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Qudah T, Alameri MA, Alqudah A, Al Meslamani A, Iqbal S. Knowledge, Attitudes, and Practices (KAP) of community pharmacists regarding antibiotic use and resistance: a cross-sectional study from the United Arab Emirates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-13. [PMID: 38598202 DOI: 10.1080/09603123.2024.2339534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
One of the main contributing factors of antibiotic resistance is the dispensing of antibiotics without prescription. This study investigated community pharmacists' knowledge, attitudes, and practices in relation to antibiotic dispensing and resistance in United Arab Emirates (UAE). A cross-sectional survey was conducted using validated questionnaire. (40.1%) had an overall positive KAP score. A total of (88%) respondents were aware of the illegality of dispensing antibiotics without a prescription. Only (31%) had good knowledge regarding amoxicillin dosage for upper respiratory tract infection. The primary misconduct found numerous pharmacists prescribing antibiotics without a prescription, even though they were aware that this should never be done. Pharmacists who attended events focused on antibiotic use and resistance were more likely to have good knowledge about antibiotics (Adjusted Odd Ratio (AOR): 1.673; 95%CI: 1.029-2.719; p = 0.038), more likely to have positive attitude (AOR: 1.889; 95%CI: 1.133-3.149; p = 0.015), and more likely to have good practice (AOR: 3.182; 95%CI: 1.541-6.572; p = 0.002).
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Affiliation(s)
- Taima Qudah
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University, Abu Dhabi, United Arab Emirates
- Al Ain University Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, United Arab Emirates
| | - Mariam Ahmad Alameri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
| | - Abdelrahim Alqudah
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, The Hashemite University, Jordan
| | - Ahmad Al Meslamani
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University, Abu Dhabi, United Arab Emirates
- Al Ain University Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, United Arab Emirates
| | - Sehar Iqbal
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University, Abu Dhabi, United Arab Emirates
- Al Ain University Health and Biomedical Research Center (HBRC), Al Ain University, Abu Dhabi, United Arab Emirates
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Islam MW, Shahjahan M, Azad AK, Hossain MJ. Factors contributing to antibiotic misuse among parents of school-going children in Dhaka City, Bangladesh. Sci Rep 2024; 14:2318. [PMID: 38282010 PMCID: PMC10822859 DOI: 10.1038/s41598-024-52313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
Antimicrobial resistance (AMR) is a pressing global health concern, especially in resource-constrained countries, such as Bangladesh. This study aimed to identify the factors contributing to antibiotic misuse by assessing knowledge, attitude, and practice (KAP). A cross-sectional study was conducted from August 20 to August 30, 2022, among 704 parents of school-going children in Dhaka South City. Descriptive statistics were used to analyze the KAP, and multivariate models, including linear and ordinal logistic regression, were used to explore the associations between these factors. The findings revealed that approximately 22% of the participants were male and 78% were female. Most parents (58%) had completed higher secondary education. Approximately 45% of the respondents demonstrated moderate knowledge, 53% had uncertain attitudes, and 64% exhibited antibiotic misuse. Factors such as parental age, education level, employment status, income, child's age, and family type significantly influenced KAP. These findings emphasize the importance of targeted education and awareness initiatives to enhance knowledge and responsible antibiotic use among parents, contributing to global efforts against antibiotic resistance. The government should enforce laws and regulations regarding the misuse of antibiotics.
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Affiliation(s)
- Md Wahidul Islam
- Population Health Studies Division, Center for Health Innovation, Research, Action, and Learning-Bangladesh (CHIRAL Bangladesh), 9-10 Chittaranjan Ave, Dhaka, 1100, Bangladesh
| | - Muhibullah Shahjahan
- Population Health Studies Division, Center for Health Innovation, Research, Action, and Learning-Bangladesh (CHIRAL Bangladesh), 9-10 Chittaranjan Ave, Dhaka, 1100, Bangladesh
| | - Abul Kalam Azad
- Department of Microbiology, Jagannath University, 9-10 Chittaranjan Ave, Dhaka, 1100, Bangladesh
| | - Md Jubayer Hossain
- Population Health Studies Division, Center for Health Innovation, Research, Action, and Learning-Bangladesh (CHIRAL Bangladesh), 9-10 Chittaranjan Ave, Dhaka, 1100, Bangladesh.
