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Abdelkarim OA, Abubakar U, Hussain MA, Abadi AEB, Mohamed AO, Osman W, Sherif AE, Ebrahim SA, Ahmed AH, Ahmed MO, Ashour A. Knowledge, Perception, and Self-Confidence of Antibiotic Resistance, Appropriate Antibiotic Therapy, and Antibiotic Stewardship Among Undergraduate Pharmacy Students in Sudan. Infect Drug Resist 2024; 17:935-949. [PMID: 38495628 PMCID: PMC10941789 DOI: 10.2147/idr.s435190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background Adequate training in infectious diseases and antibiotic resistance is crucial for pharmacy students to participate in antibiotic stewardship programs and understand microbiology careers. Aim The study was carried out to assess the knowledge and self-reported confidence in antibiotic resistance, antibiotic therapy, and antimicrobial stewardship (AMS) among final-year undergraduate pharmacy students in Sudan. Methods A cross-sectional study was conducted in three universities using a 57-item online questionnaire between April and May 2022. Results A total of 109 students (response rate 36%) participated and showed average knowledge scores of 5.6±1.7 (out of 10.0) for antibiotic resistance, 4.9±2.0 (out of 5.0) for appropriate antibiotic therapy, and 3.1±1.4 (out of 5.0) for AMS. No significant differences were observed among schools. Some students reported poor knowledge about antibiotic therapy and the consequences of resistance. One-third of students lacked confidence in interpreting microbiological results. Knowledge of antibiotic resistance among students' practice area after graduation was higher (p=0.017) and those interested in ID careers (5.8 vs 4.8) (p=0.037). Male students (5.6 vs 4.5) and those interested in ID careers (4.3 vs 3.4) (p<0.001) had higher scores of appropriate antibiotic therapy. Students attended antibiotic resistance courses (51.5 vs 45.2), and those interested in ID significantly had higher self-confidence (55.3 vs 45.8) (p=0.008). Conclusion Pharmacy students in Sudan have substantial knowledge of AMS and antibiotic resistance with poor knowledge of antibiotic therapy. Adequate training about infectious diseases and related topics is recommended to improve pharmacy students' understanding of microbiological findings, other competencies, and skills to incorporate in antimicrobial stewardship.
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Affiliation(s)
- Omalhassan Amir Abdelkarim
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Mohamed A Hussain
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Abd Elrahman Babiker Abadi
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Ahmed Osman Mohamed
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Wadah Osman
- Department of Pharmacognosy, Faculty of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-KharJ, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Asmaa E Sherif
- Department of Pharmacognosy, Faculty of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-KharJ, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Sara Altayep Ebrahim
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Asmaa Hussein Ahmed
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Marwa Omer Ahmed
- Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Ahmed Ashour
- Department of Pharmacognosy, Faculty of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-KharJ, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
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Mudenda S, Matafwali SK, Mukosha M, Daka V, Chabalenge B, Chizimu J, Yamba K, Mufwambi W, Banda P, Chisha P, Mulenga F, Phiri M, Mfune RL, Kasanga M, Sartelli M, Saleem Z, Godman B. Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications. JAC Antimicrob Resist 2023; 5:dlad141. [PMID: 38130703 PMCID: PMC10733812 DOI: 10.1093/jacamr/dlad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Antifungal resistance (AFR) is a growing global public health concern. Little is currently known about knowledge, attitudes and practices regarding AFR and antifungal stewardship (AFS) in Zambia, and across the globe. To address this evidence gap, we conducted a study through a questionnaire design starting with pharmacy students as they include the next generation of healthcare professionals. Methods A cross-sectional study among 412 pharmacy students from June 2023 to July 2023 using a structured questionnaire. Multivariable analysis was used to determine key factors of influence. Results Of the 412 participants, 55.8% were female, with 81.6% aged between 18 and 25 years. Most students had good knowledge (85.9%) and positive attitudes (86.7%) but sub-optimal practices (65.8%) towards AFR and AFS. Overall, 30.2% of students accessed antifungals without a prescription. Male students were less likely to report a good knowledge of AFR (adjusted OR, AOR = 0.55, 95% CI: 0.31-0.98). Similarly, students residing in urban areas were less likely to report a positive attitude (AOR = 0.35, 95% CI: 0.13-0.91). Fourth-year students were also less likely to report good practices compared with second-year students (AOR = 0.48, 95% CI: 0.27-0.85). Conclusions Good knowledge and positive attitudes must translate into good practices toward AFR and AFS going forward. Consequently, there is a need to provide educational interventions where students have low scores regarding AFR and AFS. In addition, there is a need to implement strategies to reduce inappropriate dispensing of antifungals, especially without a prescription, to reduce AFR in Zambia.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola PO Box 71191, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka PO Box 31890, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Kaunda Yamba
