Community Pharmacists' Views of the Enforced Antibiotics Dispensing Law and Its Impact on Oral Antibiotics Sales in Saudi Arabia

Pharmacovigilance and outcomes: experience from Saudi Arabia narrative review

INTRODUCTION

Pharmacovigilance (PV) plays a central role as a quality benchmark for healthcare systems in any country. Adverse drug reactions (ADRs) contribute significantly to patient hospitalization and are major contributors to morbidity and mortality worldwide. Achieving improvements in health infrastructure and employing precise monitoring tools are essential components of drug safety. As reliance on drug therapy increases, patient exposure to potential risks rises, emphasizing the importance of minimizing ADRs.

AREA COVERED

A search for studies published from January 2010 to November 2023 was retrieved from PubMed, Medline, and Google Scholar databases. We developed the search strategies using the Mesh terms and keywords. Only English-language literature was included.

EXPERT OPINION

Twenty-nine studies met the inclusion criteria and utilized to evaluate the pharmacovigilance and its outcomes. The Saudi 2030 vision outlines an initiative to enhance patient care through a robust, safety- and quality-centered culture, fostering collaboration between drug manufacturers and regulatory authorities. This collaborative approach is expected to result in higher-quality care for the public. Moreover, a unified, simple, and advanced ADR reporting portal, in collaboration with stakeholders, is recommended to enhance the quality of ADR reporting. Also, commitment to training, updating courses, and incorporating PV practices into curricula demonstrates progress in Saudi PV System.

Knowledge, Attitude, and Practice of Antibiotic Resistance Among General Population in Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Antibiotic resistance is a global public health concern, and understanding the knowledge, attitudes, and practices (KAP) of the general population is essential for effective prevention and management. This cross-sectional study aimed to assess the KAP of antibiotic resistance among adults in Saudi Arabia.

MATERIALS AND METHODS

Between August 2023 and October 2023, 1000 participants aged 16-65 years from various regions in Saudi Arabia were surveyed using an online questionnaire. Data were analyzed using Excel and IBM SPSS Statistics version 27.0.0 (Armonk, NY: IBM Corp.). The sociodemographic characteristics of the participants were examined, and KAP variables towards antibiotic resistance were explored through a range of statistical methods, including frequencies, percentages, means, and standard deviations. Significance was defined as a p-value of ≤0.05.

RESULTS

The majority of participants were Saudi natives (98.1%) with ages between 16 and 25 years (38%), and over half were female (55.7%). More than half held a university degree (54.7%), mainly in non-medical fields (73.3%), and a significant portion reported a monthly income above 10,000 Saudi Riyals (49.7%). Regarding knowledge, 76.5% were aware of antibiotic resistance, but only 24.2% correctly identified its causes. Attitude assessments showed that 50.8% never used antibiotics as a preventive measure, and 47.3% always followed medical prescriptions. Practices revealed that 50.5% rarely used antibiotics, and 68.8% obtained antibiotic prescriptions from doctors. Additionally, 68.9% stopped taking antibiotics only after completing the course.

CONCLUSION

It is important to implement health education campaigns aimed at the public, emphasize the role of health care providers in health education for the general public, and enforce stringent regulations to control the non-prescription dispensing of antibiotics. However, further studies are needed on this subject in the future.

Suspected inappropriate use of prescription and non-prescription drugs among requesting customers: A Saudi community pharmacists' perspective

Background

Inappropriate use of medications is a global health concern, and this is attributed to the increased accessibility to prescription and non-prescription (over-the-counter) drugs at community pharmacies. We investigated the inappropriate use of prescription and non-prescription drugs in community pharmacies based on the perspectives of the community pharmacists in Saudi Arabia.

Methods

This was a questionnaire-based, cross-sectional survey which employed convenient sampling (snowball technique) to recruit participants. Being a licensed practicing pharmacist in a retail chain or an independent community pharmacy was the inclusion criteria. Participants were asked to report the drugs they suspected of being inappropriately used along with the frequency, age and gender of the suspected customers. Pharmacists were also asked to mention the action taken to limit inappropriate use at their pharmacy.

