antibiotics lower than boys' children (p = 0.016). Older mothers were lower self-medication consumption of antibiotics than youngers (p = 0.001). Moreover, the permanent job of fathers was associated with lower self-medication consumption of antibiotics than temporarily and unemployment (p = .001). The odds of self-medication consumption of antibiotics were increasing with the increase in age of children (OR: 1.21, CI95%: 1.12, 1.31 and p = 0.001). The increase in parity has been a significant association with the self-medication consumption of antibiotics (OR: 1.64, CI95%: 1.38, 1.95and p = 0.001). CONCLUSION Results of this study show that some factors such as children's age, gender, mother's age, father's occupational status, and parity are the determinants that significantly impact the self-medication prevalence.
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Affiliation(s)
- Javad Nazari
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | | | - Babak Eshrati
- Department of Community Medicine, School of Medicine, Preventive Medicine and Public Health Research Center, Social Injury Prevention Research Institute, Iran University of Medical Science, Tehran, Iran
| | | | | | | | - Rahmatollah Moradzadeh
- Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
- * E-mail: ,
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Development and Psychometric Evaluation of the Antibiotic Knowledge and Consumption Tool (AKCT). Antibiotics (Basel) 2022; 11:antibiotics11121744. [PMID: 36551401 PMCID: PMC9774259 DOI: 10.3390/antibiotics11121744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/09/2022] Open
Abstract
Knowledge of antibiotics and awareness of microbial resistance are essential for appropriate antibiotic consumption. This study aimed to develop and validate a measure of antibiotic knowledge and consumption (AKCT) and to make it available in the Arabic language and context. The tool was developed and applied on individuals ≥ 18 years, with mastery of Arabic or English. Exploratory factor analysis using principal-component analysis tested the psychometric properties of the items. AKCT scores were compared with the Infectious Numeracy Test (INT) scores to establish convergent validity. Cronbach’s α > 0.7 measured reliability. Three hundred-eighty-six participants completed the questionnaire, achieving a 95.3% response rate. Five components were retained after factor analysis: Side-effects and resistance, Access to antibiotics, Recovery after use, Antibiotics use indications, and Body response. Cronbach’s α = 0.85. The mean ± SD of AKCT = 9.82 ± 3.85 (range = 7−20); lowest scores were related to “Side-effects and resistance” (2.32 ± 2.00, max = 7) and “Antibiotic use indications” (1.61 ± 1.29, max = 5). Scores on the AKCT and INT positively correlated. The AKCT is a valuable, valid, and reliable tool developed for measurement of antibiotic knowledge and consumption behaviors to identify specific areas needing improvements; hence, targeted interventions are devised.
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Cruz JC, Perez CZ, Cabrera MCS, Lopez ER, Hoyos PV, Rojas Rojas D, Montaña AO. Factors associated with self-medication of antibiotics by caregivers in pediatric patients attending the emergency department: a case-control study. BMC Pediatr 2022; 22:520. [PMID: 36050652 PMCID: PMC9434513 DOI: 10.1186/s12887-022-03572-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Antibiotic self-medication is a common practice in pediatric caregivers in low-income countries with limited resources and represents a public health problem. Our study sought to determine what factors are associated with this practice, including differences in knowledge or attitudes of caregivers who attend a pediatric emergency service. Methods Case-control study based on surveys of caregivers of pediatric patients brought to the emergency room with clinical symptoms suggestive of acute infection. Cases were defined as those caregivers who reported self-medication of antibiotics for the current illness and controls where those who did not report self-medication. Information was collected through a self-administered questionnaire that inquired about demographic and family characteristics, attitudes and knowledge toward self-medication of antibiotics. Data were compared using logistic regression and are presented with odd ratios and confidence intervals. Results A total of 728 caregivers, 182 cases and 546 controls were included. We found that higher parental education, both in mothers (OR 0.56, 95% CI 0.40-0.79) and fathers (OR 0.62, 95% CI 0.43-0.89) was associated with less self-medication. Attitudes such as always requesting antibiotics from their doctors (OR 3.92, 95% CI 1.59-9.66), frequently buying antibiotics without a prescription (OR 23.66, 95% CI 11.76-47.59) and giving advice on antibiotics among family members (OR 2.90, 95% CI 1.75-4.82) resulted in an increased likelihood of self-medication. There was also a higher probability of antibiotic self-medication in older children (OR 1.13, 95% CI 1.09-1.17), those with a greater number of siblings (OR 1.25, 95% CI 1.09-1.43) and in those cases that received antibiotics within the last 3 months (OR 6.27, 95% CI 4.35-9.04). Overall knowledge of risk of antibiotic self-medication was low. Conclusions Some patient and family characteristics such as age, number of siblings, recent antibiotic usage and inappropriate attitudes are strongly related to antibiotic self-medication. These findings will inform future interventions to reduce self-medication in children.
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Affiliation(s)
- Jhon Camacho Cruz
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia. .,Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Calle 10 No.18-75, Bogotá, Colombia.
| | | | | | | | - Pablo Vásquez Hoyos
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Pediatrics, Sociedad de Cirugía de Bogotá - Hospital de San José, Calle 10 No.18-75, Bogotá, Colombia
| | - Diana Rojas Rojas
- Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Pediatrics, Hospital Infantil Universitario de San José, Bogotá, Colombia
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Khan FU, Mallhi TH, Khan FU, Hayat K, Rehman A, Shah S, Khan Z, Khan YH, Ahmad T, Gudi SK, Karataş Y, Fang Y. Evaluation of Consumers Perspective on the Consumption of Antibiotics, Antibiotic Resistance, and Recommendations to Improve the Rational use of Antibiotics: An Exploratory Qualitative Study From Post-Conflicted Region of Pakistan. Front Pharmacol 2022; 13:881243. [PMID: 35662689 PMCID: PMC9159815 DOI: 10.3389/fphar.2022.881243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Antibiotics misuse is a global challenge, and the situation is likely to deteriorate in conflict zones with insufficient health services. The misuse of antibiotics is not only associated with antimicrobial resistance but may also lead to serious consequences. This study was aimed to investigate the knowledge, attitude, and practices on antibiotic consumption, antibiotic resistance (ABR), and related suggestions among residents of conflicted zones in Pakistan. Methods: Semi-structured interviews were conducted at community pharmacies between June 2020 and January 2021. The primary findings were ascertained through thematic content analysis. Themes, sub-themes, and categories were drawn from the final analysis. Data analysis was carried out in six steps from getting to know the data to final report development. Results: A total of 20 consumers were interviewed with a mean interview duration of 25.4 min. The average age of participants was 35.1 years, and most of them were males. ABR was unfamiliar to the participants. Most of the participants understood the term "antibiotics," but they did not know how to use them properly. The participants were unable to distinguish between bacterial and viral illnesses. Thirteen participants believed that antibiotics have a faster effect than any other drug. Most of the participants perceived that every antibiotic could cause diarrhea, and pharmacy staff sometimes prefer other medicines such as multivitamins. Consumer practices regarding antibiotic usage and ABR were found to be poor. Most participants recommended that health officials must ensure qualified staff at pharmacies with strict regulations. Five participants said that a leaflet with antibiotic instructions in Urdu (national language) is usually beneficial, especially when making solutions from powder. Conclusions: This study underscored poor knowledge, attitude, and practices among residents of conflicted zones towards antibiotics and ABR. Low literacy rate, unavailability of healthcare facilities, absence of pharmacists at community pharmacies, and uncontrolled sales of antibiotics are some factors attributed to serious hazards, ABR, and irrational use of drugs.
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Affiliation(s)
- Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
- Institute of Pharmaceutical Sciences, the University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Asim.Ur Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Zakir Khan
- Institute of Health Sciences, Department of Pharmacology, Faculty of Medicine, Cukurova University, Adana, Turkey
- Pharmacovigilance Specialist, Balcali Hospital, Faculty of Medicines, Cukurova University, Adana, Turkey
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Tawseef Ahmad
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, Pakistan
| | - Sai Krishna Gudi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yusuf Karataş
- Institute of Health Sciences, Department of Pharmacology, Faculty of Medicine, Cukurova University, Adana, Turkey
- Pharmacovigilance Specialist, Balcali Hospital, Faculty of Medicines, Cukurova University, Adana, Turkey
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi’an, China
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12
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Paul GK, Swapon MS, Kaderi Kibria KM. Knowledge, awareness, and attitudes toward antibiotic resistance and practice of self-medication among university students in Bangladesh: A cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:115. [PMID: 35677264 PMCID: PMC9170193 DOI: 10.4103/jehp.jehp_602_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/16/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of self-medication is high in Bangladesh due to easy access and poor regulatory controls over these drugs. Our study aimed to assess the attitude of university students in Bangladesh toward antibiotic usage, especially their knowledge and awareness about antibiotics and their resistance. We also evaluated the determinants behind their attempts at drug intake without prescription. MATERIALS AND METHODS A cross-sectional study was conducted in Mawlana Bhashani Science and Technology University that included information from randomly selected 200 students from 15 departments using a structured questionnaire. The statistical analyses were performed by using SPSS software (version 21) and R programming. RESULTS The study revealed that 61.0% of the students use self-medication at different times or always; 32.5% of the respondents keep antibiotics for future use, and 38% of the students think it is right to stop antibiotics when symptoms are improving. Half of the participants (47.5%) use antibiotics based on their previous experience. The criteria of antibiotic selection have a significant relationship with knowledge about antibiotic resistance (P = 0.017) and altered prescribed medicine without doctor's advice (P < 0.001). The multivariate analysis indicates that respondents who know about antibiotic resistance select antibiotics from the community pharmacists with respect to their own experience 5.102 times higher than those who do not know about antibiotic resistance. CONCLUSIONS The study mainly explored the knowledge gaps of the students on the options that are responsible for antibiotic resistance in the community and found that students have mid-level knowledge (66%) about antibiotic resistance.