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Patrick Banda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Patience Chisha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka PO Box 50110, Zambia
| | - Florence Mulenga
- Conservation Department, World Wide Fund For Nature (WWF Zambia Country Office), Lusaka PO Box 50551, Zambia
| | - McLawrence Phiri
- Department of Pharmacy, Maina Soko Medical Center, Woodlands, Lusaka PO Box 320091, Zambia
| | - Ruth Lindizyani Mfune
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Maisa Kasanga
- Department of Epidemiology and Biostatistics, Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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3
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Gul B, Sana M, Saleem A, Mustafa ZU, Salman M, Khan YH, Mallhi TH, Sono TM, Meyer JC, Godman BB. Antimicrobial Dispensing Practices during COVID-19 and the Implications for Pakistan. Antibiotics (Basel) 2023; 12:1018. [PMID: 37370337 PMCID: PMC10294926 DOI: 10.3390/antibiotics12061018] [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: 04/24/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Antibiotics are one of the most frequently dispensed classes of medicines. However, excessive misuse and abuse enhances antimicrobial resistance (AMR). Previous studies in Pakistan have documented extensive dispensing of 'Watch' and 'Reserve' antibiotics, which is a concern. In view of this, there is a need to assess current dispensing patterns following COVID-19 in Pakistan. A cross-sectional study was undertaken, collecting dispensing data from 39 pharmacies and 53 drug stores from November 2022 to February 2023. Outlets were principally in urban areas (60.9%), with pharmacists/pharmacy technicians present in 32.6% of outlets. In total, 11,092 prescriptions were analyzed; 67.1% of patients were supplied at least one antimicrobial, 74.3% antibiotics, 10.2% antifungals and 7.9% anthelmintics. A total of 33.2% of antimicrobials were supplied without a prescription. Common indications for dispensed antibiotics were respiratory (34.3%) and gastrointestinal (16.8%) infections, which can be self-limiting. In addition, 12% of antibiotics were dispensed for the prevention or treatment of COVID-19. The most frequent antibiotics dispensed were ceftriaxone (18.4%) and amoxicillin (15.4%). Overall, 59.2% antibiotics were 'Watch' antibiotics, followed by 'Access' (40.3%) and 'Reserve' (0.5%) antibiotics. Of the total antibiotics dispensed for treating COVID-19, 68.3% were 'Watch' and 31.7% 'Access'. Overall, there appeared to be an appreciable number of antibiotics dispensed during the recent pandemic, including for patients with COVID-19, alongside generally extensive dispensing of 'Watch' antibiotics. This needs to be urgently addressed with appropriate programs among pharmacists/pharmacy technicians to reduce AMR.
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Affiliation(s)
- Bushra Gul
- Department of Medicines, Tehsil Head Quarter (THQ) Hospital, District Bhakkar, Darya Khan 3000, Punjab, Pakistan;
| | - Maria Sana
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan; (M.S.); (A.S.)
| | - Aneela Saleem
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan; (M.S.); (A.S.)
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Punja, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Punja, Pakistan;
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia; (Y.H.K.); (T.H.M.)
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia; (Y.H.K.); (T.H.M.)
| | - Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa; (T.M.S.); (J.C.M.)
- Saselamani Pharmacy, Saselamani 0928, Limpopo, South Africa
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa; (T.M.S.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa
| | - Brian B. Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa; (T.M.S.); (J.C.M.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
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Ji W, Gillani AH, Ye D, Zhao H, Du J, McIver DJ, Tian Y. Perceptions and preparedness of senior medical students about antimicrobial stewardship programs: are we providing adequate training to future prescribers? Expert Rev Anti Infect Ther 2023; 21:309-315. [PMID: 36756806 DOI: 10.1080/14787210.2023.2179034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Senior medical students will become one of the key partners in antimicrobial stewardship efforts in the future, yet the level of education and their perceptions toward this topic are not well documented in China. RESEARCH DESIGN AND METHODS We conducted a cross-sectional, anonymous, online survey between December 2021 and February 2022. The students came from six universities of all five provinces/autonomous regions in northwest China. Students completed the survey by using WeChat. RESULTS More than half of students agreed/strongly agreed that antimicrobials are overused (53.1%) and that antimicrobial resistance is a significant problem nationally (50.2%). Most of the respondents (70%) were interested in learning more about antimicrobials. Around 60% of the respondents thought they were well prepared for future use of antimicrobials. Only 30% of the respondents were familiar with the term 'Antimicrobial Stewardship,' but 80.7% were interested in taking part in an antimicrobial stewardship program training. More than half of the senior medical students thought that courses in antibacterial is suitable for second and third academic years. CONCLUSIONS It is therefore suggested to provide specific curriculum and strengthen training of antimicrobial use for medical students in the future, as well as more rotation practice in infectious diseases related departments.