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Colonia DRM, Ramírez Patiño D, Higuita-Gutiérrez LF. Knowledge, Attitudes, and Practices Regarding Antibiotic Sales in Pharmacies in Medellín, Colombia 2023. Antibiotics (Basel) 2023; 12:1456. [PMID: 37760752 PMCID: PMC10525149 DOI: 10.3390/antibiotics12091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Describe the knowledge, attitudes, and practices regarding the sale of antibiotics in pharmacies in Medellín, Colombia. METHOD A cross-sectional descriptive study was conducted in 277 selected pharmacies using a stratified sampling method with proportional allocation to represent all areas of the city. Knowledge, attitudes, and practices (KAPs) were assessed using a scale, analyzed with absolute and relative frequencies for each item, and represented in a global score ranging from 0 to 100, with a higher score indicating better KAPs. Data were analyzed using relative frequencies with 95% confidence intervals, the Mann-Whitney U test, the Kruskal-Wallis test, and linear regression. RESULTS Of the included pharmacies, 52.6% were chain pharmacies, 48.4% were attended by pharmacy assistants, and 59% of pharmacists had more than 5 years of experience. The median knowledge score was 70.8 (IQR 58.3-87.5), with 35.3% of pharmacists believing that antibiotics are effective in treating the common cold, 35.2% for treating COVID-19, and 29.4% considering them available for sale without a medical prescription. The attitude score was 53.3 (40.0-66.7), with 60.9% agreeing that prohibiting the sale of antibiotics without a prescription would decrease their sales. The practice score was 62.5 (40.0-79.2), with 65.4% of pharmacists stating that they sometimes sell antibiotics without a prescription due to patients struggling to obtain a medical consultation, 61.3% admitting to selling antibiotics without a prescription for urinary tract infections, and 41.3% for upper respiratory tract infections. Practices were predominantly influenced by pharmacy type (chain or independent) and, to a lesser extent, by knowledge and attitudes. CONCLUSION Pharmacists in Medellín exhibit inadequate knowledge, attitudes, and practices regarding the use and sale of antibiotics without a medical prescription. These findings align with international evidence highlighting the need for educational and regulatory strategies promoting rational antibiotic use in pharmacies.
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Affiliation(s)
| | | | - Luis Felipe Higuita-Gutiérrez
- Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín 050012, Colombia;
- Escuela de Microbiología, Universidad de Antioquia, Medellín 050010, Colombia
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Sani AA, Rafiq K, Akter F, Islam P, Sachi S, Sultana N, Hayat S, Usman UB, Islam MS, Islam MZ, Hossain MT. Effect of knowledge of informal poultry drug prescribers on their attitude and practice toward antimicrobial use, residues, and resistance in Bangladesh. Vet World 2023; 16:1821-1828. [PMID: 37859963 PMCID: PMC10583889 DOI: 10.14202/vetworld.2023.1821-1828] [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: 05/11/2023] [Accepted: 08/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background and Aim Informal prescribers (IPs) significantly contribute to the development of antimicrobial resistance and in disseminating pathogens from poultry to humans and other animals through the food chain, posing a serious global health threat. Therefore, this study aimed to assess whether the knowledge of IPs has an impact on their attitude and practice toward antimicrobial use, antibiotic residues, and antimicrobial resistance. Materials and Methods In this cross-sectional study, we conducted a pre-tested and questionnaire-based survey to investigate the knowledge, attitude, and practice of IPs in selected parts of the Mymensingh division, Bangladesh. Then, we used the linear regression model test with R-squared (R2) to measure the association between the study variables. Results Our investigation revealed that 70% of the IPs knew about antibiotics and 75% had good knowledge about antibiotic resistance, whereas only 50% were aware of withdrawal periods. Informal prescribers also displayed good attitudes toward the use and sale of antibiotics with withdrawal periods and completion of medication (50%). Analysis of their practice on the sale and prescription of antibiotics showed that 70% and 30% of IPs use antibiotics against bacterial infections and other conditions, respectively. Most of them do not consult a veterinarian before selling or prescribing antibiotics, although 80% claim to do so. This is because 75% of IPs gave other options regarding their consultations. However, 95% of IPs uses antibiotics only for therapeutic purposes. Furthermore, only 10% sell antibiotics based on a veterinarian's recommendation. Approximately 45% of IPs use single antibiotics at a time, while the rest use multiple antibiotics, individually or combined. Approximately 15% use antibiotics monthly, while 85% use them whenever the need arises. The knowledge and attitude of IPs are significantly affected by their age (p ≤ 0.025). The district of domicile also impacted their knowledge. Surprisingly, IPs from Jamalpur had significantly better knowledge compared to those from Mymensingh and Sherpur (p ≤ 0.01). The attitude of IPs from Jamalpur and Netrokona also differed significantly (p ≤ 0.001) from that of Mymensingh and Sherpur. The knowledge of IPs influenced their attitude up to 80.5% (r2 = 0.628) and their practice up to 75.4% (r2 = 0.545). Conclusion The knowledge of IPs greatly influenced their attitude and practice, while sociodemographics also influenced their knowledge and attitude toward antimicrobial use, antibiotic residues, and antimicrobial resistance.