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Affiliation(s)
- Gowranga Kumar Paul
- Department of Statistics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Md. Shalauddin Swapon
- Department of Statistics, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - K. M. Kaderi Kibria
- Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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13
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Allen T, Gyrd-Hansen D, Kristensen SR, Oxholm AS, Pedersen LB, Pezzino M. Physicians under Pressure: Evidence from Antibiotics Prescribing in England. Med Decis Making 2022; 42:303-312. [PMID: 35021900 PMCID: PMC8918864 DOI: 10.1177/0272989x211069931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many physicians are experiencing increasing demands from both their patients and society. Evidence is scarce on the consequences of the pressure on physicians' decision making. We present a theoretical framework and predict that increasing pressure may make physicians disregard societal welfare when treating patients. SETTING We test our prediction on general practitioners' antibiotic-prescribing choices. Because prescribing broad-spectrum antibiotics does not require microbiological testing, it can be performed more quickly than prescribing for narrow-spectrum antibiotics and is therefore often preferred by the patient. In contrast, from a societal perspective, inappropriate prescribing of broad-spectrum antibiotics should be minimized as it may contribute to antimicrobial resistance in the general population. METHODS We combine longitudinal survey data and administrative data from 2010 to 2017 to create a balanced panel of up to 1072 English general practitioners (GPs). Using a series of linear models with GP fixed effects, we estimate the importance of different sources of pressure for GPs' prescribing. RESULTS We find that the percentage of broad-spectrum antibiotics prescribed increases by 6.4% as pressure increases on English GPs. The link between pressure and prescribing holds for different sources of pressure. CONCLUSIONS Our findings suggest that there may be societal costs of physicians working under pressure. Policy makers need to take these costs into account when evaluating existing policies as well as when introducing new policies affecting physicians' work pressure. An important avenue for further research is also to determine the underlying mechanisms related to the different sources of pressure.JEL-code: I11, J28, J45. HIGHLIGHTS Many physicians are working under increasing pressure.We test the importance of pressure on physicians' prescribing of antibiotics.The prescribed rate of broad-spectrum antibiotics increases with pressure.Policy makers should be aware of the societal costs of pressured physicians.[Formula: see text].
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Affiliation(s)
- Thomas Allen
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK.,Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Dorte Gyrd-Hansen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Søren Rud Kristensen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Anne Sophie Oxholm
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark
| | - Line Bjørnskov Pedersen
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, J.B., Odense C, Denmark.,Research Unit for General Practice, University of Southern Denmark, J..B, Odense C, Denmark
| | - Mario Pezzino
- School of Social Sciences, University of Manchester, Manchester, UK
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14
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Naseef H, Joza’ D, Awawdeh A, Hasan A, Abukhalil AD, Al-Shami N, Rabba A. Evaluation of Self-Medication with Antibiotics in Primary Care Clinics in Palestine. Patient Prefer Adherence 2022; 16:2877-2892. [PMID: 36303594 PMCID: PMC9595066 DOI: 10.2147/ppa.s384671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Antibiotics are highly effective medications and essential in curing infectious diseases; however, their inappropriate use, such as self-medication, is a significant factor in developing antimicrobial resistance. OBJECTIVE This study aimed to evaluate the level of antibiotic self-medication among patients who visited primary care clinics in Palestine. METHODS Data were collected via a self-administered questionnaire, either printed or electronically, using google forms (Google Inc., USA). The sample size needed to provide a 95% confidence level and 5% margin error and assuming a prevalence of 50% of SM with antibiotics was 377 patients. A total of 700 questionnaires were randomly distributed to patients aged 18 years or older. However, 87 were excluded due to duplication, incomplete responses, or participants under 18 years old. Finally, 423 patients were included in this study, with 254 patients completing the electronic Google Forms and 181 completing the written survey. The questionnaire consists of patients' demographics, antibiotics knowledge, and self-medication behavior. In addition, descriptive statistics and knowledge scales were performed using SPSS 22 IBM to measure and assess the scope of the problem and find the association between self-medication demographics, education, and socioeconomic status. RESULTS Approximately 50% of participants reported self-medication with antibiotics, with a very high use among participants with medical knowledge. Most people have adequate awareness of antibiotics, whereas out of 423 respondents, (40.2%, n = 170) had GKL, (50.4%, n= 213) had AKL, and only (9.5%, n=40) presented PKL. The primary source for self-treatment with antibiotics was community pharmacies (87.1%, n=223), whereas (14.1%, n=36) got antibiotics from family and friends. Convenience, easy access, and experience with community pharmacists contributed to self-medications. The most commonly used antibiotic for self-medication was amoxicillin/clavulanic acid. CONCLUSION Self-medication with antibiotics is a common practice in Palestine, regardless of socioeconomic or educational status. Patients' educations about complications from inappropriate use and the possibility of side effects are essential steps to decrease patients' demands for antibiotics. Furthermore, compliance and adherence of community pharmacists in dispensing antibiotics only with a prescription is necessary.
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Affiliation(s)
- Hani Naseef
- Pharmacy Department, Birzeit University, Birzeit, State of Palestine
- Correspondence: Hani Naseef, Tel +970-598903449, Fax +970-2-2982017, Email
| | - Dana Joza’
- Pharmacy Department, Birzeit University, Birzeit, State of Palestine
| | - Ahlam Awawdeh
- Pharmacy Department, Birzeit University, Birzeit, State of Palestine
| | - Alaa Hasan
- Pharmacy Department, Birzeit University, Birzeit, State of Palestine
| | | | - Ni’meh Al-Shami
- Pharmacy Department, Birzeit University, Birzeit, State of Palestine
| | - Abdullah Rabba
- Pharmacy Department, Birzeit University, Birzeit, State of Palestine
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15
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Vijayakumar BG, Ramesh D, Kumaravel SM, Theresa M, Sethumadhavan A, Venkatesan BP, Radhakrishnan EK, Mani M, Kannan T. Chitosan with pendant (E)-5-((4-acetylphenyl) diazenyl)-6-aminouracil groups as synergetic antimicrobial agents. J Mater Chem B 2022; 10:4048-4058. [DOI: 10.1039/d2tb00240j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Conventional antimicrobial agents are losing the war against drug resistance day-by-day. Chitosan biopolymer is one of the alternative materials that lends itself well to this application by fine-tuning its bioactivity...
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16
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Kassa T, Gedif T, Andualem T, Aferu T. Antibiotics self-medication practices among health care professionals in selected public hospitals of Addis Ababa, Ethiopia. Heliyon 2022; 8:e08825. [PMID: 35128109 PMCID: PMC8803584 DOI: 10.1016/j.heliyon.2022.e08825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/08/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Self-medication is the first option and response to most illness episodes. Use of antimicrobials without health care professionals' guidance may result in greater probability of inappropriate use, missed diagnosis, delays in appropriate treatment, pathogen resistance and increased morbidity. There is no sector in the health care community which is immune to drug abuse or misuse of which the worst offenders include physicians, nurses and pharmacy professionals. Self-medication among health care professionals may be an indicator that the health professional is neglecting his or her own health. This represents serious issues for both patients and the professionals. OBJECTIVE To assess self-medication practices with antibiotics among health care professionals in selected hospitals of Addis Ababa, Ethiopia. METHOD Facility based cross-sectional study was conducted from April to May, 2017 among 317 health care professionals. Convenient sampling technique was used to select study participants. Data were collected through self-administered questionnaire and analyzed using Statistical Package for Social Sciences software version 20. Binary logistic regression analysis was done to check the relationship between the dependent variable (antibiotic self-medication) and selected independent variables (sex, age, marital status, income, professional qualification and work experience). RESULTS The prevalence of self-medication with antibiotics among health care professionals in one month recall period was found to be 72 (22.7%). The main reasons given for this practice were being familiar with the treatment options, 31 (43.1%) and need for rapid relief, 25 (34.7%). Respiratory problems, 29 (40.3%) and gastro intestinal problems, 28 (38.9%) were the most common illnesses for which self-medication with antibiotics was practiced while penicillins, 30 (41.6%) and fluoroquinolones, 29 (40.3%) constituted the two most commonly used antibiotics for the same. None of the variables had significant association with the practice of self-medication with antibiotics. CONCLUSION Self-medication with antibiotics was common among the study participants. Efforts should be made by health authorities including Drug and Therapeutics Committee, Drugs Regulatory Authority, Hospitals' management and other stakeholders to ensure safe usage of antibiotics.
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Affiliation(s)
- Tsehay Kassa
- Teklehaimanot Health Center, Addis Ababa, Ethiopia
| | - Teferi Gedif
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Temesgen Aferu
- School of Pharmacy, College of Medicine and Health Sciences, Mizan Tepi University, Mizan- Aman, Ethiopia
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17
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Saleem Z, Faller EM, Godman B, Malik MSA, Iftikhar A, Iqbal S, Akbar A, Hashim M, Amin A, Javeed S, Amir A, Zafar A, Sabih F, Hashmi FK, Hassali MA. Antibiotic consumption at community pharmacies: A multicenter repeated prevalence surveillance using WHO methodology. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211064714. [PMID: 36204499 PMCID: PMC9413637 DOI: 10.1177/23992026211064714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Antibiotics are losing their effectiveness because of the rapid emergence of
resistant bacteria. Unnecessary antimicrobial use increases antimicrobial
resistance (AMR). There are currently no published data on antibiotic
consumption in Pakistan at the community level. This is a concern given high
levels of self-purchasing of antibiotics in Pakistan and variable knowledge
regarding antibiotics and AMR among physicians and pharmacists. Objective: The objective of this repeated prevalence survey was to assess the pattern of
antibiotic consumption data among different community pharmacies to provide
a baseline for developing future pertinent initiatives. Methods: A multicenter repeated prevalence survey conducted among community pharmacies
in Lahore, a metropolitan city with a population of approximately 10 million
people, from October to December 2017 using the World Health Organization
(WHO) methodology for a global program on surveillance of antimicrobial
consumption. Results: The total number of defined daily doses (DDDs) dispensed per patient ranged
from 0.1 to 50.0. In most cases, two DDDs per patient were dispensed from
pharmacies. Co-amoxiclav was the most commonly dispensed antibiotic with a
total number of DDDs at 1018.15. Co-amoxiclav was followed by ciprofloxacin
with a total number of 486.6 DDDs and azithromycin with a total number of
472.66 DDDs. The least consumed antibiotics were cefadroxil, cefotaxime,
amikacin, and ofloxacin, with overall consumption highest in December. Conclusion: The study indicated high antibiotic usage among community pharmacies in
Lahore, Pakistan particularly broad-spectrum antibiotics, which were mostly
dispensed inappropriately. The National action plan of Pakistan on AMR
should be implemented by policymakers including restrictions on the
dispensing of antimicrobials.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
- Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | | | - Aqsa Iftikhar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sonia Iqbal
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aroosa Akbar
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Mahnoor Hashim
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Aneeqa Amin
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sidra Javeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Afreenish Amir
- National University of Medical Sciences, Rawalpindi, Pakistan
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18
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Sun R, Yao T, Zhou X, Harbarth S, Lin L. Non-biomedical factors affecting antibiotic use in the community: a mixed-methods systematic review and meta-analysis. Clin Microbiol Infect 2021; 28:345-354. [PMID: 34768017 DOI: 10.1016/j.cmi.2021.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the past two decades, human antibiotic consumption has increased globally, contributing to the emergence and spread of antimicrobial resistance and calling for urgent effective actions. OBJECTIVES To systematically identify and collate studies exploring non-biomedical factors influencing healthcare consumers' antibiotic use globally, in order to inform future interventions to improve antibiotic use practices. METHODS Data sources: PubMed, EMBASE, PsycINFO, and Cochrane. STUDY ELIGIBILITY CRITERIA Original and empirical studies that identified factors for healthcare consumers' antibiotic use. PARTICIPANTS Healthcare consumers. Assessment of risk of bias: Adapted BMJ survey appraisal tools, the Critical Appraisal Skills Programme checklist, and the Mixed Methods Appraisal Tool were utilised for quality assessment. Methods of data synthesis: The Social Ecological Framework and Health Belief Model were employed for data synthesis. We did random-effects meta-analyses to pool the odds ratios of risk factors for antibiotic use. RESULTS We included 71 articles for systematic review and analysis: 54 quantitative, nine qualitative, and eight mixed-methods studies. Prevalent non-prescription antibiotic uses and irresponsible prescriptions were reported globally, especially in low-to-middle income countries. Barriers to healthcare - wait time, transportation, stigmatization - influenced people's antibiotic use practices. Further, lack of oversight and regulation in the drug manufacturing and weak supply chain have led to the use of substandard or falsified antibiotics. Knowledge had mixed effects on antibiotic use behaviours. Meta-analyses identified pro-attitudes towards self-medication with antibiotics, relatives having medical backgrounds, older age, living in rural areas, and storing antibiotics at home to be risk factors for self-medication with antibiotics. CONCLUSIONS Non-prescription antibiotic use and irresponsible prescriptions in the community are prevalent in all WHO regions and largely driven by a mixed collection of non-biomedical factors specific to the respective setting. Future AMR strategies should incorporate implementation science approach for community-based complex interventions that addresses drivers of the target behaviours tailored to local contexts.