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Affiliation(s)
- Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dan Ye
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Pharmacy, Xi'an No. 3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shaanxi, China
| | - Hang Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiaxi Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - David J McIver
- Institute for Global Health Sciences, University of California, San Francisco, SF, USA
| | - Yun Tian
- Department of Clinical Pharmacy, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi, China
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Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications. Antibiotics (Basel) 2023; 12:antibiotics12010135. [PMID: 36671336 PMCID: PMC9854661 DOI: 10.3390/antibiotics12010135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261−7.094; p < 0.001) and age (OR = 0.524, CI = 0.327−0.842; p < 0.008) were among the key factors impacting students’ training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.
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Boury N, Van den Bogaard MED, Wasendorf C, Amon J, Judson S, Maroushek SR, Peters NT. The Use of a Multimodal Case Study To Illustrate Microbial Genetics, Metabolism, and Evolution: The Emergence of VRSA-1. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2022; 23:e00125-22. [PMID: 36532220 PMCID: PMC9753655 DOI: 10.1128/jmbe.00125-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
Antibiotic Resistance (ABR) is a global concern and while many students are aware of this issue, many of them are unclear on the mechanisms by which ABR may emerge. The mechanism of horizontal gene transfer is something many students are not familiar with. In this curriculum contribution we present 2 versions of an 'interrupted case study' that is designed as an introduction to horizontal gene transfer for early major students and as a review case for advanced major students in biology and life sciences. The case is based on an authentic patient who developed infections with both methicillin resistant Staphylococcus aureus and vancomycin resistant S. aureus. The interrupted case study is appropriate for small and large groups and engages students while content is introduced in a highly structured way. This type of case study can be done by novice and seasoned instructors and lead to considerable learning gains in both introductory and intermediate microbiology courses.
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Affiliation(s)
- N. Boury
- Plant Pathology and Micrology Department, Iowa State University, Ames, Iowa, USA
| | | | - C. Wasendorf
- Plant Pathology and Micrology Department, Iowa State University, Ames, Iowa, USA
| | - J. Amon
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - S. Judson
- Agriculture Education and Studies, Iowa State University, Ames, Iowa, USA
| | - S. R. Maroushek
- Pediatric Infectious Diseases, Hennepin Health Care and University of Minnesota, Minneapolis, Minnesota, USA
| | - N. T. Peters
- Plant Pathology and Micrology Department, Iowa State University, Ames, Iowa, USA
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Sefah IA, Akwaboah E, Sarkodie E, Godman B, Meyer JC. Evaluation of Healthcare Students' Knowledge on Antibiotic Use, Antimicrobial Resistance and Antimicrobial Stewardship Programs and Associated Factors in a Tertiary University in Ghana: Findings and Implications. Antibiotics (Basel) 2022; 11:antibiotics11121679. [PMID: 36551335 PMCID: PMC9774439 DOI: 10.3390/antibiotics11121679] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major public health problem globally, and Ghana is no exception. Good knowledge regarding antibiotic use, AMR, and the concept of antimicrobial stewardship (AMS) is critical among healthcare students to curb rising AMR rates in the future. Consequently, a need to ascertain this. A cross-sectional survey was undertaken among fifth-year pharmacy, medical students and fourth (final)-year nursing and physician assistantship students at the University of Health and Allied Sciences in Ghana to assess their knowledge on antibiotic use, AMR and AMS using a web-based self-administered structured questionnaire. Descriptive statistics, Fishers’ exact test, and multiple logistic regression analyses were performed. A total of 160 healthcare students were interviewed, of which 56.3% (n = 90) were male and 58.8% (n = 94) were in their fourth year of study. Good knowledge of antibiotic use, AMR, and AMS was associated with the study course (p = 0.001) and the number of years of study (p < 0.001). Overall, there were differences in the level of knowledge of antibiotics among the different healthcare students and their years of study. Efforts must now be made to enhance the curricula to ensure an improved and uniform transfer of knowledge of antibiotics, AMR, and AMS among the different healthcare students to sustain the fight against AMR in Ghana given growing concerns.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
| | - Emmanuel Akwaboah
- School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
| | - Emmanuel Sarkodie
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi PMB UPO KNUST, Ghana
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Correspondence: or
