Community consumption of antibacterial drugs within the Jordanian population: sources, patterns and appropriateness

Studying Microbial Ecology of Diabetic Foot Infections: Significance of PCR Analysis for Prudent Antimicrobial Stewardship

This study presents a comprehensive investigation into the microbial ecology of diabetic foot infections (DFIs), using molecular-polymerase chain reaction (PCR) analysis to accurately identify the causative agents. One hundred DFI patients were recruited and classified using the Depth Extent Phase and Associated Etiology (DEPA) score according to their severity. Results revealed polymicrobial infections in 75% of cases, predominantly featuring Staphylococcus epidermidis (83%) and Staphylococcus aureus (63%). Importantly, 20% of samples exhibited facultative anaerobes Bacteroides fragilis or Clostridium perfringens, exclusively in high DEPA score ulcers. Candida albicans coinfection was identified in 19.2% of cases, underscoring the need for mycological evaluation. Empirical antimicrobial therapy regimens were tailored to DEPA severity, yet our findings highlighted a potential gap in methicillin-resistant Staphylococcus aureus (MRSA) coverage. Despite an 88% prevalence of methicillin-resistant Staphylococci, vancomycin usage was suboptimal. This raises concerns about the underestimation of MRSA risk and the need for tailored antibiotic guidelines. Our study demonstrates the efficacy of molecular-PCR analysis in identifying diverse microbial communities in DFIs, influencing targeted antibiotic choices. The results advocate for refined antimicrobial guidelines, considering regional variations in microbial patterns and judiciously addressing multidrug-resistant strains. This research contributes crucial insights for optimizing DFIs management and helps the physicians to have a fast decision in selection the suitable antibiotic for each patient and to decrease the risk of bacterial resistance from the improper use of broad-spectrum empirical therapies.

Public Patterns and Determinants of Antibiotic Self-Medication and Antibiotic Knowledge in Southern Jordan

Antibiotic self-medication, which refers to acquisition and using antibiotics to treat infections based on personal experience and/or without a doctor's advice or prescription, is a significant public health issue jeopardizing patient health outcomes. The purpose of the present cross-sectional online survey was to assess the frequency of self-medication among the general public in various geographical locations in southern Jordan, as well as to examine the determinants to self-medication. The survey was distributed through several social media networks over the period November-December 2022, and included demographic information as well as items related to the use and abuse of antibiotics, information sources about antibiotics, the duration of use of antibiotics, and assessment of the public knowledge about appropriate antibiotic use. Inferential analysis, such as the Chi-Square test and logistic regression, were adopted to assess the associations between the different variables with self-medication. A total of 984 respondents were enrolled in the study. Of these, 752 had been using antibiotics during the last year. However, the self-medicating cases were 413 of the 752. The main source of information about the utilization of antibiotics among participants in the survey was pharmacists. The participants commonly (36.0%) tended to use antibiotics until the symptoms disappeared. Nearly half of the respondents reported usually taking antibiotics for treating a runny nose (rhinorrhea). The logistic regression analysis indicated that self-medication with antibiotics was significantly associated with female gender (p-value < 0.001), low educational level (p-value = 0.014), rural living location (p-value 0.003), no health insurance (p-value = 0.001) and occupation (p-value = 0.005). Meanwhile age had no significant relationship to self-medication. Finally, the results revealed poor understanding of key appropriate antibiotic usage, which inevitably influences self-medication practice. It is crucial to come up with several programs and governmental policies to suppress widespread antibiotic self-medication as it will affect the health of future generations of Jordanian citizens.

Antibiotic consumption at community pharmacies: A multicenter repeated prevalence surveillance using WHO methodology

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.

Self-Medication Practices with Antibiotics and Associated Factors among the Public of Malaysia: A Cross-Sectional Study

Background

Self-medication with antibiotics (SMA) is an important public health issue, which can result in the facilitated development of antibiotic resistance, and may increase the risk of inappropriate utilization of antibiotics. So, the objective of the present study was to estimate the prevalence rate of SMA and to also explore SMA practices among the lay population of Kuala Lumpur (Malaysia).

Methods

The current study was cross-sectional population-based and used a convenient sampling technique. Moreover, Lorenz’s formula was used to calculate the sample size and the required sample size was 480. Data were collected through face-to-face interviews with a pre-validated questionnaire and the study was conducted in Kuala Lumpur (Malaysia). Descriptive statistics, cross-tabulation, and logistic regression were executed by using SPSS version 24.

Results

Out of 480 participants, 45.8% were polled male and the prevalence of SMA in this study was found to be 15.1%. The majority of participants 23.1% indicated that they practiced antibiotics at least once in the last six months. The commonly self-medicated antibiotics were amoxicillin-clavulanate 20.6%, ampicillin/cloxacillin 14.2%, and levofloxacin 8.3%. Moreover, 64.8% of participants indicated that they bought their antibiotics from pharmacies. Whereas, most of the participants practice antibiotics to save money 19.2% and time 23.1%. Findings from multivariate logistic regressions showed that predictors of SMA were male gender, (95% CI: 0.300–0.877) occupation (95% CI: 0.122–10.797), health insurance (95% CI: 0.025–0.472), and education (95% CI: 0.084–0.800).

Conclusion

The results of this study indicate that SMA persists among the community and education level has a significant impact on this behavior. Thus, concerning health management authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of SMA for the future.