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Affiliation(s)
- Aminatu Abubakar Sani
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Kazi Rafiq
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Fatema Akter
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Purba Islam
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Sabbya Sachi
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Nasrin Sultana
- Department of Anatomy and Histology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Sajedul Hayat
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Usman Bashir Usman
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Ahmadu Bello University Zaria, Nigeria
| | - Md. Shafiqul Islam
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md. Zahorul Islam
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, Bangladesh
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Saleem Z, Haseeb A, Abuhussain SSA, Moore CE, Kamran SH, Qamar MU, Azmat A, Pichierri G, Raees F, Asghar S, Saeed A, Amir A, Hashmi FK, Meyer JC, Sefah IA, Rehman IU, Nadeem MU, Godman B. Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1215. [PMID: 37512028 PMCID: PMC10383515 DOI: 10.3390/medicina59071215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah 21955, Saudi Arabia
| | | | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Sairah Hafeez Kamran
- Institute of Pharmacy, Lahore College for Women University, Lahore 54000, Pakistan
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Aisha Azmat
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Giuseppe Pichierri
- Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK
| | - Fahad Raees
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Shahzad Asghar
- Department of Pharmacy, University of South Asia, Lahore 54000, Pakistan
| | - Amna Saeed
- Department of Pharmaceutical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur 22620, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
- National Institute of Health, Park Road, Islamabad 45501, Pakistan
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
| | - Inaam Ur Rehman
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Umer Nadeem
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, 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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Nagassar RP, Carrington A, Dookeeram DK, Daniel K, Bridgelal-Nagassar RJ. Knowledge, Attitudes, and Practices in Antibiotic Dispensing amongst Pharmacists in Trinidad and Tobago: Exploring a Novel Dichotomy of Antibiotic Laws. Antibiotics (Basel) 2023; 12:1094. [PMID: 37508190 PMCID: PMC10376728 DOI: 10.3390/antibiotics12071094] [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: 05/17/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
The inappropriate consumption, use, and dispensing of antibiotics are problems faced globally, with a pattern of inappropriate consumption differing in higher-income countries due to the ease of accessibility of antibiotics. The main drivers of consumption and inappropriate use are the over-the-counter sales of antibiotics by pharmacies. Trinidad and Tobago (T&T), a twin island state in the Caribbean, has two Acts of Parliament that regulate antibiotics: the Antibiotics Act and the Food and Drug Act, yet the Over-the-Counter (OTC) sale of antibiotics still exists. This study sought to determine the knowledge, attitudes, and practices regarding the OTC dispensing of antibiotics in T&T. A cross-sectional study gathered data from pharmacists in both the private and public sectors of Trinidad over 7 months. The results showed that antibiotic resistance and antibiotic abuse were seen as significant problems. The level of experience, gender (female), and age (younger) were significantly associated with having good overall knowledge of good dispensing habits and antibiotic laws (p = 0.036, p = 0.047, and p = 0.001, respectively). Pharmacists generally agreed that antibiotics under the Food and Drug Act may have contributed to OTC dispensing in the private sector (p = 0.013) and that all antibiotics should be under the Antibiotic Act (p = 0.002). Additionally, it was found that the dispensing of antibiotics OTC in the private sector (p = 0.006) occurred: without doctors' advice and without requesting prescriptions; because it was perceived as lawful (especially by older pharmacists); and because of the perceived motivation of profit. Regulation enforcement was perceived as deficient. OTC dispensing for reasons, such as misunderstanding of laws, occurs in T&T.
