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Davido B, Michelon H, Mamona C, de Truchis P, Jaffal K, Saleh-Mghir A. Efficacy of Expired Antibiotics: A Real Debate in the Context of Repeated Drug Shortages. Antibiotics (Basel) 2024; 13:466. [PMID: 38786194 PMCID: PMC11117793 DOI: 10.3390/antibiotics13050466] [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: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
This narrative review aims to discuss the main interest in and cautions associated with the use of expired antibiotics in the context of repeated shortages, notably in Europe. Articles concerning the topic of expiry dates related to antibiotic use were reviewed using keywords in the PubMed®/MEDLINE and Google Scholar databases to identify the most extensive evidence-based documentation. The present review evaluates the potential interest and efficacy of using expired drugs and their possible related adverse events. Overall, in the context of drug shortages, expiry dates could be safely extended for at least one year for most solid antibiotics (tablets or powder) used in daily clinical practice, as long as they are stored under the right conditions, in accordance with the summary of product characteristics.
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Affiliation(s)
- Benjamin Davido
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
- UMR 1173, Infection et Inflammation, Université Versailles-St-Quentin, 78000 Versailles, France;
| | - Hugues Michelon
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
| | - Christel Mamona
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
| | - Pierre de Truchis
- Hôpital Raymond Poincaré, Université Paris-Saclay, 92380 Garches, France; (H.M.); (C.M.); (P.d.T.)
| | - Karim Jaffal
- Hôpital Ambroise Paré, Université Paris-Saclay, 92100 Boulogne-Billancourt, France;
| | - Azzam Saleh-Mghir
- UMR 1173, Infection et Inflammation, Université Versailles-St-Quentin, 78000 Versailles, France;
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Kanyari SS, Senapati TR, Kar A. Disposal Practices of Unused and Expired Medicines Among the General Public and Pharmacies: A Mixed-Method Study in the Odisha State of Eastern India. Cureus 2024; 16:e52359. [PMID: 38361720 PMCID: PMC10867696 DOI: 10.7759/cureus.52359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Unused and expired medicines are potentially toxic substances that should be managed effectively to avoid possible environmental hazards. The absence of well-defined protocols in India regarding the proper disposal of unused, unwanted, and expired medications raises concerns about the potential for accidental poisoning and environmental threats. Consequently, this research was conducted to evaluate the disposal practices of medications within both urban slum households and pharmacies. Methods This questionnaire-based, mixed-method study was conducted among 385 general public residing in urban slums and 10 registered pharmacies in Bhubaneswar city, India, from September 2020 to August 2021. A semi-structured questionnaire was framed to collect data from the households and the pharmacies; key informant interview was carried out among expert members regarding the disposal of expired medicines. Results Results found that 82.1% (316/385) of the study population threw unused drugs in dustbins, whereas only 2.6% (10/385) returned the medicines to the pharmacy. The most common reason for leftover medicine was the stoppage of drugs on symptomatic relief (53.2%, 205/385), followed by changes in prescription by doctors (18%, 69/385). Out of 10 pharmacies, seven pharmacies disposed of expired drugs in general dustbins. Conclusion Our findings indicate that a majority of the participants tend to dispose of medicines in an unsafe manner. Conversely, the responsible disposal of medications is significantly influenced by patient education. Hence, healthcare professionals are better positioned to impart knowledge to the public, fostering awareness about the proper storage and safe disposal of unused, unwanted, and expired medicines.