Prevalence of Pneumococcal Carriage among Jordanian Infants in the First 6 Months of Age, 2008-2016

Background: Streptococcus pneumoniae is an opportunistic human-adapted pathogen driven by nasopharyngeal carriage. Aims: To find the pneumococcal carriage rate, resistance, serotypes, and coverage of pneumococcal conjugate vaccines (PCVs) among infants in the first six months of age in the period from March 2008 to April 2016. Methods: Nasopharyngeal swabs (NP) were taken from healthy infants from the northern part of Jordan. Swabs were processed for cultivation, identification, resistance testing and serotyping according to standard methods. Results: During the surveillance period, 484 infants of this age group were tested, with a total carriage rate of 56.2%. 96.2% of infants one to two months of age got one PCV7 injection and were 58% carriers at the time of the first injection. At age three to four months, 84.9% had received two injections, with a carriage rate of 54.9% at the time of the second injection. At ages five to six months, 12.5% had received one to three injections, with a carriage rate of 43.8%. Predominant serotypes in all age groups were 19F (12.5%), 6A (11.4%), 11A (8.4%), 19A (7.0%), 6B (6.6%), 23F (5.9%), 15B (5.1%), 15A and 23A (4.0% each). Coverage of PCV7, PCV13 and the future PCV20 among all cases were 30.5%, 50.7% and 70.6%, respectively. The highest coverage rate of 78.6% was noticed in the age group at five to six months with the future PCV20. Antibiotic resistance was the highest in the first age group. Conclusions: Pneumococcal carriage starts from the first month of the infant’s life. The highest coverage was noticed for PCV20, which implies the necessity for inoculation with future vaccines.

A scoping review of global aminoglycoside antibiotic overuse: A potential opportunity for primary ototoxicity prevention

BACKGROUND

Aminoglycosides are widely used, broad-spectrum antibiotics with significant potential for ototoxicity. Global efforts to prevent ototoxicity must account for aminoglycoside overuse and non-prescription use.

OBJECTIVES

The goals of this study were to a) estimate the prevalence of aminoglycoside overuse by synthesizing evidence on self-medication, over the counter (OTC) availability, and household antibiotic storage for later use, and to report the specific aminoglycosides used and the predictors of overuse, and b) leverage this information to comment on potential risk of ototoxicity.

METHODS

Two systematic search strings were conducted to extract peer-reviewed articles published from 2005 to 2020. The first focused on overuse of aminoglycoside antibiotics. The second focused on potentially ototoxic effects of aminoglycosides related to drug overuse.

RESULTS

A total of 26 articles were included (first search string: n = 21; second search string: n = 5). The prevalence of aminoglycoside self-medication was high and household storage and OTC availability of aminoglycosides was common. Gentamicin was the most commonly overused aminoglycoside. No studies provided information on antibiotic dosing or resultant toxicities, including ototoxicity.

CONCLUSIONS

The limited available evidence indicates that antibiotic overuse (self-medication, home storage, and non-prescription availability) is relatively common, especially in low resource settings, and that aminoglycoside antibiotics comprise a variable, but concerning, proportion of non-prescribed antibiotics. Additional evidence is needed to evaluate the relationship between these dispensing patterns and ototoxicity.

Contribution of faculties of pharmacy in Arab countries to pharmacy practice research: a bibliometric analysis (1990-2020)

OBJECTIVE

To provide an overview of pharmacy practice research by faculties of pharmacy in the Arab region using a bibliometric methodology.

METHOD

Relevant articles were retrieved from SciVerse Scopus. The search strategy was developed to retrieve all articles published in pharmacy practice journals and those with specific keywords such as 'clinical pharmacy', 'community pharmacy', 'hospital pharmacy', 'pharmacy education' and 'pharmacy practice'. The country affiliation function was used to limit the results to the Arab region.

KEY FINDINGS

The search strategy found 1496 articles authored by 8210 researchers and disseminated through 337 journals. Research on pharmacy practice produced by faculties of pharmacy in the Arab region (1) has experienced a steep growth over the last decade; (2) is mainly published by scholars in Saudi Arabia, Jordan, Qatar and the United Arab Emirates; (3) has benefited from non-Arab scholars affiliated with faculties of pharmacy in the Arab Gulf; (4) has benefited from international collaborations, specifically with researchers in the UK and Malaysia; (5) has mainly addressed seven research topics: adverse drug reactions and pharmacovigilance, medication adherence, self-medication, patient counselling, pharmacy education, perception of physicians towards pharmacists; (6) has shown a relationship between institutional funding and research output and (7) has shown the highest number of readers for topics related to polypharmacy, over-the-counter medications, self-medications, medication adherence and pharmacist intervention in disease management.

CONCLUSION

Pharmacy practice research in Arab countries has witnessed a steep rise in the last decade, partially due to international research collaboration.

Development and randomized controlled trial of an animated film aimed at reducing behaviours for acquiring antibiotics

BACKGROUND

Antimicrobial resistance (AMR) is a global health crisis but reducing antibiotic use can help. Some antibiotic use is driven by patient demand.

OBJECTIVES

To develop an intervention to discourage antibiotic-seeking behaviour in adults.

METHODS

Literature reviewed to identify behaviours for acquiring antibiotics among adults in the community. Behaviour change wheel approach was used to select the target behaviour and behaviour change techniques. An intervention in the form of a short animated film was developed and its potential impact evaluated in a randomized, controlled, online questionnaire study.

RESULTS

Asking a general medical/dental practitioner for antibiotics was identified as the target behaviour. A short stop-motion animated film was chosen to deliver several behaviour-change techniques. Education and persuasion were delivered around information about the normal microbial flora, its importance for health, the negative effect of antibiotics, and about AMR. 417 UK-based individuals completed the questionnaire; median age 34.5 years, 71% female, 91% white ethnicity. 3.8% of participants viewing the test film intended to ask for antibiotics compared with 7.9% viewing the control film. Test film viewers had significantly higher knowledge scores. At 6 week follow up, knowledge scores remained significantly different, while most attitude and intention scores were not different.

CONCLUSIONS

Some patients continue to ask for antibiotics. The film increased knowledge and reduced intentions to ask for antibiotics. At 6 weeks, knowledge gains remained but intentions not to ask for antibiotics had waned. Evaluation in the clinical environment, probably at the point of care, is needed to see if antibiotic prescribing can be impacted.