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Affiliation(s)
- Rajeev P Nagassar
- Department of Microbiology, The Sangre Grande Hospital, The Eastern Regional Health Authority, Sangre Grande, Trinidad and Tobago
| | - Amanda Carrington
- Department of Health Sciences, The University of Trinidad and Tobago, Trinidad and Tobago
| | - Darren K Dookeeram
- Department of Emergency Medicine, The Sangre Grande Hospital, The Eastern Regional Health Authority, Sangre Grande, Trinidad and Tobago
| | - Keston Daniel
- The Public Health Observatory, The Eastern Regional Health Authority, Sangre Grande, Trinidad and Tobago
| | - Roma J Bridgelal-Nagassar
- Manager, Medical Research and Audit, Directorate of Women's Health, The Ministry of Health, Trinidad and Tobago
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Kabir H, Hasan MK, Akter N, Tassdik DH, Islam DMF, Jannat DH, Tutul AH, Akter O, Ara R, Islam MD, Mahmud S, Akter M, Mitra DK. Antibiotics administration without prescription in Bangladesh. IJID REGIONS 2023; 7:11-17. [PMID: 36941825 PMCID: PMC10023939 DOI: 10.1016/j.ijregi.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
Background Antibiotic resistance is a global challenge. Therefore, adhering to proper antibiotic administration protocols is essential to mitigating the problem. This study investigated the prevalence, and factors associated with, antibiotics administration without prescription by registered doctors in Bangladesh. Method This cross-sectional survey was carried out among 1102 adults. The outcome variable was antibiotics administration without prescription. The exploratory variables included the those relating to sociodemographics, attitudes, and knowledge (antibiotic-treatable diseases, types of disease specification, and antimicrobial drugs specifications). Descriptive and inferential statistics were performed, with a p-value of 0.05 considered significant with a 95% confidence interval. Results The prevalence of antibiotics administration without prescription was found to be 37.02%. Age was significantly associated with the administration of antibiotics without prescription. Those who had taken antibiotics in the previous 2 months reported a significantly higher prevalence of antibiotics administration without prescription. The participants' attitudes toward antibiotics and knowledge of antibiotic-treatable diseases, types of disease, and antimicrobial drugs were significantly associated with antibiotics administration without prescription. Conclusion These findings may assist in facilitating relevant initiatives to improve the magnitude of antibiotics utilization without prescription, and mitigate the emergence of antibiotic resistance in Bangladesh.