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Affiliation(s)
- S Suneeti Kanyari
- Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | | | - Ansuman Kar
- Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Samuel M, Fredrick Wabwire T, Tumwine G, Waiswa P. Antimicrobial Usage by Small-Scale Commercial Poultry Farmers in Mid-Western District of Masindi Uganda: Patterns, Public Health Implications, and Antimicrobial Resistance of E. coli. Vet Med Int 2023; 2023:6644271. [PMID: 37122610 PMCID: PMC10139818 DOI: 10.1155/2023/6644271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Poultry production in Uganda is growing at a fast rate due to increasing demand, notwithstanding, poor husbandry practices, and diseases, prompting farmers to rear healthy productive flocks with antimicrobials. The study evaluated the knowledge and practices as regards the use of antibiotics among poultry farmers in Masindi district and determined the antibiotic susceptibility profiles of E. coli strains from chickens. Methods A cross-sectional study using a closed-end questionnaire was conducted in 140 selected small-scale commercial poultry farms in Masindi district between June and December, 2020. Analyzed qualitative data were presented as frequencies, percentages, and their 95% confidence intervals (95% CI). Fecal swabs from chickens were inoculated onto a MacConkey agar, and E. coli was confirmed by standard biochemical tests. Antimicrobial susceptibility was determined by the disk diffusion method for 7 antibiotics. Results Most farmers (74%) used antibiotics, mainly tetracycline (51.4%) and sulfonamides (28.6%), given to the chicks (45%), for both curative and prophylaxis purposes (80%), and via drinking water (67%). Farmers mainly used antibiotics recommended by the veterinarian (76.4%), more than relying on experience (10.7%), while 45% were involved in self-medicating the birds. On choosing the correct dosage, 45.7% read the instruction, and 42.9% consulted a veterinarian. Only 10.7% observed the drug withdrawal period, while 53.6% consumed eggs at home or sold eggs (35.7%) from birds under treatment. Of the 200 E. coli strains, 90 (45.0%) were resistant to one drug, 74 (37.0%) to two, and multidrug resistance to three classes of antibiotics was 36 (18.0%). Overall, E. coli resistance to tetracycline was (69.0%), ampicillin (37.0%), sulfonamides (36.0%), and to kanamycin (1.5%). Conclusions The small-scale poultry farmers frequently use antimicrobial drugs, mainly tetracycline and sulfonamides for curative and prophylaxis. Thus, enforcing measures against antibiotic use supported by a strong veterinary service sector and farmers' training on judicious use of antimicrobials are needed.
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Affiliation(s)
- Majalija Samuel
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Tony Fredrick Wabwire
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Gabriel Tumwine
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Peter Waiswa
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
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Effect of imidazolium-based ionic liquid on the antibacterial activity of an expired drug rifampicin. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2021.116844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Manocha S, Suranagi UD, Sah RK, Chandane RD, Kulhare S, Goyal N, Tanwar K. Current Disposal Practices of Unused and Expired Medicines Among General Public in Delhi and National Capital Region, India. Curr Drug Saf 2020; 15:13-19. [PMID: 31593533 DOI: 10.2174/1574886314666191008095344] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stocking unused or expired medicines or donating these to others can lead to accidental or inappropriate ingestion, increasing the risk of adverse drug reaction(s) and even lead to antibiotic resistance. Further improper disposal of expired or unused medicines is associated with environmental pollution, health hazards and damage to ecosystem. Ecopharmacovigilance is an important area in this context. OBJECTIVE To explore the awareness and disposal practices of unused/expired in the general public. MATERIALS AND METHODS The current study is an observational, cross-sectional, questionnaire-based study conducted in 956 medicine consumers in New Delhi and National Capital Region, India. The knowledge, attitude, and practice of consumers regarding the disposal of unused medicines were evaluated. RESULTS The majority (89.9%) of consumers opined that expiry of medicine(s) meant for completion of shelf life, production of toxic chemical and loss of or decreasing of beneficial effects of medicines. Majority (87%) of the consumers stored medicines at home. Almost all (92.6%) of the consumers threw away the expired medicines after storing for few days. Consumers discarded the expired medicines mainly in household trash (73%). The majority (93%) of consumers were in favour of a government program to collect unused or expired medicines from their home. CONCLUSION The knowledge and practices of consumers towards disposal of unused and expired medicines needs to be improved. Health care professionals, government and policy makers should offer training to educate and guide the general public on safe and proper disposal practices of expired or unused medicines.