Results

A total of 397 community pharmacists completed the questionnaire (86.9 % response rate). 86.4% of the pharmacists suspected some level of abuse or misuse to have occurred. After receiving the questionnaire, the pharmacists reported suspected inappropriate use as encountered during the past three months. Cumulative inappropriate use was reported 1069 times (prescription drugs - 530; non-prescription drugs - 539). The top three inappropriately used prescription-drug categories were gabapentinoids (22.5%), antipsychotics (17.5%) and topical corticosteroids (12.1%). Among non-prescription drugs, cough products (33.2%) ranked first, followed by cold and flu products (29.5%) and first-generation antihistamines (10.8%). The cross tabulations revealed that being in the age range of 26-50 years and being a male was significantly associated (p < 0.001) with abuse/misuse of antipsychotics, antidepressants, gabapentinoids, cough products and first-generation antihistamines. Eye products (Bimatoprost) and skin products abuse/misuse had significant association with female gender (p < 0.001).

Conclusion

The results of our study provide crucial information to the healthcare authorities regarding the medications that can be inappropriately used at the community pharmacies in Saudi Arabia which necessitates implementation of stringent dispensing regulations. Educational programs can be implemented to increase the awareness among public regarding the harmful effects of inappropriate use of drugs.

Knowledge, Attitude, and Practice of using Antibiotics among the Community in Eastern Province, Saudi Arabia

Objectives

The purpose of this study is to explore and evaluate the knowledge, attitude, and practice of using antibiotics among the community in the Eastern Province, of Saudi Arabia.

Methods

A cross-sectional study was conducted, from February 2022 through March 2022, among people in Eastern Province, Saudi Arabia.

Results

The study population was 753 of the Saudi community. The questionnaire used open-ended and multiple-choice questions. Out of 753 participants, only 254 (55.6%) think that antibiotics can treat a bacterial infection, whereas 163 (35.7%) and 82 (17.9%) think it treats viral and fungal infections respectively. 26 (5.7%) of the respondents think that they should be stopped when the antibiotics are finished, while 72 (15.8%) think that they should be stopped when the symptoms disappear. The most common side effect in the respondent's opinion was diarrhea 183 (40%), followed by 168 (36.76%) antibiotics resistance. The major reason for taking antibiotics without a prescription was found to be mild symptoms 28 (50.90%), adequate information 21 (38.18%), difficulty in taking appointments 17 (30.90%), long waiting hours during the hospital visits 15 (27.27%). 169 (36.9%) kept the leftover antibiotics for reuse. The most common antibiotics used for self-medication were found to be Amoxicillin and clavulanic acid 23 (41.8%), followed by Amoxicillin 9 (16.36%). Knowledge of antibiotic resistance was highest in the age group 20-30 (62.7%) (P < 0.05).

Conclusion

People in Saudi Arabia show a high awareness of antibiotics' proper usage, and this returns to the great awareness campaign held by The Ministry of Health (MoH).

Prevalence of antibiotic misuse in cases of pneumonia and diarrhea in Saudi Arabia

Background

Antibiotic misuse is a major public health issue with long-term repercussions.

Objective

The purpose of this investigation was to evaluate the effects of pneumonia and diarrhea, with an emphasis on antibiotic misuse.

Methodology

This study included 410 participants (217 fathers and 193 mothers), of whom 239 purchased antibiotics for their children without a prescription, whereas 171 had a prescription or were unsure if one was required.

Results

Antibiotics were used incorrectly by 58.1% of respondents. About 51.2% of participants said they were taking two antibiotics at the same time. Around 30% of people admitted to using antibiotics inefficiently. The most prevalent reason for use was "viral and bacterial," followed by "viral," and then "bacterial," with 35%, 21%, and 20%, respectively. In addition, 22.4% of patients have used antibiotics for an unknown reason.