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Affiliation(s)
- Ruyu Sun
- Zhejiang University, Hangzhou, Zhejiang, P.R.China
| | - Tingting Yao
- Zhejiang University, Hangzhou, Zhejiang, P.R.China
| | - Xudong Zhou
- Zhejiang University, Hangzhou, Zhejiang, P.R.China
| | - Stephan Harbarth
- University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Leesa Lin
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, P. R. China.
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19
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Yeika EV, Ingelbeen B, Kemah BL, Wirsiy FS, Fomengia JN, van der Sande MAB. Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa. Trop Med Int Health 2021; 26:862-881. [PMID: 33942448 DOI: 10.1111/tmi.13600] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate and compare the prevalence, reasons, sources and factors associated with self-medication with antibiotics (SMA) within Africa. METHODS Systematic review and meta-analysis. An electronic search of PubMed and Google Scholar databases was performed for observational studies conducted between January 2005 and February 2020. Two reviewers independently screened abstracts and full texts using the PRISMA flowchart and performed quality assessment of eligible studies. Both qualitative and quantitative syntheses were carried out. RESULTS Forty studies from 19 countries were eligible for qualitative synthesis. The prevalence of SMA in Africa ranged from 12.1% to 93.9% with a median prevalence of 55.7% (IQR 41-75%). Western Africa was the sub-region with the highest reported prevalence of 70.1% (IQR 48.3-82.1%), followed by Northern Africa with 48.1% (IQR 41.1-64.3%). We identified 27 antibiotics used for self-medication from 13 different antibiotic classes. Most frequently used antibiotics were penicillins (31 studies), tetracyclines (25 studies) and fluoroquinolones (23 studies). 41% of these antibiotics belong to the WHO Watch Group. The most frequent indications for SMA were upper respiratory tract infections (27 studies), gastrointestinal tract symptoms (25 studies) and febrile illnesses (18 studies). Common sources of antibiotics used for self-medication were community pharmacies (31 studies), family/friends (20 studies), leftover antibiotics (19 studies) and patent medicine stores (18 studies). The most frequently reported factor associated with SMA was no education/low educational status (nine studies). CONCLUSIONS The prevalence of SMA is high in Africa and varies across sub-regions with the highest prevalence reported in Western Africa. Drivers of SMA are complex, comprising of socio-economic factors and insufficient access to health care coupled with poorly implemented policies regulating antibiotic sales.
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Affiliation(s)
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ben-Lawrence Kemah
- University Hospitals North Midlands, Stoke-on-Trent, UK.,Health Education & Research Organization, Buea, Cameroon
| | | | - Joseph Nkeangu Fomengia
- École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium.,Sintieh Research Academy, Yaoundé, Cameroon
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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20
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Kotwani A, Joshi J, Lamkang AS, Sharma A, Kaloni D. Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India. Pharm Pract (Granada) 2021; 19:2206. [PMID: 33828621 PMCID: PMC8005328 DOI: 10.18549/pharmpract.2021.1.2206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/21/2021] [Indexed: 01/11/2023] Open
Abstract
Background: In Low-and Middle-Income Countries, including India, consumers often purchase
antibiotics over-the-counter (OTC) from retail pharmacies. This practice
leads to the inappropriate use of antibiotics in the community which is an
important driver for the development of antimicrobial resistance. A better
understanding of consumers’ views towards this grave public health
concern is critical to developing evidence-based intervention programs for
awareness among the general population. Objective: To explore knowledge, practice and, behavior of consumers towards
antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior
of consumers for antibiotics, and to gain insight which will help in
developing evidence-based policy interventions. Methods: 72 in-depth consumer interviews were conducted in all 11 districts of the
National Capital Territory of Delhi. The qualitative data were analyzed
using thematic analysis. Results: Our study found that retail pharmacies were the first point of consultation
for common ailments for patients/consumers once home remedies failed; they
were largely unaware of the threat of antimicrobial resistance.
Consumers’ knowledge of antibiotic use and about antimicrobial
resistance was low, they used old prescriptions, and bought antibiotics OTC
to save time and money. Despite the presence of regulations constituted to
regulate the sale of antibiotics by the Government and the implementation of
national campaigns, the practice of self-medication and behaviors such as
OTC purchase, non-adherence to prescribed antibiotics was prevalent.
Consumers perceive that antibiotics provide quick relief and accelerate the
curing process and retail pharmacy shops try to protect their retail
business interests by honoring old prescriptions and self-medication for
antibiotics. Conclusions: The lack of awareness and insufficient knowledge about what antibiotics are
and issues such as antimicrobial resistance or antibiotic resistance
resulted in misuse of antibiotics by consumers. Limited access to public
healthcare and affordability of private healthcare are factors that
contribute towards the self-medication/OTC purchase of antibiotics. The
regular misuse of antibiotics through irrational use reinforces the need for
strong enactment of strategies like continuous community awareness
campaigns. Mitigation efforts should focus upon educating consumers
continuously and sustainably for the understanding of antibiotic misuse,
antimicrobial resistance, and promote better compliance with
regulations.
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Affiliation(s)
- Anita Kotwani
- PhD (Pharmacol). Professor & Head of Pharmacology Department, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi. Delhi (India).
| | - Jyoti Joshi
- MD, MBBS (Commun Med). Adjunct Professor. Amity Institute of Public Health, Center for Disease Dynamics, Economics and Policy (CDDEP), Amity University and Head-South Asia. New Delhi (India).
| | - Anjana S Lamkang
- PhD (Anthropol). Fellow. Center for Disease Dynamics, Economics and Policy (CDDEP). New Delhi (India).
| | - Ayushi Sharma
- MSc (Anthropol). Senior Research Fellow. Pharmacology Department, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi. Delhi (India).
| | - Deeksha Kaloni
- MTech. (Biotechnol). Junior Research Fellow. Pharmacology Department, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi. Delhi (India).
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21
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Hassan MM, El Zowalaty ME, Lundkvist Å, Järhult JD, Khan Nayem MR, Tanzin AZ, Badsha MR, Khan SA, Ashour HM. Residual antimicrobial agents in food originating from animals. Trends Food Sci Technol 2021; 111:141-150. [PMID: 33746363 PMCID: PMC7953985 DOI: 10.1016/j.tifs.2021.01.075] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
Background The agricultural food products industry in Bangladesh depends on utilizing antimicrobials indiscriminately as growth promoters and for controlling infectious diseases. Thus, there is always a risk of antimicrobial agent accumulation in food sources that originate from agricultural production. Methods In the present study, we collected data from published articles between January, 2013 and December, 2019 on antimicrobial residues in human food sources such as meat, milk, eggs, and fishes. Results Liver contained the highest percentage of antimicrobial residues (74%; 95% CI: 59.66–85.37) against the invitro enteric pathogen Escherichia coli in layer chickens. Similar results were demonstrated in liver (68%; 95% CI: 53.30–80.48) and kidney (66%, 95% CI: 51.23–78.79) of layer chickens against Bacillus cereus and Bacillus subtilis. Amongst all antibiotics, the highest concentrations of ciprofloxacin were detected in kidney (48.57%; 95% CI: 31.38–66.01), followed by liver (47.56; 95% CI: 40.88–54.30) of broiler chickens. Ciprofloxacin was also present in liver (46.15%; 95% CI: 33.70–58.96) of layer chickens. The percentage of ciprofloxacin in thigh and breast meat in broiler bird were 41.54% (95% CI: 34.54–48.79) and 37.95% (95% CI: 31.11–45.15) respectively. Enrofloxacin was the second most dominant antimicrobial agent and was present in the liver of both types of poultry (Broiler and Layer chickens: 41.54%; 95% CI: 29.44–54.4 and 437.33%; 95% CI: 30.99–44.01). The prevalence rates of enrofloxacin in thigh and breast meat of broiler chickens were 24.10% (95% CI: 18.28–30.73) and 20.51% (95% CI: 15.08–26.87), respectively. Tetracycline, a commonly used antibiotic in livestock, was present in the liver (49.23%; 95% CI: 36.60–61.93) of layer chickens. In case of aquaculture food products, the highest amount of amoxicillin (683.2 mg/kg) was detected in Tilapia fish (Oreochromis niloticus), followed by 584.4 mg/kg in climbing perch (Anabas testudineus) and 555.6 mg/kg in Rui fish (Labeo rohita). Among the five types of fishes, Rui fish (0.000515 mg/kg) contained the highest concentrations of chloramphenicol antibiotic residues. Conclusions The presence of antimicrobial residues in meat, milk, egg, and fish is a serious public health threat due to the potential induction of antimicrobial resistance. It can negatively impact the food supply chain, especially with the current strain that it is already facing with the current COVID-19 pandemic. The findings of the present study highlight the ongoing risk of residual antimicrobial agents in food of animal origin in Bangladesh and countries with similar practices. This can draw the attention of public health officials to propose plans to mitigate or stop this practice.