| | - Johanna Caterina Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
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Ahmed N, Tahir K, Aslam S, Cheema SM, Rabaan AA, Turkistani SA, Garout M, Halwani MA, Aljeldah M, Al Shammari BR, Sabour AA, Alshiekheid MA, Alshamrani SA, Azmi RA, Al-Absi GH, Zeb S, Yean CY. Heavy Metal (Arsenic) Induced Antibiotic Resistance among Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria of Nosocomial Origin. Pharmaceuticals (Basel) 2022; 15:1426. [PMID: 36422556 PMCID: PMC9692669 DOI: 10.3390/ph15111426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 08/26/2023] Open
Abstract
Antimicrobial resistance (AMR) is a leading cause of treatment failure for many infectious diseases worldwide. Improper overdosing and the misuse of antibiotics contributes significantly to the emergence of drug-resistant bacteria. The co-contamination of heavy metals and antibiotic compounds existing in the environment might also be involved in the spread of AMR. The current study was designed to test the efficacy of heavy metals (arsenic) induced AMR patterns in clinically isolated extended-spectrum β-lactamase (ESBL) producing bacteria. A total of 300 clinically isolated ESBL-producing bacteria were collected from a tertiary care hospital in Lahore, Pakistan, with the demographic characteristics of patients. After the collection of bacterial isolates, these were reinoculated on agar media for reidentification purposes. Direct antimicrobial sensitivity testing (AST) for bacterial isolates by disk diffusion methods was used to determine the AST patterns with and without heavy metal. The heavy metal was concentrated in dilutions of 1.25 g/mL. The collected bacterial isolates were isolated from wounds (n = 63, 21%), urine (n = 112, 37.3%), blood (n = 43, 14.3%), pus (n = 49, 16.3%), and aspirate (n = 33, 11%) samples. From the total 300 bacterial isolates, n = 172 were Escherichia coli (57.3%), 57 were Klebsiella spp. (19%), 32 were Pseudomonas aeruginosa (10.6%), 21 were Proteus mirabilis (7%) and 18 were Enterobacter spp. (6%). Most of the antibiotic drugs were found resistant to tested bacteria. Colistin and Polymyxin-B showed the highest sensitivity against all tested bacteria, but when tested with heavy metals, these antibiotics were also found to be significantly resistant. We found that heavy metals induced the resistance capability in bacterial isolates, which leads to higher AMR patterns as compared to without heavy metal tested isolates. The results of the current study explored the heavy metal as an inducer of AMR and may contribute to the formation and spread of AMR in settings that are contaminated with heavy metals.
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Affiliation(s)
- Naveed Ahmed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Department of Microbiology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan
| | - Kinza Tahir
- Department of Medical Education, Allama Iqbal Medical College, Lahore 54000, Pakistan
| | - Sara Aslam
- Department of Medical Education, Allama Iqbal Medical College, Lahore 54000, Pakistan
| | - Sara Masood Cheema
- Department of Pathology, Azra Naheed Medical College, Lahore 54000, Pakistan
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Safaa A. Turkistani
- Department of Medical Laboratory Sciences, Fakeeh College for Medical Science, Jeddah 21134, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Muhammad A. Halwani
- Department of Medical Microbiology, Faculty of Medicine, Al Baha University, Al Baha 4781, Saudi Arabia
| | - Mohammed Aljeldah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia
| | - Basim R. Al Shammari
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hafr Al Batin, Hafr Al Batin 39831, Saudi Arabia
| | - Amal A. Sabour
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Maha A. Alshiekheid
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Saleh A. Alshamrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Reyouf Al Azmi
- Infection Prevention and Control, Eastern Health Cluster, Dammam 32253, Saudi Arabia
| | - Ghadeer H. Al-Absi
- College of Pharmacy, Department of Pharmacy Practice, Alfaisal University, Riyadh 325476, Saudi Arabia
| | - Shah Zeb
- Department of Microbiology, Faculty of Biomedical and Health Science, The University of Haripur, Haripur 22610, Pakistan
| | - Chan Yean Yean
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Mustafa ZU, Manzoor MN, Shahid A, Salman M, Hayat K, Yasmin K, Baraka MA, Mathew S, Kanwal M, Parveen S, Jamal I, Khan AH, Godman B, Saleem F, Bashaar M. Nurses’ Perceptions, Involvement, Confidence and Perceived Barriers Towards Antimicrobial Stewardship Program in Pakistan: Findings from a Multi-Center, Cross-Sectional Study. J Multidiscip Healthc 2022; 15:2553-2562. [PMID: 36388630 PMCID: PMC9642086 DOI: 10.2147/jmdh.s376664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses’ perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance. Methods A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22. Results A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP. Conclusion Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan54700, Pakistan
| | | | - Arfah Shahid