Knowledge, attitudes, ethical and social perspectives towards fecal microbiota transplantation (FMT) among Jordanian healthcare providers

BACKGROUND

Fecal microbiota transplant (FMT) is a treatment modality that involves the introduction of stool from a healthy pre-screened donor into the gastrointestinal tract of a patient. It exerts its therapeutic effects by remodeling the gut microbiota and treating microbial dysbiosis-imbalance. FMT is not regulated in Jordan, and regulatory effort for FMT therapy in Jordan, an Islamic conservative country, might be faced with unique cultural, social, religious, and ethical challenges. We aimed to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT use among Jordanian healthcare professionals.

METHODS

An observational, cross-sectional study design was used to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT among 300 Jordanian healthcare professionals.

RESULTS

A large proportion (39 %) thought that the safety and efficacy of this technique are limited and 29.3 % thought there is no evidence to support its use. Almost all (95 %) responded that they would only perform it in certain cases, if ethically justified, and 48.3 % would use it due to treatment failure of other approaches. When reporting about reasons for not using it, 40 % reported that they would not perform it due to concerns about medical litigation, fear of infections (38 %), and lack of knowledge of long safety and efficacy (31.3 %). Interestingly, all practitioners said they would perform this procedure through the lower rather than upper gastrointestinal tract modality and the majority will protect the patient's confidentiality via double-blinding (43.3 %). For a subset of participants (n = 100), the cultural constraints that might affect the choice of performing FMT were mainly due to donor's religion, followed by dietary intake, and alcohol consumption.

CONCLUSIONS

Our healthcare practitioners are generally reluctant to use the FMT modality due to religious and ethical reasons but would consider it if there was a failure of other treatment and after taking into consideration many legislative, social, ethical and practice-based challenges including safety, efficacy and absence of guidelines.

Self-Treatment with Antibiotics: Knowledge level, Prevalence and Indications for Practicing Among University Students in Jordan

BACKGROUND

Self-treatment with antibiotics involves obtaining medicines without a prescription, sharing medicines with members of one's social circle, or using leftover medicines stored at home.

OBJECTIVE

Assess the prevalence, knowledge level, reasons for practicing self-treatment of antibiotic among undergraduate university students.

METHODS

The study was conducted cross-sectional on a sample of 201 students. A pre-validated questionnaire called "self-treatment with antibiotics", containing 27 close-ended questions, was administered to each subject. Data were analyzed using SPSS version 16 and the results were expressed as counts and percentages.

RESULTS AND DISCUSSION

Knowledge about self-treatment with antibiotics was good in general, and health-related students had a better level of knowledge about self-treatment with antibiotics than non-health-related students. The majority of the participants had not used self-treatment with antibiotics. Gender, age, and the last time antibiotic taken affected self-treatment with antibiotics. The most common indication for self-treatment with antibiotics was flu, cold, and tonsillitis. The most common reason for practicing self-treatment with antibiotics was being considered as a convenient and rapid solution. Internet was the main source for university students regarding knowledge about antibiotic use and resistance.

CONCLUSION

Self-treatment with antibiotics is affected by several social and demographic variables, and the role of media, public policies, university curricula as well as physicians and pharmacists should be enforced and activated to eliminate inappropriate uses of antibiotics and to correct misconceptions that encourage self-treatment with antibiotics.

Egyptian community pharmacists' attitudes and practices towards antibiotic dispensing and antibiotic resistance; a cross-sectional survey in Greater Cairo

BACKGROUND

Antibiotic resistance is an increasing worldwide crisis. In Egypt, it is prohibited by law to dispense antibiotics with no prescription; however, there are no active and enforced governmental policies and laws to regulate such a process. This has led to increased antibiotic dispensing and consumption.

AIMS

To assess some basic knowledge and attitudes towards antibiotic resistance and the practice of antibiotic dispensing among Egyptian community pharmacists in Greater Cairo.

METHODOLOGY

An observational cross-sectional self-administrated survey targeting licensed community pharmacists in Greater Cairo, Egypt. The survey was validated by both face and content validation.

RESULTS

Exactly 531 pharmacists were invited to join the survey, and only 461 pharmacists agreed to participate. Approximately half of the participants (51.2%) were considered to have good basic knowledge regarding antibiotic use and antibiotic resistance. The majority (74%) of the respondents strongly agreed that antibiotics are over-prescribed in Egypt, and almost all of them (90%) were hoping the Ministry of Health could publish guidelines for antibiotic dispensing in Egypt. Male pharmacists were more likely to engage and communicate with either patient or prescriber during the antibiotic dispensing process compared to females.

CONCLUSION

The Egyptian Ministry of Health should regulate and monitor the process of dispensing antibiotics without a prescription with law enforcements. Moreover, community pharmacists should have more awareness on the consequences of the problem of antibiotic dispensing without a prescription, regardless of the business profit behind it.

Practices, awareness and attitudes toward self-medication of analgesics among health sciences students in Riyadh, Saudi Arabia

BACKGROUND

Self-medication is a common practice among health sciences students in Saudi Arabia. It is known that inappropriate selfmedication may harm individuals due to increasing the risk of drug misuse or delaying a hospital visit by masking some symptoms. Thus, the aim of our study is to investigate and assess practices, awareness and attitudes toward analgesics self-medication among health science students in Riyadh, Saudi Arabia.

METHODS

This is a cross-sectional study in a form of electronic survey that was conducted among health sciences students from different universities in Riyadh, Saudi Arabia in 2016. Two hundred and seventy-two students responded to the questionnaire. The electronic questionnaire survey covered demographics, self-medication practice and the analgesics consumption, attitude and awareness about the safety of self-medication practice of analgesics.

RESULTS

Factors associated with high prevalence of self-medication were not significant except for age (P = 0.04). Health sciences students had adequate knowledge about the safety of analgesics consumption itself and simultaneous use of analgesics with other drugs, significantly different by college; 80% for Pharmacy, 71% for Medicine, 61% for Nursing and Dentistry, and 25% for Applied Medical Sciences and pre-professional students (p = 0.037).