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Affiliation(s)
- Mohammad Mahmudul Hassan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Mohamed E El Zowalaty
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, 27272, United Arab Emirates.,Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, SE 75 123, Sweden
| | - Åke Lundkvist
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, SE 75 123, Sweden
| | - Josef D Järhult
- Zoonosis Science Center, Department of Medial Sciences, Uppsala University, Sweden
| | - Md Raihan Khan Nayem
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Abu Zubayer Tanzin
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Md Rahim Badsha
- Faculty of Food Science and Technology, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Shahneaz Ali Khan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Hossam M Ashour
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, St.Petersburg, Florida, 33701, USA.,Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
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22
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Nusair MB, Al-Azzam S, Alhamad H, Momani MY. The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study. Int J Clin Pract 2021; 75:e13665. [PMID: 32772449 DOI: 10.1111/ijcp.13665] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Self-medication with antibiotics is one of the leading causes of antibiotic resistance and drug therapy problems, making antibiotic self-medication practices a global concern. Despite global efforts to limit these practices, self-medication with antibiotics remains prevalent in developing countries. This study aimed to investigate the prevalence and patterns of self-medication with antibiotics in Jordan and to compare the findings of self-medication practices with antibiotics with results from 2006. METHOD A cross-sectional community-based study used a convenient sampling technique and recruited a large sample from all over Jordan. Between February and April 2019 trained 5th-year pharmacy students recruited participants (eg, door to door) who had taken antibiotics in the preceding month. The questionnaire consisted of 14 questions that aimed to describe the patterns of self-medication with antibiotics. RESULTS A total of 1928 participants took part in this study. Of the 1928 respondents, 40.4% reported having used an antibiotic without a prescription in the previous month. Participants who had self-medicated with antibiotics had primarily used them for sore throat and influenza. Self-medicated participants had obtained antibiotics primarily from pharmacies (57.2%) and relied primarily on pharmacists (34.8%) and their own previous experience (35.2%) for information on the proper use of antibiotics. The rate of self-medication with antibiotics in Jordan in 2019 (40.4%) had not changed significantly since 2006 (39.5%, P = .295). However, self-medication practices (eg, source of antibiotic supply and information) have changed over the year. CONCLUSION The findings of this study revealed that the prevalence of self-medication with antibiotics in Jordan remains high. This is a significant concern that requires a quick response from the government authorities to develop a collaborative approach to stop the dispensing of antibiotics without a prescription.
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Affiliation(s)
- Mohammad B Nusair
- Pharmacy Practice Department, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Sayer Al-Azzam
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hamza Alhamad
- Faculty of Pharmacy, Zarqa University, Zarqa, Jordan
| | - Mohammad Y Momani
- Pharmacy Practice Department, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
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23
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Makowska M, Boguszewski R, Nowakowski M, Podkowińska M. Self-Medication-Related Behaviors and Poland's COVID-19 Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228344. [PMID: 33187315 PMCID: PMC7696561 DOI: 10.3390/ijerph17228344] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 01/14/2023]
Abstract
(1) Background: The SARS-CoV-2 pandemic has changed the functioning of Polish health systems. Telemedicine has been developed and access to prescription drugs (Rx) has been facilitated. This study examined whether these changes and the imposition of a three-month lockdown caused Polish people to engage in more self-medication-related behaviors. (2) Method: After the fourth (final) stage of defrosting the Polish economy, an online survey of a quota sample of 1013 Polish respondents was conducted. (3) Results: Almost half of the respondents (45.6%) indicated that they had engaged in at least one behavior associated with inappropriate self-medication during the lockdown (e.g., 16.6% took medication as a precaution, and 16.8% took an Rx formulation without consultation). Some of these people had never engaged in such behaviors prior to the lockdown. Linear regression showed that higher values of a composite ("lockdown") index of self-medication-related behaviors occurring during lockdown were predicted by greater religiosity and the presence of children in a household. Also, independent samples t-tests showed that people who were afraid for their financial future and people who feared for their health obtained higher lockdown index scores than people not having such worries. (4) Conclusions: Self-medication-related behaviors were more common among Poles before lockdown than during the lockdown (which is unsurprising given that the lengths of the periods compared were hugely different), worryingly, many people exhibited such behaviors for the first time during the lockdown.
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Affiliation(s)
- Marta Makowska
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynownska 166 St. 02-787 Warsaw, Poland; (M.M.); (M.P.)
| | - Rafał Boguszewski
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynownska 166 St. 02-787 Warsaw, Poland; (M.M.); (M.P.)
- Correspondence:
| | - Michał Nowakowski
- Department of Social Health Problems, Maria Curie-Skłodowska University in Lublin, Plac Marii Curie-Skłodowskiej 5, 20-031 Lublin, Poland;
| | - Monika Podkowińska
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynownska 166 St. 02-787 Warsaw, Poland; (M.M.); (M.P.)
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24
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Dhingra S, Rahman NAA, Peile E, Rahman M, Sartelli M, Hassali MA, Islam T, Islam S, Haque M. Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter. Front Public Health 2020; 8:535668. [PMID: 33251170 PMCID: PMC7672122 DOI: 10.3389/fpubh.2020.535668] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Antibiotics changed medical practice by significantly decreasing the morbidity and mortality associated with bacterial infection. However, infectious diseases remain the leading cause of death in the world. There is global concern about the rise in antimicrobial resistance (AMR), which affects both developed and developing countries. AMR is a public health challenge with extensive health, economic, and societal implications. This paper sets AMR in context, starting with the history of antibiotics, including the discovery of penicillin and the golden era of antibiotics, before exploring the problems and challenges we now face due to AMR. Among the factors discussed is the low level of development of new antimicrobials and the irrational prescribing of antibiotics in developed and developing countries. A fundamental problem is the knowledge, attitude, and practice (KAP) regarding antibiotics among medical practitioners, and we explore this aspect in some depth, including a discussion on the KAP among medical students. We conclude with suggestions on how to address this public health threat, including recommendations on training medical students about antibiotics, and strategies to overcome the problems of irrational antibiotic prescribing and AMR.
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Affiliation(s)
- Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nor Azlina A. Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Ed Peile
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Motiur Rahman
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Massimo Sartelli
- Department of General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Mohamed Azmi Hassali
- The Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | | | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
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25
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Gillani AH, Chang J, Aslam F, Saeed A, Shukar S, Khanum F, Jairoun A, Nicholson A, Mohamed Ibrahim MI, Fang Y. Public knowledge, attitude, and practice regarding antibiotics use in Punjab, Pakistan: a cross-sectional study. Expert Rev Anti Infect Ther 2020; 19:399-411. [PMID: 32912015 DOI: 10.1080/14787210.2021.1823216] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Public awareness about antibiotics use is critical in antimicrobial resistance. We evaluated knowledge, attitudes, and practices among the general population of Punjab, Pakistan in this cross-sectional study. METHODS We used a 50-item questionnaire to collect information on participant demographics, knowledge, and attitudes about antibiotics use and to evaluate the practices of taking antibiotics without a doctor's prescription. RESULTS Of the 2106 participants who completed surveys, 35.4% thought antibiotics could cure viral infections; 47.5% believed they are effective against cold and flu. Nearly 60% percent of respondents had self-medicated with antibiotics. Married people (adjusted odds ratio (AOR) = 1.285, 95% confidence interval (CI): 1.004-1.643 p = 0.046), higher antibiotics use knowledge (AOR = 0.818, 95% CI: 0.674-0.993 p = 0.042), ever purchased antibiotics without a physician's prescription (AOR = 2.024 95% CI: 1.674-2.457 p ≤ 0.001) and storing antibiotics at home (AOR = 0.801 95% CI: 0.652-0.985 p = 0.035) were significantly associated with self-medication practices. CONCLUSIONS A high proportion of inappropriate antibiotics use exists among the general population of Punjab. Interventions are needed to improve health literacy and supervise antibiotics sales in retail pharmacies.
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Affiliation(s)
- Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Centre for Health Reform and Development Research, Xian, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Centre for Health Reform and Development Research, Xian, China
| | - Fahmida Aslam
- School of Business Administration, International Food and Drug Policy Law and Research Center, Shenyang Pharmaceutical University, Shenyang, China
| | - Amna Saeed
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Centre for Health Reform and Development Research, Xian, China
| | - Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Centre for Health Reform and Development Research, Xian, China
| | - Farhat Khanum
- Department of Pharmacy, Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Ammar Jairoun
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Alison Nicholson
- Department of Microbiology, The University of the West Indies (UWI), Kingston, Jamaica
| | - Mohamed Izham Mohamed Ibrahim
- Department of Social & Administrative Pharmacy, Clinical Pharmacy and Practice Section, College of Pharmacy Qatar University, Doha, Qatar
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xian Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Centre for Health Reform and Development Research, Xian, China
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26
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Iskandar K, Molinier L, Hallit S, Sartelli M, Catena F, Coccolini F, Craig Hardcastle T, Roques C, Salameh P. Drivers of Antibiotic Resistance Transmissionin Low- and Middle-Income Countriesfrom a "One Health" Perspective-A Review. Antibiotics (Basel) 2020; 9:E372. [PMID: 32630353 PMCID: PMC7400606 DOI: 10.3390/antibiotics9070372] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Antibiotic resistance is an ecosystem problem threatening the interrelated human-animalenvironmenthealth under the "One Health" framework. Resistant bacteria arising in onegeographical area can spread via cross-reservoir transmission to other areas worldwide either bydirect exposure or through the food chain and the environment. Drivers of antibiotic resistance arecomplex and multi-sectoral particularly in Lower- and Middle-income countries. These includeinappropriate socio-ecological behaviors; poverty; overcrowding; lack of surveillance systems; foodsupply chain safety issues; highly contaminated waste effluents; and loose rules and regulations. Inorder to examine the drivers of antibiotic resistance from a "one health" perspective, a literaturereview was conducted on three databases including PubMed, Medline and Google Scholar. A totalof 485 studies of potential relevance were selected, out of which 182 were included in this review.Results have shown that the aforementioned market failures are the leading cause for the negativeexternality of antibiotic resistance that extends in scope from the individual to the global ecosystem.Incremental and sustainable global actions can make the change, however, the problem willcontinue to prevail if governments do not prioritize the "One health" approach and if individual'saccountability is still denied in a world struggling with profound socio-economic problems.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1027, F-31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1027, Université Paul Sabatier Toulouse III, F-31000 Toulouse, France;
| | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Massimo Sartelli
- Department of surgery, University of Macerata, 62100 Macerata, Italy;
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, 43126 Parma, Italy;
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Cisanello University Hospital, 56100 Pisa, Italy;
| | - Timothy Craig Hardcastle
- Department of Trauma service, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa;
- Department of Surgery, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congela, Durban 4041, South Africa
| | - Christine Roques
- Departement of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR 5503, 31330 Toulouse, France;
- Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, 31330 Toulouse, France
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
- Faculty of Public Health, Lebanese University, Beirut 1103, Lebanon
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27
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Access to antibiotics without prescription in community pharmacies in Yemen during the political conflict. Public Health 2020; 183:30-35. [PMID: 32416475 DOI: 10.1016/j.puhe.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 01/15/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The practice of dispensing non-prescribed antibiotics aggravates the global burden of antibiotic resistance. The objective of this study is to assess the practice of community pharmacists regarding dispensing antibiotics without a prescription based on simulated clinical scenarios. STUDY DESIGN Cross-sectional study. METHODS The study was performed between 15 April to 18 June 2015. Five different clinical scenarios were simulated, involving sore throat, otitis media, cough, diarrhea, and urinary tract infection (UTI). Three different levels of demand were used to convince the pharmacists to dispense antibiotics data was analyzed using SPSS, version 21.0. RESULTS Two-hundred community pharmacies in Sana'a were visited for each clinical scenario. The majority of pharmacies (73.3%) dispensed antibiotics without medical prescriptions in different levels of demand. Most antibiotics were dispensed for the sore throat simulated scenario (99.5%), followed by cough (92%), diarrhea (75.5%), and otitis media (52%). The lowest percentage of dispensed antibiotics was in the UTI scenario, with 48%. Among the pharmacists who dispensed antibiotics, 74.2% provided an explanation to the simulated patients regarding how to use antibiotics, 77.6% counseled the patient about treatment duration and only 11.9% of the pharmacists asked about the pregnancy status. Regarding the cough scenario, 83% of the pharmacists inquired about the type of cough before dispensing medication. CONCLUSION Antibiotics in Yemen can be easily obtained without medical prescription or evidence-based indication.