- Department of Medicine, Rawalpindi Medical University, Rawalpindi46000, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Khalida Yasmin
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Mohamed A Baraka
- Clinical Pharmacy Program, College of Pharmacy, Al Ain Campus, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Nasr city, Cairo, Egypt
| | - Smitha Mathew
- Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter Hospital, Okara South City, Pakistan
| | - Samina Parveen
- Department of Pharmacy Services, District Headquarter Hospital, Chakwal, Pakistan
| | - Irsa Jamal
- Department of Pharmacy Services, District Headquarter Hospital, Kasur, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Mohammad Bashaar
- SMART Afghan International Trainings and Consultancy, Kabul, Afghanistan
- Correspondence: Mohammad Bashaar, SMART Afghan International Trainings and Consultancy, Shahri Naw, Hospital Street No. 1, Kabul, Afghanistan, Tel +93788233865, Email
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10
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Min S, Zhou Y, Sun Y, Ye J, Dong Y, Wang X, Zhou Z, Zhou H, Li H. Knowledge, attitude, and practice associated with antimicrobial resistance among medical students between 2017 and 2022: A survey in East China. Front Public Health 2022; 10:1010582. [PMID: 36353280 PMCID: PMC9637849 DOI: 10.3389/fpubh.2022.1010582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/07/2022] [Indexed: 01/27/2023] Open
Abstract
This study described the knowledge, attitude, practice regarding antimicrobial resistance (AMR) among medical students between 2017 and 2022 in East China. A questionnaire-based survey was conducted with a total of 1,066 respondents. We highlighted that the undergraduates had a significant increase in the knowledge of antimicrobial resistance during the 5 years from 2017 to 2022 (p < 0.001). The majority of the assertions about the AMR were correctly identified by respondents. However, gaps were still observed in the issues of antimicrobial targets and bacterial transmission. In addition, overconfident attitudes and inappropriate behaviors of antimicrobial overuse and misuse were observed in the respondents. A number of 30.2% to 45.2% of the respondents asserted that there is no risk of AMR as long as the antimicrobials are taken correctly, and a proportion of the students (25.3% in 2022; 69.3% in 2017, p < 0.001) declared to buy antimicrobials from friends or family members to treat the same illness. Finally, spearman correlation coefficient was enrolled to compare the correlation of the student's KAP. Results showed that the students' knowledge of antimicrobials had a correlation with attitude (p = 0.0126) and practice (p < 0.001), suggesting that public education on knowledge could influence the behaviors among the medical students. Taken all together, our findings show a need to strengthen the medical students' cogitation on antimicrobial attitude and practice of appropriate usage as an essential strategy to reduce intractable public health problems. Additional curriculum reforms will be needed to add more specific AMR-related lectures to raise awareness amongst medical students in China.
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Affiliation(s)
- Shengyi Min
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yuxuan Zhou
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yuxuan Sun
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Jiaquan Ye
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Yongfei Dong
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Xichao Wang
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Zhemin Zhou
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China
| | - Hanyu Zhou
- Central Laboratory, The First Affiliated Hospital of Wannan Medical College, Wuhu, China,*Correspondence: Heng Li
| | - Heng Li
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, China,Hanyu Zhou
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11
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Torumkuney D, Jamil B, Nizamuddin S, van Hasselt J, Pirzada U, Manenzhe R. Country data on AMR in Pakistan in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77:i18-i25. [PMID: 36065729 PMCID: PMC9445852 DOI: 10.1093/jac/dkac213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review the current situation with respect to AMR in Pakistan and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR and improve patient outcomes. Methods National AMR initiatives, antibiotic use and prescribing in Pakistan, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens (Streptococcus pneumoniae and Haemophilus influenzae) were identified. National and international antibiotic prescribing guidelines for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, plus local antibiotic availability. Insights from a local clinician and clinical microbiologist were sought to contextualize this information. Conclusions Pakistan is active in developing initiatives to address AMR such as compiling a National Action Plan. However, antibiotic consumption is high and although there is legislation in place prohibiting over-the-counter purchase of antibiotics, this is still possible. Healthcare professionals use local and international antibiotic prescribing guidelines for CA-RTIs when managing patients. As highlighted by the clinical microbiologist’s expert comments, surveillance of AMR in locally prevalent microorganisms is lacking. A more standardized inclusive approach in developing local guidelines, using up-to-date local surveillance data of isolates from community-acquired infections, could make management guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Bushra Jamil