Conclusion

Saudi parents of children with pneumonia and diarrhea abuse antibiotics. Saudi legislation banning medications without a prescription has helped reduce antibiotic abuse, but more community-based education and awareness are needed.

Antimicrobial Resistance Awareness, Antibiotics Prescription Errors and Dispensing Patterns by Community Pharmacists in Saudi Arabia

BACKGROUND

Antibiotic overuse and misuse have greatly facilitated the development of antimicrobial resistance (AMR). The Kingdom of Saudi Arabia is one of the countries that took a strategic approach, beginning with the prohibition of over-the-counter antibiotic dispensing, followed by the implementation of antimicrobial stewardship programs and various educational and awareness governmental activities and plans. However, the status of antibiotic prescriptions and dispensing in Saudi community pharmacies is still unclear. As a result, this study investigates community pharmacists' antibiotic dispensing practices and their knowledge of their role in fighting AMR, in addition to the status of antibiotic prescribing errors by physicians.

METHOD

This is an online-based survey study of 671 participants distributed among community pharmacists of large pharmacy chains throughout the Saudi Arabia.

RESULT

A number of 671 community pharmacists were participated in total, with a response rate of 96.57% (648 responses). The majority of community pharmacists (67%) had a long experience (>5 years) in this field. An antibiotic prescribing error was prevalent, with a mean of 3.32 per month in each pharmacy. Dentists (36.7%) and general practitioners (28.7%) were the most prescribers associated with antibiotic prescription errors. Most community pharmacists had a generally good practice of dispensing antibiotics, accounting for 71.5% of daily antibiotic dispensing. However, more than one-third of those pharmacists (35.2%) agreed on dispensing topical antibiotics without a prescription, based on their evaluation of the case presented in the pharmacy, as the majority of community pharmacists demonstrated a significant understanding of AMR.

CONCLUSION

The current study demonstrated that there is a good antibiotic dispensing practice in the community pharmacies in Saudi Arabia, in addition to a substantial understanding of the community pharmacist's vital role in fighting AMR. This study could inform decision-makers on antibiotic usage in Saudi community pharmacies to improve the current inappropriate antibiotic use and dispensing situation and, thus, control AMR spread in Saudi Arabia.

The evaluation of adverse drug reactions in Saudi Arabia: A retrospective observational study

Purpose

This study aimed to assess the type, severity, seriousness, reasons, and outcomes of adverse drug reactions (ADRs) in the reports submitted to the regional spontaneous ADR database.

Methods

A retrospective observational study was conducted to analyze all the Tabuk Health Affairs hospitals in Saudi Arabia submitted to SFDA from January 2020 to December 2020. The database was structured according to the Saudi ADR form’s fields. The Naranjo algorithm was used to assess the causes of the ADRs (sFDA, 2022).

Results

For 1 year, 2,349 ADR reports, along with 242 suspected drugs for 4,114 reactions, were submitted to SFDA. We found more males than females had ADRs (56.1% vs. 43.8%, P < 0.05).

Antimicrobial drugs (26.9%), hematologic drugs (19.7%), and neuropsychiatric drugs (12.9%) were responsible for most ADRs. Most of the reactions were associated with the use of ciprofloxacin (7.7%), followed by the combination of lopinavir and ritonavir (4.1%). Two deaths resulted from salbutamol and cefazolin use. Based on the results of the Naranjo assessment of causality, cardiovascular events (9.9%) exhibited the highest score (≥9) for a causal relationship with the suspected drugs, followed by dermatological events (9.5%).

Conclusions

The spontaneous report database is an important and valuable source of aftermarket authorization safety information. In our study, most drugs used as antimicrobial, cardiovascular, and hematologic therapies were associated with a higher risk of developing severe and serious events. We recommend monitoring and using medications optimally to ensure patient safety.