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28
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Wang X, Xuan Z, Storella TH, Zhou X. Determinants of non-prescription antibiotic dispensing in Chinese community pharmacies from socio-ecological and health system perspectives. Soc Sci Med 2020; 256:113035. [PMID: 32442877 DOI: 10.1016/j.socscimed.2020.113035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
Although non-prescription antibiotic dispensing (NPAD) has been officially forbidden by the Chinese government since 2004, it is still a common practice throughout the country. In this study, we use China as an example to explore the determinants of NPAD within the framework of its health system from a socio-ecological perspective. A mixed-method combining the simulated client method (SCM) and key informant interviews conducted in Zhejiang, Hubei, and Sichuan provinces was adopted. 73.3% of the SCM interactions engendered NPAD (91.7% through antibiotic requests vs. 55% through consultation) in Chinese community pharmacies; a much higher rate than the global average. At the intrapersonal level, NPAD was found to be driven by profits from selling non-prescription antibiotics and traditional Chinese medicine. At the interpersonal level, NPAD was driven by fierce competition in the community pharmacy market and by customers' unreasonable expectations. At the institutional level, it is easy for community pharmacies to evade the Food and Drug Administration's (FDA) supervision by obtaining unsupervised and fake prescriptions, refusing to give customers sale receipts, and hiding their antibiotic supplies and sale records. At the policy level, the low cost of violating the prescription-only antibiotic sale regulation and poor FDA supervision facilitated NPAD. The Chinese health system has thus failed to establish and regulate a diverse network of pharmacies for patients to fill their prescriptions; few antibiotic prescriptions are transferred from hospitals to community pharmacies. Education campaigns to increase awareness about the risks of self-medication with antibiotics among the general public, recognizable standardize prescriptions for customers to fill their prescriptions in community pharmacies, regulations on Internet and private clinic doctors' antibiotic prescribing behaviors, electronic tracking and tracing system to purchases and sales data of antibiotics and other prescription drugs, increasing cost of violating the prescription-only regulations for antibiotics sales are expected interventions to reduce NPAD.
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Affiliation(s)
- Xiaomin Wang
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA, 02118, USA.
| | - Théo H Storella
- College of Social Studies, Wesleyan University, 45 Wyllys Avenue, Middletown, CT, CT 06459, USA.
| | - Xudong Zhou
- Institute of Social Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China.
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29
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Abushaheen MA, Muzaheed, Fatani AJ, Alosaimi M, Mansy W, George M, Acharya S, Rathod S, Divakar DD, Jhugroo C, Vellappally S, Khan AA, Shaik J, Jhugroo P. Antimicrobial resistance, mechanisms and its clinical significance. Dis Mon 2020; 66:100971. [PMID: 32201008 DOI: 10.1016/j.disamonth.2020.100971] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Antimicrobial agents play a key role in controlling and curing infectious disease. Soon after the discovery of the first antibiotic, the challenge of antibiotic resistance commenced. Antimicrobial agents use different mechanisms against bacteria to prevent their pathogenesis and they can be classified as bactericidal or bacteriostatic. Antibiotics are one of the antimicrobial agents which has several classes, each with different targets. Consequently, bacteria are endlessly using methods to overcome the effectivity of the antibiotics by using distinct types of mechanisms. Comprehending the mechanisms of resistance is vital for better understanding and to continue use of current antibiotics. Which also helps to formulate synthetic antimicrobials to overcome the current mechanism of resistance. Also, encourage in prudent use and misuse of antimicrobial agents. Thus, decline in treatment costs and in the rate of morbidity and mortality. This review will be concentrating on the mechanism of actions of several antibiotics and how bacteria develop resistance to them, as well as the method of acquiring the resistance in several bacteria and how can a strain be resistant to several types of antibiotics. This review also analyzes the prevalence, major clinical implications, clinical causes of antibiotic resistance. Further, it evaluates the global burden of antimicrobial resistance, identifies various challenges and strategies in addressing the issue. Finally, put forward certain recommendations to prevent the spread and reduce the rate of resistance growth.
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Affiliation(s)
- Manar Ali Abushaheen
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muzaheed
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Amal Jamil Fatani
- Department of Pharmacology & Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alosaimi
- Consultant, Department of Restorative Dentistry, College of Dentistry, King Saud bin Abdul Aziz University for Health Sciences, P.O Box: 22490, Riyadh 11426, Saudi Arabia
| | - Wael Mansy
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Saudi Arabia; Pharmacology Department, Faculty of Medicine, Cairo University, Egypt
| | - Merin George
- General Dentist and Public Health Researcher, Australia
| | - Sadananda Acharya
- Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sanjay Rathod
- Department of Post Graduate Studies and Research in Microbiology, Gulbarga University, Gulbarga- 585106, India
| | - Darshan Devang Divakar
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Chitra Jhugroo
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Sajith Vellappally
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Aftab Ahmed Khan
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Jilani Shaik
- Genome Research Chair, Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Poojdev Jhugroo
- CAP Research Ltd., 2nd Floor Orbis Court, 132 St Jean Road 72218 Quatre Bornes, Mauritius
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Gravningen K, Field N, Blix HS, Asfeldt AM, Småbrekke L. Non-prescription purchase of antibiotics during travel abroad among a general adult population in Norway: Findings from the seventh Tromsø Study. PLoS One 2020; 15:e0228792. [PMID: 32053671 PMCID: PMC7017991 DOI: 10.1371/journal.pone.0228792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-prescription purchase of antibiotics is undesirable and has not recently been investigated in a representative population in a high-income low-use country during travel abroad. This study examined self-reported prevalence of antibiotic purchase abroad with and without prescription among participants reporting international travel in a general adult population in Norway, and the associations with socio-demographic, lifestyle and health factors. METHODS We analysed questionnaire-data from 19995 participants (10470 women) ≥40 years in the population-based Tromsø Study 7, 2015-2016. Data from the Norwegian Prescription Database were used to examine antibiotic use in Norway. We calculated adjusted odds ratios (AOR) for "travel abroad", "any antibiotic purchase abroad", and "antibiotic purchase abroad with" and "without prescription" using multivariable logistic regression. RESULTS Over half (55.0%, 95%CI 54.3-55.7%) participants reported travel abroad of >1 week duration in the past year. Travelers were more likely than non-travelers to be women (AOR = 2.02, 95%CI 1.42-2.88%) and report high education/income, childhood mostly lived abroad, healthy lifestyle, and good/excellent self-rated health. In total, 17904 travel episodes to 148 countries were reported. Altogether, 3.7% (95% CI 3.4%-4.1%) of travelers had purchased antibiotic abroad in the past year. Non-prescription purchase (1.5%, 95% CI 1.3-1.7) was associated with younger age, being female (AOR 1.41, 1.0-1.97), number of travels (reference: one episode, two: AOR = 1.82, 1.25-2.67, three: 2.60, 1.58-4.28, four: 3.10, 1.40-6.36 and ≥five: 4.70, 2.30-9.62), occurrences of diarrhoea (one: 2.42, 1.50-3.93 and ≥two: 3.08, 1.29-7.35), and antibiotic use in Norway in the past year (1.84, 1.29-2.62), whereas purchase with prescription (2.4%, 2.1-2.7) was associated with low income, growing-up abroad, recent hospital admission, additionally including number of travels/diarrhoea, and antibiotic use in Norway. Thailand (10.7%, 95% CI 7.8-14.3), Turkey (5.5%, 3.8-7.8) and Spain (3.6%, 3.0-4.3) were the countries most commonly associated with any antibiotic purchase. About two in five travelers who bought antibiotics in Thailand had done so without prescription, three in five in Turkey, and less than one in three in Spain. CONCLUSION Overall, a small proportion of travelers had bought antibiotics abroad in the past year. Low prevalence of non-prescription purchase may be explained by awareness of the risks associated with self-medication, cultural views, unawareness of the non-prescription availability, and/or few infections. Divergent predictors for purchase abroad with versus without prescription may suggest different reasons for these practices.
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Affiliation(s)
- Kirsten Gravningen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, United Kingdom
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Anne Mette Asfeldt
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Lars Småbrekke
- Department of Pharmacy, UiT - The Arctic University of Norway, Tromsø, Norway
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Sunpuwan M, Punpuing S, Jaruruengpaisan W, Kinsman J, Wertheim H. What is in the drug packet?: access and use of non-prescribed poly-pharmaceutical packs (Yaa Chud) in the community in Thailand. BMC Public Health 2019; 19:971. [PMID: 31331304 PMCID: PMC6647088 DOI: 10.1186/s12889-019-7300-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Yaa Chud' is a non-prescribed poly-pharmaceutical pack containing several types of drugs, including antibiotics and steroids, which can be purchased over the counter in Thailand for self-medication. Although it is illegal, it is still available at some community outlets. This study aimed to understand access to and use of Yaa Chud at the community level in order to raise awareness on its usage and to provide policy recommendations to address the problem. METHODS This study employed qualitative methods, including in-depth interviews with 18 drug suppliers and 16 community members, and six focus group discussions. It included inventories from 17 drug suppliers. Data were collected in selected communities of the Kanchanaburi Demographic Surveillance System, located in the western region of Thailand.Thematic analysis was based upon the Health Services Utilization Model and conducted using the Open Code qualitative software program. RESULTS Overcrowding, long waiting times, and a perceived unwelcoming environment at public health-care service outlets were identified as factors that drive people into the private sector, where loose regulation of drug laws facilitates access and use of Yaa Chud. Migrants and older people were most likely to seek and use Yaa Chud, especially for mild illness. Availability, easy access through a user's network, low cost, and perceived effectiveness were identified as factors that enable access and use of Yaa Chud. CONCLUSIONS Though illegal in Thailand, Yaa Chud is likely to remain available for self-medication by community members, due to the persisting demand by the elderly and migrant workers. There is an urgent need to replace these mixed medications with better choices. Safer Yaa Chud may be a preferred, first-line health-care option, which could help reduce congestion in the formal health-care setting. At the same time, enforcement of regulatory compliance needs to be continued in order to stop the supply of unsafe Yaa Chud.