- Department of Medicine, Section of Infectious Diseases, The Aga Khan University Hospital, Karachi, Pakistan
| | - Summiya Nizamuddin
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Section of Microbiology, Department of Pathology, 7A Block R3, Johar Town, Lahore, Pakistan
| | - James van Hasselt
- GlaxoSmithKline, The Campus, Flushing Meadows, 57 Sloane Street, Bryanston, Gauteng, 2021, South Africa
| | - Uzma Pirzada
- GlaxoSmithKline, 35 Dockyard Road, West Wharf, Karachi 74000, Pakistan
| | - Rendani Manenzhe
- GlaxoSmithKline, The Campus, Flushing Meadows, 57 Sloane Street, Bryanston, Gauteng, 2021, South Africa
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12
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Exploring Knowledge of Antibiotic Use, Resistance, and Stewardship Programs among Pharmacy Technicians Serving in Ambulatory Care Settings in Pakistan and the Implications. Antibiotics (Basel) 2022; 11:antibiotics11070921. [PMID: 35884175 PMCID: PMC9311796 DOI: 10.3390/antibiotics11070921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Antimicrobial resistance (AMR) is a leading global health threat, increasing morbidity, mortality, and costs, with excessive and irrational use of antimicrobials contributing to the development of AMR. Consequently, the aims of this study were to evaluate the understanding of antibiotic use, AMR, and antimicrobial stewardship programs (ASPs) among pharmacy technicians serving in ambulatory healthcare settings in Pakistan. A cross-sectional survey was conducted among pharmacy technicians serving in 144 ambulatory care settings in seven districts of Punjab province using a validated questionnaire. Overall, 376 technicians completed the survey (85.8% response rate). The majority were men (89.1%), aged 25−35 years (45.1%), serving in emergency departments (43.9%) and filling 31−60 prescriptions per day (37.5%). Most (79.5%) knew that antibiotics were one of the most frequently prescribed drug classes, while 59.8% believed antibiotics for common colds did not speed up recovery. Inadequate duration (59.6%) and inadequate dosages (57.7%) of antibiotic therapy were reported as the leading causes of AMR. Terms including ‘superbugs’, ‘multidrug resistance’, and ‘extensively drug resistance’ were known to 42.0%, 25.3%, and 20.7% of participants, respectively; however, <10% knew about ASPs, including their core elements and purpose. Our study revealed that pharmacy technicians have adequate awareness of antibiotic use but are currently unaware of AMR and ASPs, which is a concern.
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13
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Hayat K, Fatima N, Umer MF, Khan FU, Khan FU, Najeeb ZUR, Ghaffari MA, Raza SQ, Liu W, Chen C, Fang Y. Understanding of Future Prescribers About Antimicrobial Resistance and Their Preparedness Towards Antimicrobial Stewardship Activities in Pakistan: Findings and Implications. Front Pharmacol 2022; 13:771083. [PMID: 35350757 PMCID: PMC8957880 DOI: 10.3389/fphar.2022.771083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/03/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Insufficient antimicrobial-related training for physicians during their undergraduate education could have a negative impact on their prescribing. Unlike previous studies, this study not only explored the understanding and perception of Pakistani medical students about antibiotics and resistance, but also their preparedness towards antimicrobial stewardship programs. Methods: An online cross-sectional study was undertaken with final-year medical students using a validated questionnaire from January 2021 to May 2021. Descriptive and inference statistics were applied for data analysis. Results: Of 411 students, only 6.3% had undergone antimicrobial resistance (AMR) training. 16.1% of students believed that antibiotics are effective for viral ailments. More than half of the students agreed that AMR is a major healthcare problem in Pakistan (65.9%). Most students viewed poor infection control practices (66.9%), the use of too many broad-spectrum antibiotics (68.4%) for a longer duration (62.8%) with inadequate doses (67.9%) as the causes of AMR. The student’s preparation was insufficient in interpreting microbiological and pathological results (26.3%), selecting the correct antibiotics (22.1%), and awareness of the antibiotic spectrum (20.9%). The median preparedness score showed significant differences with sex (p = 0.049), age (p < 0.001), institute type (p = 0.014), and family income (p = 0.006). Conclusion: Pakistani medical students showed adequate understanding of antibiotics, but lacked preparedness for several components of ASPs, including interpretation of microbiological results and spectrum of antibiotics. More steps need to be taken to prepare medical students for AMR and stewardship initiatives adequately.