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Affiliation(s)
- Humayun Kabir
- Department of Public Health, North South University, Dhaka-1229, Bangladesh
- Corresponding authors: Humayun Kabir; Md Kamrul Hasan; Department of Public Health, North South University, Dhaka-1229, Bangladesh
| | - Md Kamrul Hasan
- Department of Public Health, North South University, Dhaka-1229, Bangladesh
- Department of Biochemistry and Molecular Biology, Tejgoan College, Dhaka-1215, Bangladesh
- Corresponding authors: Humayun Kabir; Md Kamrul Hasan; Department of Public Health, North South University, Dhaka-1229, Bangladesh
| | - Nahida Akter
- Grameen Caledonian College of Nursing, Dhaka-1216, Bangladesh
- Penn State Ross and Carol Nese College of Nursing, Penn State University, University Park, PA, USA
| | | | - Dr Md Fakrul Islam
- Department of Public Health, North South University, Dhaka-1229, Bangladesh
| | - Dr Hasina Jannat
- Department of Public Health, North South University, Dhaka-1229, Bangladesh
| | | | - Ojifa Akter
- School of Medical Sciences, Shahjalal University of Science and Technology, Sylhet-3114, Bangladesh
| | - Rawshan Ara
- Prime College of Nursing, Dhaka-1229, Bangladesh
| | - Muhammad Didarul Islam
- School of Medical Sciences, Shahjalal University of Science and Technology, Sylhet-3114, Bangladesh
- Department of Gerontology and Geriatric Welfare, University of Dhaka, Dhaka-1000, Bangladesh
| | - Sohel Mahmud
- Department of Biochemistry and Molecular Biology, Tejgoan College, Dhaka-1215, Bangladesh
| | - Masuda Akter
- Faculty of Medicine, University of Dhaka, Dhaka-1000, Bangladesh
- Saic Nursing College, Dhaka-1216, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka-1229, Bangladesh
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Hashmi A, Ul Haq MI, Malik M, Hussain A, Gajdács M, Jamshed S. Perceptions of community pharmacists regarding their role in antimicrobial stewardship in Pakistan: A way forward. Heliyon 2023; 9:e14843. [PMID: 37025891 PMCID: PMC10070906 DOI: 10.1016/j.heliyon.2023.e14843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/20/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023] Open
Abstract
Background Antimicrobial resistance is one of the biggest challenges to healthcare resulting in increased morbidity and mortality, and associated with drug resistant infections. Community pharmacists (CPs) can play a key role in antimicrobial stewardship (AMS) programs to aid the prudent use of antibiotics, and in infection prevention and control. Objective The aim of this study was to assess perceptions of CPs regarding their role, awareness, collaboration, facilitators and barriers towards effective AMS practices in Pakistan. Method ology: A descriptive, cross-sectional study design was adopted, where convenience and snowball sampling methods were applied to enroll respondents (pharmacists working at these community pharmacies in different cities of Pakistan) of the study. After sample size determination, n = 386 CPs were enrolled. A pre-validated questionnaire was used regarding CPs roles and perceptions in association with AMS. Statistical analysis was performed using SPSS v. 21. Results The results of the study reported that 57.3% (n = 221) of CPs had strong familiarity with term AMS. 52.1% (n = 201) of CPs agreed that they require adequate training to undertake activities in AMS programmes in their setting. The results of the study showed that 92.7% (n = 358) of the pharmacists thought real time feedback would be helpful. Significant association was observed in AMS awareness, approach, collaboration and barriers with regards to the respondents' gender, age groups and levels of experience in a community pharmacy. Conclusions The study concluded that CPs were aware of AMS programmes, their relevance and necessity of AMS in their everyday practice, but had inadequate training and resources to implement it in Pakistan.