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Affiliation(s)
- Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand.
| | - Wipaporn Jaruruengpaisan
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Heiman Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- The Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Clinical Microbiology and the Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
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Ateshim Y, Bereket B, Major F, Emun Y, Woldai B, Pasha I, Habte E, Russom M. Prevalence of self-medication with antibiotics and associated factors in the community of Asmara, Eritrea: a descriptive cross sectional survey. BMC Public Health 2019; 19:726. [PMID: 31182071 PMCID: PMC6558833 DOI: 10.1186/s12889-019-7020-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Development of drug resistance caused by self-medication with antibiotics, can be seen as one of the growing global threats. Self-medication is defined as the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms. The purpose of this study is to assess the practice of self-medication with antibiotics and associated factors among the community of Asmara, Eritrea. METHODS This was a community based descriptive cross-sectional study conducted in 16 selected sub-districts of Asmara from September to November 2017. A Two-stage cluster sampling was employed to select study sites and participants. Data was collected in a face to face interview with a structured questionnaire and entered to CSPro version 6.2. Descriptive statistics, cross-tabulation and logistic regression were executed using SPSS version 22. RESULTS A total of 580 study participants were recruited with a response rate of 99.5% (N = 577). The prevalence of Self-medication with antibiotics (SMA) in this study was found to be 45.1% [95% CI (40.5, 49.6)] and majority of them practiced once or twice in a period of 12 months. The main reasons for SMA were previous successful experience (34.4%) and the illness being 'not serious enough to seek medical care' (25.7%). Of those who self-medicated, 84.1% of used amoxicillin at least once. Wound infection (17.9%) and sore throat (13.9%) were the most self-recognized complaints that required self-medication. Antibiotics were supplied and recommended mostly by the community drug outlets. Only Sex (p = 0.046), knowledge (p = 0.019) and attitude (p < 0.001) of the participants were found significantly associated with the practice of SMA in the multivariate logistic regression. CONCLUSIONS Though majority of the respondents considered self-medication with antibiotics as inappropriate practice, about half of them were practicing it anyway. Therefore immediate attention from relevant bodies is required.
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Affiliation(s)
- Yonatan Ateshim
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea.
| | - Batseba Bereket
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Feruz Major
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Youel Emun
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Biruck Woldai
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Ismail Pasha
- School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
| | - Eyasu Habte
- Biostatistics and Epidemiology Unit, School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea
| | - Mulugeta Russom
- Eritrean Pharmacovigilance Centre, National Medicine and Food Administration, Ministry of Health, Asmara, Eritrea
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Al-Ayed MSZ. Parents' Knowledge, Attitudes and Practices on Antibiotic Use by Children. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2019; 7:93-99. [PMID: 31080389 PMCID: PMC6503695 DOI: 10.4103/sjmms.sjmms_171_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background and Objective: Deficient knowledge on antibiotics causes misuse. This study aimed to investigate parents’ knowledge, attitudes and practices on antibiotic use by children in various cities of Saudi Arabia. Methods: This cross-sectional study was carried out using a previously validated questionnaire. The questionnaire was translated into Arabic and hosted on Google Forms. Parents of children aged ≤14 years, whose contact details were available with the author, were contacted and requested to participate in the study. For those who agreed to participate, the Google Forms link was shared through WhatsApp between July and August 2016. The respondents were also encouraged to share the link with contacts who had children aged ≤14 years. Descriptive and inferential statistical analyses were performed. Results: In total, 544 parents responded from various cities of Saudi Arabia. Of these, about 75% were males (mean age = 49.9 years) and the majority (~68%) had a university degree and above. In the 6 months preceding the study, 431 respondents had taken their children to physicians. Of these, only 7.2% reported not being prescribed any antibiotics, whereas 66.8% were prescribed an oral antibiotic one or two times and 26% were more than three times. In terms of prescription, 373 respondents (68.6%) purchased antibiotics without a prescription, whereas 171 (31.4%) purchased it only after obtaining a prescription. However, only seven (1.3%) followed instructions regarding antibiotic usage, whereas 50% did not receive any advice from their doctor regarding use. All demographic characteristics, except gender and residence, were found to have significant effect on parents’ knowledge on antibiotic use (P < 0.05). Conclusion: This study found that in various cities of Saudi Arabia, parents’ knowledge, attitudes and practices on antibiotics for their children are poor. These findings highlight the need for parental education programs regarding antibiotic use and for implementing more stringent regulations on antibiotic prescription.
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Lescure D, Paget J, Schellevis F, van Dijk L. Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon Countries: A Systematic Review of the Literature. Front Public Health 2018; 6:370. [PMID: 30619809 PMCID: PMC6304439 DOI: 10.3389/fpubh.2018.00370] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Self-medication with antibiotics, which comes in different forms [e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial resistance as it often happens in a non-prudent manner. In order to tackle this persistent public health problem, its drivers need to be known. The aim of this study was therefore to identify determinants of self-medication with antibiotics via a systematic literature review. Methods: A comprehensive search on determinants of self-medication with antibiotics in the ambulatory care was conducted in PubMed, Scopus, and Embase for studies published between January 2000 and March 2017. There was no limit on the language nor on the type of study. The search was restricted to European and Anglo-Saxon countries. Pairs of reviewers independently screened the abstracts and full texts and performed a quality assessment. Results: From the initial 664 abstracts, 54 publications that included 44 countries were retrieved of which most identified patient related determinants. Important determinants include storing antibiotics at home, poor access to healthcare, and having the intention to self-medicate. Healthcare professionals contribute to the practice of self-medication when catering for demanding and socially vulnerable patients. Healthcare system related determinants include dispensing antibiotics in whole packages and the lack of enforcement of medicine regulations. For some determinants (e.g., patients' age) contradictory results were found. Conclusion: Self-medication with antibiotics is driven by a variety of determinants on the patient, healthcare professional, and system levels. Policy makers should recognise the complexity of self-medication in order to develop multifaceted interventions that target healthcare professionals and patients simultaneously.
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Affiliation(s)
- Dominique Lescure
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - John Paget
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Francois Schellevis
- Department of General Practice and Elderly Care Medicine, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Liset van Dijk
- Department of Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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Mboya EA, Sanga LA, Ngocho JS. Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a cross sectional study. Pan Afr Med J 2018; 31:165. [PMID: 31086618 PMCID: PMC6492205 DOI: 10.11604/pamj.2018.31.165.15991] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction Irrational use of antibiotics includes prescription of incorrect doses, self-medication and treatment of non-bacterial illness. As a direct consequence of irrational antibiotic use, resistance to the commonly available antibiotics has been increasing rapidly. This phenomenon is associated with poorer health outcomes, longer hospitalization, increased cost to both the patient and government, and increased mortality. The aim of this study was to determine the prevalence of, and examine factors associated with, irrational use of antibiotics in the Moshi municipality, Northern Tanzania. Methods We conducted a cross-sectional descriptive study between April and May 2017 in the Moshi municipality. Twelve drug outlets, of which five were pharmacies and seven accredited drug dispensing outlets (ADDOs), were selected at random. On exiting these outlets, all adults who had purchased antibiotics were interviewed using structured questionnaires. Results A total of 152 adults were enrolled in this study. The median (QR) age was 31 years (25-42). The majority, 94 (61.8%), of the participants were female. ADDOs contributed 81 (53.3%) and pharmacies contributed 71 (46.7%) of all participants. Overall, 135 (88.8%) of antibiotic purchases were irrational. The most prevalent form of irrational antibiotic use was non-prescription usage; 116 of the 152 (76.3%) purchases fell in this category. Purchases of the incomplete dosage and purchases for non-bacterial illness were also widespread. Poor knowledge about the use of antibiotics had a significant association with irrational use of antibiotics (aOR=5.1, 95% CI: 1.80-15.15). Conclusion Irrational use of antibiotics is highly prevalent in this population. Non-prescription use of antibiotics is the most prevalent form. Poor knowledge about antibiotic use plays a significant role in irrational antibiotic use. There is a need to review the accessibility of antibiotics in drug outlets.
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Affiliation(s)
| | - Leah Anku Sanga
- Kilimanjaro Christian Medical University College, P.O. Box 2240 Moshi, Tanzania
| | - James Samwel Ngocho
- Kilimanjaro Christian Medical University College, P.O. Box 2240 Moshi, Tanzania.,Institute of Public Health, Kilimanjaro Christian Medical University College, P.O. Box 2240 Moshi, Tanzania
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Rehman IU, Asad MM, Bukhsh A, Ali Z, Ata H, Dujaili JA, Blebil AQ, Khan TM. Knowledge and Practice of Pharmacists toward Antimicrobial Stewardship in Pakistan. PHARMACY 2018; 6:pharmacy6040116. [PMID: 30360517 PMCID: PMC6306925 DOI: 10.3390/pharmacy6040116] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/16/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background: The irrational use, “over the counter supply”, and unregulated supply chains of antimicrobials are contributing toward antimicrobial resistance. Antimicrobial stewardship programs regulate antimicrobials usage to prevent resistance and reduce health care burden. Objective: To assess the knowledge and practice of pharmacists’ working in various healthcare settings toward antimicrobial stewardship in Pakistan. Method: A cross-sectional study was conducted among pharmacists working in different sectors between March to June 2017. Results: A total of 181 pharmacists participated, of whom (n = 145, 80.1%) were males. The majority of participants were in the 20–30 age group (n = 147, 81.2%) and hold Doctor of Pharmacy degrees. More than 80% of pharmacists agreed that “antimicrobial stewardship is essential to improve patient care”; while (n = 159, 87.8%) pharmacists agreed that “pharmacist should be trained on the use of antimicrobial”. Close to 90% of pharmacists agreed that “adequate training should be provided to pharmacists on antimicrobial use”. Regarding the practice of antimicrobial stewardship, (n = 72, 39.8%) pharmacists often/always “make efforts to prevent or reduce the transmission of infections within the community”; (n = 58, 32%) pharmacists never “dispense antimicrobials without a prescription”; and (n = 60, 32%) pharmacist often/always “communicate with prescribers if unsure about the appropriateness of an antibiotic prescription”. Conclusions: Increased antimicrobial stewardship efforts can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. Pharmacists in Pakistan have good knowledge and adopt positive practices toward antimicrobial stewardship. Pharmacist and other health care professionals should collaborate within multi-disciplinary teams to reduce the problem of antimicrobial resistance and improve the quality of life of patients.
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Affiliation(s)
- Inayat Ur Rehman
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor, Malaysia.
- Department of Pharmacy, Abdul Wali Khan University, Mardan 23200, Pakistan.
| | - Malik Muhammad Asad
- Department of Pharmaceutical services, Jinnah Postgraduate Medical Center, Karachi 75510, Pakistan.
| | - Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor, Malaysia.