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Affiliation(s)
- Sachin Manocha
- Department of Pharmacology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Umesh D Suranagi
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | - Ravinder K Sah
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | | | - Sumit Kulhare
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | - Nitesh Goyal
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
| | - Krishna Tanwar
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
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Bekele KM, Abay AM, Mengistu KA, Atsbeha BW, Demeke CA, Belay WS, Yimenu DK. Knowledge, Attitude, and Practice on Over-the-Counter Drugs Among Pharmacy and Medical Students: A Facility-Based Cross-Sectional Study. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:135-146. [PMID: 32983946 PMCID: PMC7501988 DOI: 10.2147/iprp.s266786] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Self-medication with over-the-counter (OTC) medications is common among medicine and health science students. For safe use of OTC medications, students are expected to have proper knowledge, attitude, and practice (KAP) towards OTC medications and subsequent adverse drug reactions (ADRs). Objective The aim of this study was to assess KAP of OTC medications use and related factors among medical and pharmacy students at the University of Gondar, Gondar, Northwest Ethiopia. Methods A cross-sectional study was conducted. Data were collected using a self-administered questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) version 24. Chi-square analysis was conducted and multivariable logistic regression analysis was used to determine the association between KAP and OTC use and its related adverse effects. A P value of less than 0.05 was used to declare statistical significance. Results A total of 380 students (229 medical students and 151 pharmacy students) participated in the study. The majority of the respondents 303 (79.7%) reported that they have the practice of self-medication. Fever 69 (80.2%), headache 21 (24.4%), and abdominal cramp 20 (23.3%) were the most common conditions for which the students go for self-medication while paracetamol 51 (59.3%) followed by non-steroidal anti-inflammatory drugs (NSAIDs) 44 (51.2%) were the most commonly used classes of drugs. An intention for time-saving caused by the waiting time due to crowds in medical consultation rooms 212 (77.4%) and a desire for quick relief 171 (62.4%) were the main reasons for the self-medication practice with OTC medications. Conclusion Self-medication is widely practiced among medical and pharmacy students. Significant problems and malpractices were identified, such as sharing of OTC medications, the use of expired medicines, doubling the dose of medications when they were ineffective, storage of OTC medications, and not reading labels and expiry dates.
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Affiliation(s)
- Kidist Mulugeta Bekele
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ahmed Moges Abay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kidist Abiye Mengistu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanemeskel Weldegerima Atsbeha
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Abiyu Demeke
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wudneh Simegn Belay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Rees GM, Barrett DC, Buller H, Mills HL, Reyher KK. Storage of prescription veterinary medicines on UK dairy farms: a cross-sectional study. Vet Rec 2019; 184:153. [PMID: 30413673 PMCID: PMC6589450 DOI: 10.1136/vr.105041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/24/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Prescription veterinary medicine (PVM) use in the UK is an area of increasing focus for the veterinary profession. While many studies measure antimicrobial use on dairy farms, none report the quantity of antimicrobials stored on farms, nor the ways in which they are stored. The majority of PVM treatments occur in the absence of the prescribing veterinarian, yet there is an identifiable knowledge gap surrounding PVM use and farmer decision making. To provide an evidence base for future work on PVM use, data were collected from 27 dairy farms in England and Wales in Autumn 2016. The number of different PVMs stored on farms ranged from 9 to 35, with antimicrobials being the most common therapeutic group stored. Injectable antimicrobials comprised the greatest weight of active ingredient found, while intramammary antimicrobials were the most frequent unit of medicine stored. Antimicrobials classed by the European Medicines Agency as critically important to human health were present on most farms, and the presence of expired medicines and medicines not licensed for use in dairy cattle was also common. The medicine resources available to farmers are likely to influence their treatment decisions; therefore, evidence of the PVM stored on farms can help inform understanding of medicine use.
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Affiliation(s)
- Gwen M Rees
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - David C Barrett
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Henry Buller
- School of Geography, Department of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Harriet L Mills
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
Introduction: Antibiotic-resistant infections have become increasingly prevalent nowadays. As a result, it is essential to examine the key socioeconomic and political factors which contribute to the rise in the prevalence of antibiotic resistance in developing and developed nations. This study aims to identify the various contributors to the development of antibiotic resistance in each type of nation. Methods: PUBMED was used to identify primary research, systematic reviews, and narrative reviews published before Jan 2017. Search terms included antibiotic resistance, antimicrobial resistance, superbugs, multidrug-resistant organisms, developing countries, developed countries. Publications from different countries were included to ensure generalizability. Publications were excluded if they didn't mention factors causing resistance, focused on the molecular basis of resistance, or if they were case reports. Publicly available reports from national and international health agencies were used. Results: In developing countries, key contributors identified included: (1) Lack of surveillance of resistance development, (2) poor quality of available antibiotics, (3) clinical misuse, and (4) ease of availability of antibiotics. In developed countries, poor hospital-level regulation and excessive antibiotic use in food-producing animals play a major role in leading to antibiotic resistance. Finally, research on novel antibiotics is slow ing down due to the lack of economic incentives for antibiotic research. Conclusion: Overall, multiple factors, which are distinct for developing and developed countries, contribute to the increase in the prevalence of antibiotic resistance globally. The results highlight the need to improve the regulatory framework for antibiotic use and research globally.
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Affiliation(s)
- Aastha Chokshi
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David Cennimo
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Helen Horng
- Department of Pharmacy, University Hospital, Newark, New Jersey, USA
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