CONCLUSION

The occurrence of self-medication practices is distressingly high among health sciences students. It is necessary to educate the students about the side effects and drawbacks of irresponsible selfmedication.

Patterns of self-medication among medical and nonmedical University students in Jordan

Background and objective

Self-medication practice involves consumption of medicines by one's own initiative or on the consultation of others without the guidance of a physician. Self-medication and use of over-the-counter drugs are prevalent worldwide public health concerns. University students of medical and nonmedical disciplines may have different levels of health education. This study evaluated the prevalence and patterns of self-medication and the attitudes toward this practice among medical and nonmedical university students in Jordan.

Methods

A descriptive cross-sectional study was conducted in 504 students (medical: 248 and nonmedical: 256). The students were invited to complete a questionnaire that included questions primarily related to patterns of physician visits, self-medication practice, symptoms provoking self-medication, and sources of advice.

Results

Self-medication was highly prevalent and comparable between medical and nonmedical students (~96%). Headache (81.9%), cold (58.3%), and flu (53%) were the frequent symptoms provoking self-medication among students. Self-medication for headache (86.7% vs 77.3%) and tooth pain (53.1% vs 27%) was significantly higher among medical vs nonmedical students, respectively. Self-treatment with painkillers (82.3% vs 73%) or antiallergy (11.3% vs 5.9%) drugs was significantly higher among medical students, while the use of anti-flu decongestants (47.6% vs 60.2%) was lower compared to nonmedical students, respectively. Nonmedical vs medical students were significantly more dependent on friends (14.8% vs 7.7%) and own experience (7.4% vs 2.4%) as a source of self-medication advice.

Conclusion

Self-medication is common among Jordanian university students of medical and nonmedical disciplines. This practice, if used irrationally, may constitute a health problem that needs awareness and interventions by health care regulators in Jordan. Future studies are warranted to examine the impact of self-medication on students' health.

Extended-spectrum β-lactamase producing E. coli in urinary tract infections: A two-center, cross-sectional study of prevalence, genotypes and risk factors in Amman, Jordan

BACKGROUND

To determine the prevalence, phenotypes, and genotypes of extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) among patients with urinary tract infection along with identifying the associated risk factors.

METHODS

A cross-sectional study was conducted at two tertiary hospitals in Amman, Jordan between June and October, 2016. One hundred twenty one E. coli isolates from hospitalized patients with urinary tract infection were phenotypically assessed for ESBL production using the double disc diffusion test. Positive isolates to ESBL production were further genotyped using multiplex PCR. A nested case-control study was used to determine the independent risk factors.

RESULTS

ESBL-producing E. coli were found in 75/121 (62%) isolates. Molecular genotyping demonstrated that CTX-M group1 (42.7%) predominated followed by combination of SHV and CTX-M group1 (20%). In the regression model, previous hospitalization and use of urinary catheter were identified as independent risk factors for ESBL-producing E. coli infections.

CONCLUSION

We report a high prevalence of ESBL-producing E. coli which is in concordance with other studies from developing countries. Additionally, CTX-M group1 has emerged as the predominant ESBL produced by E. coli, which is consistent with reported results throughout the world. Independent risk factors to UTI infections due to ESBL-producing E. coli include previous hospitalization and use of urinary catheter.

An exploration of parents' knowledge, attitudes and practices towards the use of antibiotics in childhood upper respiratory tract infections in a tertiary Jordanian Hospital

Objectives

The present study aimed to evaluate the parents' knowledge, attitudes and practices (KAP) towards the use of antibiotics for childhood upper respiratory tract infections (URTIs), at the Jordanian University Hospital.

Methods

This was a cross-sectional study. During the study period, 1301 parents of young children completed a validated – structured questionnaire.

Results

Gaps in common knowledge related to antibiotics and their use were noted among participants. Nearly half of respondents believed that antibiotics are void from adverse effects, while 72.4% of them believed that a child should be given an antibiotic if it develops fever, even though 60% they were aware that most URTIs were viral in nature. Parents reported that they administered antibiotics to children without medical advice most of the time for various causes, including using a previously prescribed antibiotic for a similar illness (27.1%), or based on pharmacist's recommendation (23.8%).

Conclusion

The results demonstrated the need for educational interventions to increase the awareness of parents about antibiotics to reduce inappropriate use and its consequences.

Antibiotics use among Palestine refugees attending UNRWA primary health care centers in Jordan - A cross-sectional study

The irrational use of antibiotics is increasing in Jordanian refugee camps and consequently so too is bacterial resistance. About one-third of health expenditures at UNRWA health centers in Jordan are attributed to antibiotics.

OBJECTIVE

We studied knowledge, attitude and behaviour of Palestine refugees attending UNRWA health centers in Jordan regarding antibiotic use in order to plan public health interventions accordingly.

METHODS

A cross-sectional, interviewer-administered survey among 250 adult Palestine refugees at four different health centers was conducted.

RESULTS

Irrational antibiotic use was widespread: 63% of patients share antibiotics at home, 38% use left-over antibiotics and 60% purchase antibiotics directly from the pharmacy without prescription (OTC) .¹ At the same time, knowledge about antibiotics side effects, resistance, and target agent was low. 90% of patients trust their doctor, however long waiting hours prevent them from seeking medical advice, which significantly increased self-medication.

CONCLUSIONS

Our findings suggest a strong need for public education about antibiotics. In addition, health institutional level improvements such as shorter waiting hours and strict regulations prohibiting dispensing without prescription are necessary to combat growing bacterial resistance.