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| | - Zahid Ali
- Department of Pharmacy, University of Peshawar, Peshawar 25210, Pakistan.
| | - Humera Ata
- Maternal, Newborn, and Child Health (MNCH) Project Coordinator at Frontier Primary Health Care, Mardan 23200, Pakistan.
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor, Malaysia.
| | - Ali Qais Blebil
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor, Malaysia.
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
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Yezli S, Yassin Y, Mushi A, Maashi F, Aljabri N, Mohamed G, Bieh K, Awam A, Alotaibi B. Knowledge, attitude and practice (KAP) survey regarding antibiotic use among pilgrims attending the 2015 Hajj mass gathering. Travel Med Infect Dis 2018; 28:52-58. [PMID: 30118860 DOI: 10.1016/j.tmaid.2018.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Overuse and misuse of antibiotics have been reported in Hajj. However, little is known about Knowledge, Attitude and Practice (KAP) of pilgrims themselves in relation to these agents. METHODS Adult pilgrims from seven countries attending the 2015 Hajj were interviewed using a structured KAP questionnaire. RESULTS KAP information was collected from 1476 pilgrims. Misconceptions regarding antibiotics included that they: cure all diseases (24.6%); cure common cold and flu (63.0%); are used to stop fever (47.3%); have no side effects (43.2%). Negative attitudes included prophylactic use (50%), self-medication (43.2%), non-compliance with therapy (63.5%) and storage of left-overs for future use (54.1%). In practice, 87.3% of pilgrims admitted to using non-prescribed antibiotics, only 19.3% use antibiotic as directed by their doctor and 54% do not usually check the expiry date of antibiotics before use. Over 60% brought antibiotics from their home country to KSA and 39.2% acquired non-prescribed antibiotics in Saudi Arabia. KAP scores were higher among the younger age group (≤43 years old) and among those with healthcare-related work or education and increased with increasing levels of education. CONCLUSIONS Multifaceted and multidisciplinary approaches, both in KSA and in pilgrims' countries of origin, are needed to address antibiotic misuse during Hajj.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fuad Maashi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Gamal Mohamed
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kingsley Bieh
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Awam Awam
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Badriah Alotaibi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
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Prevalence of self-medication practice among health sciences students in Kermanshah, Iran. BMC Pharmacol Toxicol 2018; 19:36. [PMID: 29970167 PMCID: PMC6029137 DOI: 10.1186/s40360-018-0231-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background The possibility of self-medication is higher in health sciences students than other students because of easy access to drug information resources and relatively sufficient familiarity with various kinds of drugs. The current study was aimed to determine the prevalence of self-medication and its related factors among the health sciences students. Methods A total of 250 health sciences students were included in this cross-sectional study via random sampling. Data were collected by a researcher-made self-medication questionnaire. The collected data were analyzed by SPSS-20 software using descriptive and inferential statistics (chi-square test). Results The prevalence of self-medication was 89.6%. Prior experience about the illness, non-seriousness of the illness and availability of drugs were the most prevalent reasons for self-medication. The most commonly used medications included common cold drugs, analgesics and antibiotics. The most frequently used medications were cold pill, acetaminophen pill and amoxicillin capsule. Most students obtained their pharmaceutical information from the pharmacist physician and online sources. Self-medication did not show a significant difference in terms of variables such as age, gender, marital status, insurance status and residence. Conclusion Given the high prevalence of self-medication among the health sciences students, training courses about the self-medication risks, more supervision over prohibition of over-the-counter drugs and adequate facilities for students’ access to medical services are suggested to be provided. Electronic supplementary material The online version of this article (10.1186/s40360-018-0231-4) contains supplementary material, which is available to authorized users.
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Wang X, Lin L, Xuan Z, Li L, Zhou X. Keeping Antibiotics at Home Promotes Self-Medication with Antibiotics among Chinese University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040687. [PMID: 29621165 PMCID: PMC5923729 DOI: 10.3390/ijerph15040687] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 01/21/2023]
Abstract
Background: Inappropriate use of antibiotics has caused antimicrobial resistance, presenting a major health challenge to the world population. Self-medication with antibiotics (SMA) is currently at an alarming level in China. Objectives: To determine the sources of antibiotics leftover at home, the risk factors of keeping antibiotics at home, and the associations between keeping antibiotics at home and SMA among Chinese university students. Methods: Six provinces were purposely selected from six regions of China, and one multi-disciplinary university was selected from each chosen province. A total of 11,192 university students were selected using cluster random sampling from the selected universities. Logistic regression was conducted to examine the relationship between keeping antibiotics at home and SMA. Results: Out of the 11,192 students surveyed, 7057 (63.1%) reported keeping antibiotics at home at the time they were surveyed. Of those who kept antibiotics in their home, 1965 (27.8%) reported that these antibiotics were left over from a previous prescription by a doctor and 4893 (69.3%), purchased antibiotics over the counter. Additionally, 29.6% (507/1711) of students self-medicated with antibiotics when ill during the month before the survey. Students keeping antibiotics at home were five times (95% CI 3.53, 7.05) more likely to engage in SMA when ill and 2.6 times (95% CI 2.34, 2.89) more likely to self-medicating with antibiotics for prophylaxis than the other students. Female students, those with a family background of higher education, and those who had a parent working in the medical field had a significantly higher chance of keeping antibiotics at home. Conclusions: The high prevalence of keeping antibiotics at home and SMA among young adults is a serious concern. Professional regulations and population-tailored health education are needed.
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Affiliation(s)
- Xiaomin Wang
- Zhejiang University Institute of Social Medicine, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
| | - Leesa Lin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
- Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
- Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, Boston, MA 02118, USA.
| | - Lu Li
- Zhejiang University Institute of Social Medicine, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
| | - Xudong Zhou
- Zhejiang University Institute of Social Medicine, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
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Abstract
Introduction Despite of the global dilemma of antibiotics resistance, this issue is more worsen in developing countries or places where the antibiotics can be dispensed or purchased without prescription such as in Saudi Arabia. Most health awareness campaigns and published studies regarding the self-medication with antibiotics in Saudi Arabia are conducted within hospitals. The prevalence and reasons of self-medication with antibiotics were not well studied from community perspective in Saudi Arabia. This study was conducted to investigate the prevalence of self-medication with antibiotics in Saudi Arabia. Methodology A cross-sectional study using online survey and snowball technique was conducted during the period from January 2017 to May 2017 targeting people who are living in Saudi Arabia. Results A total of 1264 respondent completed the questionnaire and included in the study. About 34% of respondents have used antibiotic without a prescription, and 81.3% of them knew that it might be harmful to health. The most antibiotic used for self-medication was Amoxicillin/clavulanic acid (45.1%) followed by amoxicillin (39.9%). The most common illness and reasons for seeking antibiotic without prescription were tonsillitis (76.7%) and the previous experience of using a particular antibiotic (52.1%) respectively. The major source of self-medication with antibiotic was previous doctor's prescription (36.6%). Conclusion The relative high prevalence of self-medication with antibiotics necessitates taking serious steps by health authorities to implement the law of forbidding the sale of antibiotics without prescription.
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Niclós G, Olivar T, Rodilla V. Factors associated with self-medication in Spain: a cross-sectional study in different age groups. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:258-266. [DOI: 10.1111/ijpp.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 05/31/2017] [Indexed: 11/30/2022]
Abstract
Abstract
Objective
The identification of factors which may influence a patient’s decision to self-medicate.
Methods
Descriptive, cross-sectional study of the adult population (at least 16 years old), using data from the 2009 European Health Interview Survey in Spain, which included 22 188 subjects. Logistic regression models enabled us to estimate the effect of each analysed variable on self-medication.
Key findings
In total, 14 863 (67%) individuals reported using medication (prescribed and non-prescribed) and 3274 (22.0%) of them self-medicated. Using logistic regression and stratifying by age, four different models have been constructed. Our results include different variables in each of the models to explain self-medication, but the one that appears on all four models is education level. Age is the other important factor which influences self-medication. Self-medication is strongly associated with factors related to socio-demographic, such as sex, educational level or age, as well as several health factors such as long-standing illness or physical activity.
Conclusions
When our data are compared to those from previous Spanish surveys carried out in 2003 and 2006, we can conclude that self-medication is increasing in Spain.
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Affiliation(s)
- Gracia Niclós
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
| | - Teresa Olivar
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
| | - Vicent Rodilla
- Department of Pharmacy, Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
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Hassali MA, Arief M, Saleem F, Khan MU, Ahmad A, Mariam W, Bheemavarapu H, Syed IA. Assessment of attitudes and practices of young Malaysian adults about antibiotics use: a cross-sectional study. Pharm Pract (Granada) 2017; 15:929. [PMID: 28690695 PMCID: PMC5499350 DOI: 10.18549/pharmpract.2017.02.929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 06/02/2017] [Indexed: 11/14/2022] Open
Abstract
Objective: The present study was aimed to evaluate the practices and attitudes of young Malaysian adults towards the use of antibiotics, and to determine the socioeconomic factors associated with the antibiotic use. Methods: A survey was carried in Cheras community by approaching a conveniently selected sample of 480 participants. A pre-tested questionnaire was used for data collection. Result: Of 480 participants approached, 400 agreed to participate in this study, giving a response rate of 83.3%. The study results showed that 42.75% of the participants exhibited poor attitudes towards antibiotic usage. Chinese race and high income were significantly associated with the positive attitudes towards antibiotic usage. It is shown that the practice of the participants towards antibiotics was relatively poor. The majority of participants agreed that they do not consult a doctor for minor illnesses (64%). The main reason for not consulting a doctor was the high fees of consultation (34.25%) and the inconvenience of visit (29.25%). However, a large proportion of respondents (77.5%) agreed that there is a need to enhance antibiotic education among public. Conclusion: The study results identified some crucial gaps in the attitudes and practices of Cheras community about the use of antibiotics. Thus, improving the public knowledge and changing their attitude towards antibiotic use along with proper interventions to regulate the ease of their availability would play a significant role for the effective use of antibiotics in the community.
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Affiliation(s)
- Mohamed A Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Penang (Malaysia).
| | - Mohammad Arief
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University. Kuala Lumpur (Malaysia).
| | - Fahad Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy & Health Sciences, University of Balochistan. Quetta (Pakistan).
| | - Muhammad U Khan
- Faculty of pharmacy, University of Sydney, Sydney, NSW (Australia).
| | - Akram Ahmad
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University. Kuala Lumpur (Malaysia).
| | - Warisha Mariam
- Department of Community Medicine, Maulana Azad Medical College. New Delhi (India).
| | - Harika Bheemavarapu
- Department of Pharmaceutical Analysis, Talla Padmavati College of Pharmacy. Warangal (India).
| | - Iizhar A Syed
- Department of Pharmacy, Ibn Sina College of pharmacy. Jeddah (Saudi Arabia).