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Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Noor Fatima
- Department of Pharmacology, Central Park Medical College, Lahore, Pakistan
| | | | - Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | | | - Muhammad Abuzar Ghaffari
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Syed Qasim Raza
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Wenchen Liu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Chen Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Centre for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China
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14
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A Peer Educational Tool to Promote Antimicrobial Stewardship on a University Campus. PHARMACY 2021; 9:pharmacy9040199. [PMID: 34941631 PMCID: PMC8703290 DOI: 10.3390/pharmacy9040199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is a major public health threat. Patient education on the appropriate use of antibiotics is a key component in combating antimicrobial resistance. The purpose of this study was to analyze the utility of an origami fortune teller as a novel peer educational tool in promoting antimicrobial stewardship on a university campus. An origami fortune teller, with various case scenarios to demonstrate key antibiotic principles, was developed and used by peer educators to educate students attending a university wellness fair. The case studies included: antibiotic indications; differentiation between viral vs. bacterial infection; proper use of antibiotics; non-pharmacologic measures to combat infection; and antibiotic resistance. Students were asked to take an assessment pre and post working with the tool. One hundred and forty-three students received education using the novel tool. A significant improvement in the assessment score was observed after education was completed using the novel tool (69.5 vs. 96.6 p ≤ 0.05).
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15
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Khan FU, Khan A, Shah S, Hayat K, Usman A, Khan FU, Khan Z, Karataş Y, Ahmad T, Chang J, Malik UR, Khan A, Shukar S, Kadirhaz M, Fang Y. Exploring Undergraduate Pharmacy Students Perspectives Towards Antibiotics Use, Antibiotic Resistance, and Antibiotic Stewardship Programs Along With the Pharmacy Teachers' Perspectives: A Mixed-Methods Study From Pakistan. Front Pharmacol 2021; 12:754000. [PMID: 34819859 PMCID: PMC8606649 DOI: 10.3389/fphar.2021.754000] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Antibiotic resistance (ABR) is one of the major issues around the globe. Timely education and awareness of pharmacy students regarding the appropriate use of antibiotics, ABR, and antimicrobial stewardships are required. Methods: The present study was first conducted in 12 (public and private sector) universities among undergraduate pharmacy students (UGPS) (n = 414) irrespective of their study year through a validated questionnaire, and the insights of pharmacy teachers were taken through in-depth semi-structured interviews in the second phase. For the quantitative data, different statistical methods were used, and data were presented in tabulated form, whereas inductive thematic interpretation was used to categorize themes and derive conclusions from qualitative evidence. Results: The majority of the students were males (n = 223, 54%) with the mean age group 19–23 years, and 20 faculty members were interviewed with a mean duration of 15 min. Students have good knowledge about antibiotics use and the majority purchased antibiotics through prescription (n = 277, 66.9%) during the last month and strongly agreed to stop unnecessary household storage (n = 183 44.2%). Most of the students have heard the terminologies related to antimicrobial resistance through social media while unaware (n = 104, 25.1%) of a Pakistan national action plan against AMR (antimicrobial resistance). Overall, respondents have a somewhat good understanding of the ABR. Regular use of antibiotics without consultation of a physician can lead to ABR and some wrong answers were observed (162, 39.1%; p > 0.05). The majority of the students (n = 198, 47.8%) and teachers believe that the current pharmacy syllabus must be swiftly updated with the new subjects related to ABR and AMS (antimicrobial stewardship) in Pakistan. The UGPS have emphasized (n = 220, 53.1%; Median = 1, IQR = 2) establishing a link between academia and hospitals. The ABR issue has been highlighted by pharmacy faculty members, who have urged students to take practical efforts toward ABR and AMS knowledge. Conclusion: The UGPS knowledge related to ABR and AMS must be updated. Students at the undergraduate level must get training in order to encourage the sensible use of antibiotics. Courses on ABR and AMS should be included in present pharmacy curricula.