Parents' attitude, awareness and behaviour towards influenza vaccination in Pakistan

National immunization program of Pakistan does not include Influenza vaccines. The low rate of immunization might be attributed to the poor knowledge of influenza vaccination in Pakistan. Current study was aimed to assess the knowledge and attitude of influenza vaccination among parents. A questionnaire-based cross sectional study was conducted among randomly selected parents with at least one child aged >6 months. The responses were recorded against 27 items questionnaire assessing knowledge, perception, attitude and behaviours of parents. Data were analysed by using appropriate statistical methods. A total 532 responses were recorded with male gender preponderance (65%). Most of the parents (61.1%) reported that their children had received or planned to receive all recommended vaccines in Expanded Program on Immunization (EPI) of Pakistan. Only one third of the parents (24.4%) were aware of the availability of influenza vaccines in Pakistan, and very few (6.6%) reported vaccinating their child against influenza. Exploring the parents' attitudes regarding children vaccination, the top motivator was 'immunization is important to keep my children healthy' (relative index = 0.93, p < 0.000). However, substantial number of parents believed that influenza is not a serious disease (18.5%) and vaccines are accompanied by several side effects (24.6%). A positive attitude was reflected among parents who were aware of influenza vaccines in Pakistan. About 35% participants believed that influenza vaccines are not required for healthy children. Current study demonstrated very low vaccination rate against influenza. Awareness and health literacy regarding influenza vaccine is poor among parents. These findings necessitate the need to appropriately structured awareness programs regarding influenza vaccination among parents.

Negative Impact of Prolonged Antibiotics or Persistent Diarrhea on Vitamin K1 Levels in 2-24 Weeks aged Egyptian Infants

Background

To evaluate the hazard of prolonged antibiotic therapy and/or persistent diarrhea on vitamin K1 (VK1) level and bleeding profile in infants (2–24 weeks).

Methods

A one-year case-control study, conducted at Ain Shams University, Egypt. 338 infants (2–24 weeks) were recruited and divided into 3 groups (1:1:3 ratios); group A (n=67) patients who received antibiotics for ≥10 days, group B (n=67) who had persistent diarrhea ≥ 14 days and group C (n=204) age- and gender- matched infants who had not either received antibiotics nor had diarrhea. All subjected to clinical assessment, bleeding history and had their complete blood count (CBC), PT and PTT, liver transaminases and VK1 level assayed.

Results

There was a significant increase in frequency of VKDB (vitamin K deficiency bleeding) and abnormal bleeding profile in cases than control group. There was significant negative correlation between VK1 level and duration of diarrhea, length of antibiotics used and bleeding profile. Antibiotic usage has hazardous effect on VK1 level in those with diarrhea; more patients were receiving antibiotic in those with persistent diarrhea and VKDB (N=55) than those with persistent diarrhea and normal VK1 (N=12). The longer duration of antibiotic therapy the lower level of VK1. Combining cephalosporin/penicillin therapy and/or diarrhea, in particular, had an impact on VK1 level.

Conclusion

VKDB, a preventable cause of life-threatening hemorrhage, is still a major health problem in Egyptian infants, where persistent diarrhea and misuse of antibiotics are prevalent, necessitate a booster dose of VK in those high risk infants.

Self-medication misuse in the Middle East: a systematic literature review

Regulations usually distinguish between prescription‐only (POM) and over‐the‐counter (OTC) medicines. The former requires medical prescription; the latter are available for SM of common minor or easily treated ailments. However, in the Eastern Mediterranean countries, theoretical prescription medicines can easily be purchased without a prescription, as self‐medication (SM) resulting in potential misuse and unnecessary risk for patients. The magnitude of this activity is uncertain. The aim of this article, therefore, is to undertake a comprehensive review to identify the different types of medicines that can easily be purchased as SM in Middle East and recognized as misused. An extensive review of the published literature (1990–2015) was conducted using Pubmed, web of science, Cochrane, and Google Scholar databases, for OTC medicine misuse in the Middle East. A total of 72 papers were identified. Medicines involved in misuse included: codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. Self‐medication misuse of medicines seemed widespread. Individual treatment patterns were not clearly identified. Studies were not standardized, limiting the comparability between studies and the estimation of the scale of misuse. Pharmacists, friends, or parents were found to be the main sources of SMs. Knowledge and attitudes are an important contributing factor in the misuse of these medications. Strategies and interventions to limit misuse were rarely identified in literature. In conclusion, a massive problem involving a range of medicines was found in Middle East. Standardization of studies is a prerequisite to the understanding and prevention of misuse of self‐medication.

Active educational intervention as a tool to improve safe and appropriate use of antibiotics

Misconception about antibiotics use among the public has been widely outlined to be a main reason for inappropriate use of antibiotics including failure to complete treatment, skipping of doses, re-use of leftover medicines and overuse of antibiotics. The study was devised to evaluate whether education might be a potential strategy to promote safer use of antibiotics and reducing self-medication. Two hundred seventy one adults were asked to complete two questionnaires; a pre and posteducation. The questionnaires comprised of three parts consisting of 17 statements assessing the knowledge on: appropriate use, safe use and resistance of antibiotics. Knowledge score was estimated by calculating the percentage of correct responses. The mean (SD) knowledge score pre-education was 59.4% (20.3). However, posteducation the score was 65.9% (17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and good. Posteducation, participants within poor and adequate knowledge categories were significantly shifted to the good category describing better knowledge, McNemar-χ2 = 28.7, df = 3, p < 0.001.

It is concluded that using tailored education material targeting antibiotic need and use with a major aim of improving the public knowledge about antibiotics can be an effective and feasible strategy. This pilot study could be considered as the starting point for a wider scale public educational intervention study and national antibiotic campaign. However, the improvement in participant’s knowledge might not reflect an actual change in antibiotics–seeking behaviour or future retention of knowledge. Future research should seek to assess the impact of education on participant’s behaviour.