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Self-medication with antibiotics in Serbian households: a case for action? Int J Clin Pharm 2017; 39:507-513. [PMID: 28391441 DOI: 10.1007/s11096-017-0461-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Background Irregular antibiotic use, including self-medication contributes to the development of antibiotic resistance. One method of accessing antibiotic use in the community is through obtaining an in house inventory of drugs. Objective The aim of this study was to investigate the extent of storage and self-medication with antibiotics agents in households in Novi Sad, Serbia. Setting Households in Novi Sad. Method The study was performed during a 4-month period (October 2015-January 2016) using a sample of 112 households in Novi Sad, Serbia. Two trained interviewers performed the survey by visiting each household. The study consisted of making an inventory of all drugs in household and a semi-structured interview about drug use practices and perceptions. Main outcome measure Number of antibiotics obtained without prescription. Results Out of 112 surveyed households, antibiotics were encountered in 55 (49.1%). Antibiotics constituted 11.98% (92/768) of total number of drug items in households. Out of all antibiotics in households, 41 (44.57%) were not in current use, and presented left-overs from previous treatment. Antibiotics were usually acquired with prescription (67, 67.7%), while about a quarter of packages were used for self-medication-purchased at pharmacy without prescription (19, 20.65%) or obtained through friends or family member (6, 6.52%).The most commonly used antibiotics for self-medication was amoxicillin (reported indications included common cold, cough, pharyngitis and tooth-ache). Conclusion Antibiotics were present in large share of households in Novi Sad. Self-medication with antibiotics and sale of antibiotics without prescription represent an important problem in Serbia.
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Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim. Int J Clin Pharm 2016; 39:165-172. [DOI: 10.1007/s11096-016-0415-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022]
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El-Hawy RM, Ashmawy MI, Kamal MM, Khamis HA, Abo El-Hamed NM, Eladely GI, Abdo MH, Hashem Y, Ramadan M, Hamdy DA. Studying the knowledge, attitude and practice of antibiotic misuse among Alexandria population. Eur J Hosp Pharm 2016; 24:349-354. [PMID: 31156970 DOI: 10.1136/ejhpharm-2016-001032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/04/2022] Open
Abstract
Aim To assess knowledge, attitude and practice (KAP) of antimicrobial self-medication among a convenience sample of population in Alexandria, Egypt. Methodology A descriptive cross-sectional study using a self-administrated semi-constructed questionnaire. A convenience sample of 359 participants was studied using appropriate consent. The questionnaire had four sections: demographics, KAP, professional medical knowledge and attitude of children caregivers toward antimicrobial self-medication. The questionnaire was initially constructed in English and then translated into its final Arabic version. The Arabic version was pilot-tested and face-validated. Descriptive and quantitative analysis were performed using SPSS (V.20.0). Results Approximately 64% (231) of the studied population used antibiotics without prescription in the past 12 months. This was significantly correlated with female gender and lack of knowledge. The main reason for self-medication was due to saving time and effort (109, 47%) followed by not preferring doctor visits (89, 39%). More than 60% of cases used amoxicillin-clavulanic acid. The main sources of antibiotics were leftovers from previously prescribed pharmaceuticals and those purchased from community pharmacies. 85 participants were young children caregivers of which 18 (21%) reported administering antibiotics to their children without consulting a physician. Out of 115 who claimed attaining medical background, only 30 (26%) managed to answer section 3 correctly with 23 of them reporting antibiotic self-medication. Conclusion This study showed an increased tendency towards antibiotic self-medication among Alexandrian adults and children that was not significantly decreased in population with medical background. The reasons discussed within the study should be further addressed to decrease such practice.
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Affiliation(s)
| | | | - Menna M Kamal
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Hager A Khamis
- Faculty of Science, Alexandria University, Alexandria, Egypt
| | | | - Gehad I Eladely
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mayar H Abdo
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yosra Hashem
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Marwa Ramadan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dalia A Hamdy
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Lodenyo MM, Otsyula BK, Downing R, Yakubu K, Miima M, Ifeyinwa O. Factors affecting time of access of in-patient care at Webuye District hospital, Kenya. Afr J Prim Health Care Fam Med 2016; 8:e1-e9. [PMID: 27796120 PMCID: PMC5086783 DOI: 10.4102/phcfm.v8i1.898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/02/2015] [Accepted: 10/22/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Among many Kenyan rural communities, access to in-patient healthcare services is seriously constrained. It is important to understand who has ready access to the facilities and services offered and what factors prevent those who do not from doing so. AIM To identify factors affecting time of access of in-patient healthcare services at a rural district hospital in Kenya. SETTING Webuye District hospital in Western Kenya. METHODS A cross-sectional, comparative, hospital-based survey among 398 in-patients using an interviewer-administered questionnaire. Results were analysed using SPSS V.12.01. RESULTS The median age of the respondents, majority of whom were female respondents(55%), was 24 years. Median time of presentation to the hospital after onset of illness was 12.5 days. Two hundred and forty seven patients (62%) presented to the hospital within 2 weeks of onset of illness, while 151 (38%) presented after 2 weeks or more. Ten-year increase in age, perception of a supernatural cause of illness, having an illness that was considered bearable and belief in the effectiveness of treatment offered in-hospital were significant predictors for waiting more than 2 weeks to present at the hospital. CONCLUSION Ten-year increment in age, perception of a supernatural cause of illness(predisposing factors), having an illness that is considered bearable and belief in the effectiveness of treatment offered in-hospital (need factors) affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.
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Kalungia AC, Burger J, Godman B, Costa JDO, Simuwelu C. Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia. Expert Rev Anti Infect Ther 2016; 14:1215-1223. [PMID: 27548801 DOI: 10.1080/14787210.2016.1227702] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern. Consequently, the aim is to ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia. METHODS The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios. RESULTS Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients' indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees' professional qualification in four out of five simulations. CONCLUSION Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.
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Affiliation(s)
| | - Johanita Burger
- b Medicine Usage in South Africa (MUSA), Faculty of Health Sciences , North-West University (Potchefstroom campus) , Potchefstroom , South Africa
| | - Brian Godman
- c Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Juliana de Oliveira Costa
- e SUS Collaborating Centre - Health Technology Assessment & Excellence in Health, Department of Social Pharmacy, College of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Brazil
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Bilal M, Haseeb A, Khan MH, Arshad MH, Ladak AA, Niazi SK, Musharraf MD, Manji AAK. Self-Medication with Antibiotics among People Dwelling in Rural Areas of Sindh. J Clin Diagn Res 2016; 10:OC08-13. [PMID: 27437263 DOI: 10.7860/jcdr/2016/18294.7730] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/02/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Self-medication with antibiotics is becoming increasingly common due to multiple factors. The public who are using these antibiotics generally do not have full information regarding their proper use, especially the dosages and possible side-effects. Hence, unregulated use of such medicines may cause dangerous adverse effects in the patients. AIM The study was aimed to evaluate the prevalence and practice of self-medication with antibiotics among people dwelling in the rural areas of province Sindh. MATERIALS AND METHODS A cross-sectional survey was performed at Outpatient Department of Civil Hospital Karachi, from January to March 2015. Four hundred rural dwellers who lived in the outskirts of Karachi city area of province Sindh were recruited for the study in the aforementioned time period through non-probability convenience sampling. RESULTS The investigation reported a prevalence of 81.25% among rural dwellers of Sindh with regards to self-medication of antibiotics. The most common reason behind self-medication were economic reasons (88.0%). Amoxicillin (52.0%) was found to be the most self-prescribed antibiotic. Majority of the participants (74.7%) didn't know about the phenomena of antibiotic resistance associated with inadequate use of antibiotics and only 25 subjects identified correctly that the situation would lead to increase resistance. CONCLUSION The self-medication rates with antibiotic are higher in rural areas of Sindh. There is an urgent need for the government to enforce stricter laws on pharmacies dispensing medications, especially antibiotics, without prescriptions. Lastly, provision of cost effective treatment from public sector can significantly reduce self-medication with antibiotics among rural dwellers of Sindh.
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Affiliation(s)
- Muhammad Bilal
- Faculty, Department of Medicine, Dow Medical College. Dow University of Health Sciences , Karachi, Pakistan
| | - Abdul Haseeb
- Faculty, Department of Medicine, Dow Medical College, Dow University of Health Sciences , Karachi, Pakistan
| | - Mohammad Hassaan Khan
- Faculty, Department of Medicine, Medical College, Aga Khan University Hospital , Karachi, Pakistan
| | - Mohammad Hussham Arshad
- Faculty, Department of Medicine, Medical College, Aga Khan University Hospital , Karachi, Pakistan
| | - Asma Akbar Ladak
- Pre-Medical Student, Department of Biological Sciences, The Lyceum , Karachi, Pakistan
| | - Sufyan Khan Niazi
- Pre-Medical Student, Department of Biological Sciences, The Lyceum , Karachi, Pakistan
| | | | - Adil Al-Karim Manji
- Pre-Medical Student, Department of Biological Sciences, Karachi Grammar School , Karachi, Pakistan
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Gebretekle GB, Serbessa MK. Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals' perspective. Antimicrob Resist Infect Control 2016; 5:2. [PMID: 26835006 PMCID: PMC4734870 DOI: 10.1186/s13756-016-0101-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the counter sale of antibiotics is a global problem and it is increasingly recognized as a source of antibiotic misuse and is believed to increase treatment costs, adverse effects of treatment and emergence of resistance. The increasing trend of over the counter sale of antibiotics in Ethiopia calls for exploration of why such dispensing is practiced. This study aims to explore reasons for over the counter sale of antibiotics in the community pharmacies of Addis Ababa, Ethiopia. METHODS A phenomenological qualitative study was conducted in five randomly selected community pharmacies of Addis Ababa. One pharmacy professional from each pharmacy were interviewed at the spot using semi-structured, open-ended interview checklist. Besides, observation of professionals' dispensing practice was made for at least one hour in the same community pharmacies using an observation checklist. Findings were categorized into specific themes that were developed following the objectives. This was facilitated by use of OpenCode 3.6 software. RESULTS All participants pointed out that antibiotics were frequently dispensed without prescription and contend that the trend of such dispensing has been increasing. The findings indicated that the nonprescription sales of antibiotics were common for Amoxicillin, Ciprofloxacin and Cotrimoxazole. The poor, less educated and younger groups of the population were reported to frequently request antibiotics without prescription. The main reasons for nonprescription sale of antibiotics by pharmacy professionals were found to be related to pharmacy owner's influence to maximize revenue, customer's pressure, weak regulatory mechanism and professional conflicts of interest. CONCLUSION The study shows that nonprescription sale of antibiotics was common practice at least in Addis Ababa. The main reasons for this malpractice were the need to maximize revenue and weak regulatory mechanism. Hence, strong regulatory enforcement and community awareness campaign is called for to limit nonprescription sale of antibiotics.
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Affiliation(s)
| | - Mirgissa Kaba Serbessa
- School of Public Health, College of Health Sciences, Addis Ababa University, P .O. Box: 1176, Addis Ababa, Ethiopia
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