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Affiliation(s)
- Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Abubakar Usman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Malaysia
| | - Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
| | - Zakir Khan
- Department of Pharmacology, Institute of Health Sciences, Çukurova University, Adana, Turkey
| | - Yusuf Karataş
- Department of Pharmacology, Institute of Health Sciences, Çukurova University, Adana, Turkey
| | - Tawseef Ahmad
- Department of Pharmacy, COMSATS University Islamabad, Abbottabad, Pakistan
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
| | - Usman Rashid Malik
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
| | - Asad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Sundus Shukar
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
| | - Muhtar Kadirhaz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science and Technology Innovation Harbor, Xi'an, China
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16
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Mubarak N, Arif S, Irshad M, Aqeel RM, Khalid A, Ijaz UEB, Mahmood K, Jamshed S, Zin CS, Saif-ur-Rehman N. How Are We Educating Future Physicians and Pharmacists in Pakistan? A Survey of the Medical and Pharmacy Student's Perception on Learning and Preparedness to Assume Future Roles in Antibiotic Use and Resistance. Antibiotics (Basel) 2021; 10:antibiotics10101204. [PMID: 34680785 PMCID: PMC8532898 DOI: 10.3390/antibiotics10101204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/18/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Medical and pharmacy students are future healthcare professionals who will be on the forefront in dealing with antibiotics in hospitals or community settings. Whether the current medical and pharmacy education in Pakistan prepares students to take future roles in antibiotic use remains an under-researched area. Aim: This study aims to compare medical and pharmacy students’ perceived preparedness, learning practices and usefulness of the education and training on antibiotic use and resistance imparted during undergraduate studies in Pakistan. Design and Setting: It was amulti-centre cross-sectional survey of medical and pharmacy colleges in Punjab, Pakistan. Method: A self-administered questionnaire was used to collect data from final year medical and pharmacy students. Descriptive statistics were used for categorical variables while independent t-test and One-way ANOVA computed group differences. Result: Nine hundred forty-eight respondents (526 medical and 422 pharmacy students) completed the survey from 26 medical and 19 pharmacy colleges. Majority (76.1%) of the pharmacy students had not completed a clinical rotation in infectious diseases. The top three most often used sources of learning antibiotic use and resistance were the same among the medical and the pharmacy students; included textbooks, Wikipedia, and smart phone apps. Overall self-perceived preparedness scores showed no significant difference between pharmacy and medical students. The least prepared areas by medical and pharmacy students included transition from intravenous to oral antibiotics and interpretation of antibiograms. Both medical and pharmacy students found problem solving sessions attended by a small group of students to be the most useful (very useful) teaching methodology to learn antibiotic use and resistance. Conclusions: Differences exist between medical and pharmacy students in educational resources used, topics covered during undergraduate degree. To curb the growing antibiotic misuse and resistance, the concerned authorities should undertake targeted educational reforms to ensure that future physicians and pharmacists can play a pivotal role in rationalizing the use of antibiotics.
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Affiliation(s)
- Naeem Mubarak
- Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (M.I.); (R.M.A.); (A.K.); (U.eB.I.); (N.S.-u.-R.)
- Correspondence: (N.M.); (S.J.); (C.S.Z.)
| | - Sara Arif
- Jinnah Burn and Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore 54000, Pakistan;
| | - Mahnoor Irshad
- Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (M.I.); (R.M.A.); (A.K.); (U.eB.I.); (N.S.-u.-R.)
| | - Rana Muhammad Aqeel
- Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (M.I.); (R.M.A.); (A.K.); (U.eB.I.); (N.S.-u.-R.)
| | - Ayesha Khalid
- Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (M.I.); (R.M.A.); (A.K.); (U.eB.I.); (N.S.-u.-R.)
| | - Umm e Barirah Ijaz
- Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (M.I.); (R.M.A.); (A.K.); (U.eB.I.); (N.S.-u.-R.)
| | - Khalid Mahmood
- Institute of Information Management, University of the Punjab, Lahore 54000, Pakistan;
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Kuala Terengganu 22200, Malaysia
- Correspondence: (N.M.); (S.J.); (C.S.Z.)
| | - Che Suraya Zin
- Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia
- Correspondence: (N.M.); (S.J.); (C.S.Z.)
| | - Nasira Saif-ur-Rehman
- Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (M.I.); (R.M.A.); (A.K.); (U.eB.I.); (N.S.-u.-R.)
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Hussain I, Yousaf N, Haider S, Jalil P, Saleem MU, Imran I, Majeed A, Rehman AU, Uzair M, Rasool MF, Alqahtani F, Alqhtani H. Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications. Antibiotics (Basel) 2021; 10:866. [PMID: 34356787 PMCID: PMC8300619 DOI: 10.3390/antibiotics10070866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 12/04/2022] Open
Abstract
The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students' knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.
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Affiliation(s)
- Iltaf Hussain
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Nisa Yousaf
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Sana Haider
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Pervisha Jalil
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Muhammad Usman Saleem
- Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Abdul Majeed
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Anees ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Muhammad Uzair
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (I.H.); (N.Y.); (S.H.); (P.J.); (A.M.); (A.u.R.)
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Hussain Alqhtani
- Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran 61441, Saudi Arabia;
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