Patient Attitudes and Patterns of Self-Medication with Antibiotics – A Cross-Sectional Study in Bulgaria

BACKGROUND: Self-medication with antibiotics is a major concern worldwide because of the high risks of antimicrobial resistance which may result in complicated courses of treatment, increased risk of death and excess costs to the healthcare systems.AIM: The aim was to study the attitudes and self-medication patterns as related to the use of antibiotics among the general Bulgarian population and their determinants.MATERIALS AND METHODS: A questionnaire-based survey was performed among the patients in two randomly selected municipalities. The questionnaire was mailed to 50 randomly selected adult patients by each of the 33 responding GPs thus addressing a total of 1650 participants.RESULTS: A total of 1050 patients completed and returned the questionnaire. The observed self-medication rate was 43%. The women and the younger employees and students tended to have a higher self-medication rate. Fever (22%), sore throat and cough (12.7%) and discomfort when urinating (8.2%) were the most frequent patterns related to the practice of self-medication.CONCLUSION: This analysis reported an extensive use of self-medication with antibiotics in the study population before the changes in the Bulgarian legislation. Younger age and social status (students, employed) were the most important socio-demographic patterns that had probably led towards self-medication with antibiotics.

Antibiotic dispensation by Lebanese pharmacists: a comparison of higher and lower socio-economic levels

INTRODUCTION

Indiscriminate use of antibiotics contributes to a global spread of antimicrobial resistance. Previous studies showed an excessive consumption of antibiotics purchased without medical prescription from community pharmacies, mainly in developing countries. There is a shortage of studies revealing the role of community pharmacists in the overuse of antibiotics. Our objective is to study the dispensing policy of non-medical prescription antibiotics in community pharmacies, assessing the possible influence of the socio-economic level of the area over this practice.

METHODS

A cross-sectional study was conducted between February and May 2011 among 100 pharmacists working in Beirut's pharmacies and its suburbs. Pharmacies were divided into 2 groups according to the socio-economic level of the population living in the pharmacy area. A self-administered questionnaire was filled by pharmacists.

RESULTS

Over-the-counter antibiotic availability existed in both higher and lower socio-economic areas: on the whole, 32% of antibiotics were dispensed without medical prescription, with higher frequency in lower socio-economic areas (p=0.003). Dispensing injectable antibiotics without medical prescription was significantly higher in lower socio-economic areas (p=0.021), as well as dispensing an association of 2 antibiotics without medical prescription (p=0.001). Pharmacists working in lower socio-economic areas recommended more frequent antibiotics to children and the elderly (p<0.001 and p=0.004, respectively).

CONCLUSION

Dispensing antibiotics without medical prescription in Beirut community pharmacies is a common practice, particularly in lower socioeconomic areas. This public health problem should be addressed at the social, educational, and legislative levels.

A survey of patient behaviours and beliefs regarding antibiotic self-medication for respiratory tract infections in Poland

INTRODUCTION

Self-medication can contribute to the inappropriate use of antibiotics in respiratory tract infections (RTI). This phenomenon has not been well described, particularly in Poland. The aim of our study was to describe the prevalence of antibiotic self-medication for RTI, to explore factors influencing antibiotic use without prescription, and to determine the available sources of such antibiotics.

MATERIAL AND METHODS

A self-administered questionnaire completed by patients presenting to family medicine clinics at Lodz and Wroclaw from 1(st) March to 15(th) May 2010.

RESULTS

A total of 891 patients in ten clinics completed the survey (response rate, 89.1%). Overall, 41.4% (n = 369) of patients reported self-medication with an antibiotic for RTI. The most common reason for antibiotic self-medication was a belief that antibiotics treat the majority of infections, including influenza and influenza-like illnesses (43.9%; n = 162). The predominant sources of antibiotics for self-medication were antibiotics from previous prescriptions stored by the patient at home (73.7%, n = 272), those received from a pharmacy without prescription (13.5%; n = 50), or from family members and friends (12.7%; n = 47).

CONCLUSIONS

Antibiotic self-medication for RTI was common in this population. This may be due to the belief that the antibiotics treat the majority of infections. A recommendation to either ask patients to return unused antibiotics to the physician's office or to dispense antibiotics in the exact amount which is necessary for an individual course, as well as the targeted education of pharmacy personnel and the general population, appear to be justified.

Characterization of Antimicrobial Resistance and Class 1 Integrons Found inEscherichia coliIsolates from Human Stools and Drinking Water Sources in Jordan

This study demonstrates that Escherichia coli isolates from human stools showed mostly higher minimum inhibitory concentrations (MICs) and significant rates of resistance (32%-67%, P<0.05) than Escherichia coli water isolates in Jordan, as follows: ampicillin (67% vs 28%), trimethoprim/sulfamethoxazole (67% vs 28%) nalidixic acid (63% vs 20%), cefuroxime (32% vs 4%), gentamicin (32% vs 17%), norfloxacin (32% vs 12%) and tetracycline (33% vs 16%). The prevalence of integron integrase genes (Intl1) in these isolates was also significantly higher in patients' stools (67%, P <0.05) than in water (36%), but the distribution of Sul 1/Sul 2 or both in association with postive Intl1 and resistance to ampicillin and sulfamethoxazole was not significantly higher (74% versus 62%, P <0.05) in isolates from stool and water. Plasmid profiles of representative multiresistant E. coli isolates from both sources indicated the presence of two common plasmids (49,25 kb) in 11/12 (91.6%), and all E. coli transconjugants were positive for class 1 integron markers (Intl 1, Sul 1 and Sul2) and mostly associated with three transferable drug-resistant determinants to ampicillin, sulfamethoxazole and tetracycline. These results indicate that class 1 integrons with conjugative R-plasmids are common and transferable among commensal antimicrobial multiresistant E. coli isolated from human feces and drinking water sources in Jordan.

Assessing the overuse of antibiotics in children with URTIs in Saudi Arabia: development of the parental perception on antibiotics scale (PAPA scale)

Background: Antibiotic overuse is influenced by several factors that can only be measured using a valid and reliable psychosocial measurement instrument. This study aims to establish translation and early stage validation of an instrument recently developed by this research team to measure factors influencing the overuse of antibiotics in children with upper respiratory tract infections in Saudi Arabia.

Method: The content evaluation panel was composed of area experts approached using the Delphi Technique. Experts were provided with the questionnaires iteratively, on a three-round basis until consensus on the relevance of items was reached independently. Translation was achieved by adapting Brislin’s model of translation.

Results: After going through the iterative process with the experts, consensus was reached to 58 items (including demographics). Experts also pointed out some issues related to ambiguity and redundancy in some items. A final Arabic version was produced from the translation process.

Conclusion: This study produced preliminary validation of the developed instrument from the experts’ contributions. Then, the instrument was translated from English to Arabic. The instrument will undergo further validation steps in the future, such as construct validity.

The epidemiology and molecular characterization of methicillin-resistant staphylococci sampled from a healthy Jordanian population

The prevalence of natural carriage and molecular epidemiology of methicillin-resistantStaphylococcus aureus(MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) isolates in a Jordanian community were investigated. The MRSA nasal carriage rate in 227 healthy volunteers was 7·5% and the majority (81%) of MRSA harboured the resistance element SCCmectype IVe and were of a novelspatype t9519 (76%); other significantspagene types were t223 (14·7%) and t044 (5·9%). All MRSA isolates were susceptible to other classes of antibiotics, and tested positive for at least three virulence factor encoding genes, but only two harboured thepvlgene. MR-CoNS carriage was 54·2% and these isolates were characterized by single, double and untypable SCCmecelements, withStaphylococcus epidermidisSCCmectype IVa predominating. Of eight subjects with nasal co-colonization of MR-CoNS + MRSA, three shared SCCmectype IV in both groups of organisms. This is the first report of methicillin-resistant staphylococci carriage in a Jordanian community and its findings are important for epidemiological study and infection control measures of these organisms.

Purchase of Antimicrobials in Retail Pharmacies When a Prescription is Not Required

Objectives: The patterns of purchasing prescription antimicrobials with or without a prescription from retail pharmacies in Ulaanbaatar, Mongolia, were examined in relation to purchasers’ socioeconomic status and price of the product.

Methods: A survey was conducted at 250 randomly selected pharmacies in Ulaanbaatar. A total of 619 customers were interviewed, and the medicines they bought at the stores were examined by medical doctors. The use of prescriptions and advice in purchasing medicines and sociodemographic characteristics of the subjects were determined.

Results: Interviews were conducted with 297 customers who purchased prescription antimicrobials in front of the store in which they made their purchase. Among these 297 customers, only 19.5% (n=58) purchased medicine with a formal prescription, and 37.4% (n=111) purchased medicines on their own initiative and without the guidance of medical professionals. Purchase without a prescription was not associated with the subjects’ gender, age, educational status or area of residence. Lower-priced antimicrobials were purchased without prescriptions more frequently than those with a higher price (P<0.05).

Conclusion: The purchase of antimicrobials without prescriptions is common across all sociodemographic strata in Ulaanbaatar, Mongolia. Considering the increases in number of retail pharmacies and in sales of antimicrobials associated with economic development, measures to enforce regulations and to promote education among the general public and pharmacy professionals are required.

Self-medication practices with antibiotics among tertiary level students in Accra, Ghana: a cross-sectional study

The study was carried out to estimate the prevalence of self-medication with antibiotics among tertiary level students in Accra (Ghana) and evaluate factors associated with the practice. This was a descriptive cross-sectional study and involved face-to-face interviews of 600 respondents selected by convenient sampling. Prevalence of self medication was 70% (95% CI: 66.3-73.7), and the practice was significantly lower among medically inclined students (OR: 0.2, 95% CI: 0.1-0.4, p < 0.001). Among the respondents who practiced self medication, the most common frequency of antibiotic usage was at intervals of one month (30%, 95% CI: 25.6-34.4%), and the most common antibiotic used was amoxacillin (23.9%, 95% CI: 21.0-26.8%). Treatment failure were reported by 35% (95% CI: 30.5-39.6%) of the respondents, and the main reasons cited for self medication were that, it was less expensive compared to medical care in the hospital and secondly, medical care in hospitals were associated with long delays. Forty nine percent (95% CI: 44.2-53.8%) of the respondents had poor knowledge about the health implications of irrational use of antibiotics, and 46% (95% CI: 41.2-50.8%) did not comply with the completion of the full course of antibiotics. Self medication among tertiary students in Accra is an important public health problem and this may reflect the situation among tertiary students in the whole of Ghana.

Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study

Factors associated with antibiotic use, resistance and safety have been well recognized worldwide in the literature. Nevertheless, only few studies have been conducted in Jordan in this area. The aim of this study was to assess knowledge, behavior and attitude toward antibiotics use among adult Jordanians. The study represents a cross sectional survey using an interviewer administered questionnaire. Data collected from a random sample of 1141 adult Jordanians, recruited at different settings, regarding their knowledge about the effectiveness of, resistance toward, and self medications with antibiotics against bacterial, viral and parasitic diseases. 67.1% believed that antibiotics treat common cold and cough. 28.1% misused antibiotics as analgesics. 11.9% of females showed inadequate knowledge about the safe use of antibiotics during pregnancy and nursing. 28.5% kept antibiotics at home for emergency use and 55.6% use them as prophylaxis against infections. 49.0% use left-over antibiotics without physicians' consultation while 51.8% use antibiotics based on a relative advice. 22.9% of physicians prescribe antibiotics over the phone and >50.0% routinely prescribe antibiotics to treat common cold symptoms. Our findings indicated that young adults showed unsatisfactory knowledge of proper antibiotic use. Therefore, there is an urge for educational programs using all media means.

Determination of the antibiofilm, antiadhesive, and anti-MRSA activities of seven Salvia species

Background:

Several Salvia species are indigenous to Jordan and are widely used as beverages and spices and for their medicinal properties. The objective of the study was to establish the antimicrobial activities, including the antiadhesive and antibiofilm effects of seven different Salvia species.

Materials and Methods:

Methods used for planktonic culture included agar diffusion, broth microdilution, and minimal biocidal concentration determination while viable count was used for the determination of the antibiofilm and antiadhesion activities. Overnight cultures of reference strains of Candida albicans, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus and clinical strains of methicillin-resistant S. aureus (MRSA) were used as test microorganisms.

Results:

An antimicrobial activity toward planktonic cultures demonstrated a significant bacteriocidal activity (≥4 log cycle reduction) for the S. triloba extract against S. aureus including MRSA. Its volatile oil exhibited an antimicrobial activity covering all tested microorganisms with the exception of P. aeruginosa. S. triloba extract and volatile oil were successful in preventing and controlling the biofilm, demonstrating antiadhesion and antibiofilm activities, respectively.

Conclusion:

These reported activities for S. triloba extract and volatile oil allows their listing as potential antibiofilm and anti-MRSA natural agents. This might suggest their use as an antiseptic in the prophylaxis and treatment of S. aureus-associated skin infections. The antimicrobial activity of the other tested Salvia species was negligible.

Survey of ototopical self medication among patients attending ENT and family medicine departments in a Nigerian hospital

BACKGROUND

Ototopical self-medication is a common practice in Nigeria.

OBJECTIVE

The aim of the study was to establish the proportion of patients with otological problems that practice ototopical self-medication.

METHODS

A 12-week cross-sectional study of all the new patients attending the general outpatient (also called family medicine (FM)) and ear, nose and throat (ENT) departments of a Nigerian specialist hospital was carried out. A semi-structured questionnaire was used to obtain information on bio data, practice of ototopical self medication among new patients with otological problems, the drugs used and the reasons for engaging in the practice. The results were analysed using SPSS version 11 and presented in Tables.

RESULTS

Out of 3276 patients that visited the hospital during the study period, 402 had otological problems. Of these, 125 (31%) used ototopical self-medication, giving a hospital incidence of 3.8%. 115 (92%) patients consented to fill in the questionnaire on the self-use of ototopical agents. Otalgia was the most common indication (27%) for ototopical self-medication. Gentamycin and Chloramphenicol topical agents were the most commonly used by the study participants. A total of 39 participants (34%) reported to have used non-prescribed self-medication because it was time saving. In 69 of the participants (60%), the drugs were self recommended while chemists and nurses recommended their use in 23 (20%) and 22 (19%) participants, respectively.

CONCLUSION

In Nigeria, there is a need for public enlightenment and health education about the possible drawbacks of this practice.

Self-medication with antibiotics in rural population in Greece: a cross-sectional multicenter study

BACKGROUND

Self-medication is an important driver of antimicrobial overuse as well as a worldwide problem. The aim of the present study was to estimate the use of antibiotics, without medical prescription, in a sample of rural population presenting in primary care in southern Greece.

METHODS

The study included data from 1,139 randomly selected adults (545 men/594 women, mean age +/- SD: 56.2 +/- 19.8 years), who visited the 6 rural Health Centres of southern Greece, between November 2009 and January 2010. The eligible participants were sought out on a one-to-one basis and asked to answer an anonymous questionnaire.

RESULTS

Use of antibiotics within the past 12 months was reported by 888 participants (77.9%). 508 individuals (44.6%) reported that they had received antibiotics without medical prescription at least one time. The major source of self-medication was the pharmacy without prescription (76.2%). The antibiotics most frequently used for self-medication were amoxicillin (18.3%), amoxicillin/clavulanic acid (15.4%), cefaclor (9.7%), cefuroxim (7.9%), cefprozil (4.7%) and ciprofloxacin (2.3%). Fever (41.2%), common cold (32.0%) and sore throat (20.6%) were the most frequent indications for the use of self-medicated antibiotics.

CONCLUSION

In Greece, despite the open and rapid access to primary care services, it appears that a high proportion of rural adult population use antibiotics without medical prescription preferably for fever and common cold.

Abuse and misuse of prescription and nonprescription drugs sold in community pharmacies in Jordan

The aim of this study was to investigate abuse/misuse of prescription and nonprescription drugs in community pharmacies in Jordan by random distribution of a structured questionnaire to 405 pharmacies (November 2005-January 2006). Data were analyzed using SPSS for windows (version 14.0). Most respondents (94.1%) suspected that some level of abuse/misuse occurred in their pharmacy, which was highest for decongestants, cough/cold preparations, benzodiazepines, and antibiotics. Abuse/misuse of prescription and nonprescription drugs is present in Jordan, but current methods for controlling the problem are ineffective, and better methods should be developed. The study's limitations are noted..

Antimicrobial use in a country with insufficient enforcement of pharmaceutical regulations: A survey of consumption and retail sales in Ulaanbaatar, Mongolia

OBJECTIVE

To examine the inappropriate use of antimicrobials by investigating (1) actual utilization pattern and retail sales and (2) antimicrobial resistant information provided by health professionals in Ulaanbaatar, Mongolia.

METHODS

We investigated antimicrobial use in Ulaanbaatar, Mongolia by surveying 619 consenting customers who attended 250 randomly chosen pharmacies in December 2006. Pharmacy staff were also interviewed about antimicrobials purchased. In January 2007, we surveyed 117 consenting Ulaanbaatar medical doctors from seven local hospitals about their perceptions of treatment failure due to antimicrobial resistance.

RESULTS

Among 619 pharmacy customers, 48% of them had bought at least one type of antimicrobial medicine and, of these, 42% had a prescription to purchase antimicrobials. On average, 67% of the customers reported that a pharmacy worker had given them information regarding the dose and timing at which the medicine should be used but only 9% reported that they had been given information regarding possible adverse effects. The survey of medical doctors suggested that some antibiotics had become less effective clinically between 2001 and 2006.

CONCLUSION

The study shows that less than half of all customers who purchased an antibiotic at a pharmacy had a prescription. This shows that antimicrobials can be readily purchased without a prescription despite the existence of laws making such practices illegal. There is a need to establish a vigilant drug regulatory authority to promote enforcement and regulation of medicines in Mongolia. To create awareness regarding the dangers of antimicrobial resistance, educational campaigns for consumers are also necessary.