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Knowledge and Attitudes of Small Animal Veterinarians on Antimicrobial Use Practices Impacting the Selection of Antimicrobial Resistance in Dogs and Cats in Illinois, United States: A Spatial Epidemiological Approach. Antibiotics (Basel) 2023; 12:antibiotics12030542. [PMID: 36978409 PMCID: PMC10044024 DOI: 10.3390/antibiotics12030542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Inappropriate antimicrobial use in animals and humans has been associated with the emergence of antimicrobial resistance, which has become a global public health concern. Veterinarians’ practice locations and their knowledge and opinions on antimicrobial resistance may influence their antimicrobial prescription practices, which could impact the emergence of antimicrobial-resistant bacteria. This study used a spatial modeling approach to identify areas where veterinarians are knowledgeable about factors that impact the selection of antimicrobial resistance. In addition, we sought to identify regions with higher- and lower-than-expected response rates to our survey to aid future antimicrobial stewardship efforts. A total of 83 veterinarians who treated dogs and/or cats across 34 different Illinois counties responded to our online survey. Most of the responders (90.9%) considered that insufficient doses or duration of antibiotic treatments contribute the most to the selection of antimicrobial resistance. A high proportion of veterinarians (78.7%) attended educational programs on antimicrobial use and resistance; however, only 46.2% were knowledgeable about the current antimicrobial resistance profiles of prevalent bacteria in their area. A mean knowledge score for each county was calculated based on the responses of veterinarians to the survey questions. Local Moran’s I statistic was used to identify counties with high and low knowledge scores. A high knowledge score area in the northeast region and a low knowledge score area in the southeast of Illinois were identified. Using scan statistics with a Poisson model that accounted for the estimated number of veterinarians in a county, a higher-than-expected response rate area was identified in central-east Illinois and a lower-than-expected area in the northeast. This study showed the effectiveness of using geographic analysis and spatial statistics to identify locations where future antimicrobial stewardship programs should focus.
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Antibiotic Resistance Knowledge, Attitudes, and Practices among Pharmacists: A Cross-Sectional Study in West Bank, Palestine. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2023; 2023:2294048. [PMID: 36755779 PMCID: PMC9902159 DOI: 10.1155/2023/2294048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/19/2022] [Accepted: 10/27/2022] [Indexed: 02/02/2023]
Abstract
Antibiotic resistance is an increasing problem worldwide. Dispensing antibiotics without prescription is a major contributing factor to antibiotic resistance. Pharmacists as healthcare providers are, in many studies, considered responsible for this practice. This study aims to explore Palestinian pharmacists' knowledge, attitudes, and practices concerning antibiotic resistance. A descriptive cross-sectional survey was conducted in 2021-2022. A random sample of 152 pharmacists was selected from the West Bank. Data were collected using a self-administered questionnaire that includes five sections: demographic characteristics, knowledge, attitudes, practices, and potential interventions. Results indicated that 60% of pharmacists dispense antibiotics without a prescription. A significant association between pharmacies' locality and antibiotic knowledge, attitudes, and practices was found. Pharmacists' knowledge-related responses indicated that 92.1% of the pharmacists agreed that inappropriate use of antibiotics can lead to ineffective treatment and 86.2% disagreed that patients can stop taking antibiotics upon symptoms' improvement. Only 17.1% disagreed that antibiotics should always be used to treat upper respiratory tract infections. Over two-thirds considered that they are aware of the regulations about antibiotic dispensing and acknowledged that antibiotics are classified as prescription drugs. Furthermore, 71.7% and 53.3% agreed that they have good knowledge of the pharmacological aspects of antibiotics and antibiotic resistance. Concerning attitudes, 75.6% agreed that antibiotic resistance is an important and serious public health issue facing the world, and 52% thought that antibiotic dispensing without a prescription is a common practice in the West Bank. Our findings indicate that pharmacists' locality and practices related to antibiotic dispensing without prescription are associated with the increase in antibiotics misuse and bacterial resistance. There is a need to design education and training programs and implement legislation in Palestine to decrease antibiotic resistance.
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Jambo A, Edessa D, Adem F, Gashaw T. Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2023; 11:20503121231163792. [PMID: 37065976 PMCID: PMC10102944 DOI: 10.1177/20503121231163792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021. Methods A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval. Results Of the total participants, 116 (16.74%, 95% confidence interval: 14.1-19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00-2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64-6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07-2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10-2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14-2.84) were associated with an initial inappropriate antimicrobial use. Conclusion Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.
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Affiliation(s)
- Abera Jambo
- Clinical Pharmacy Department, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
- Abera Jambo, Clinical Pharmacy Department,
School of Pharmacy, College of Health and Medical Sciences, Haramaya University,
Harar, Ethiopia.
| | - Dumessa Edessa
- Clinical Pharmacy Department, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Fuad Adem
- Clinical Pharmacy Department, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and
Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya
University, Harar, Ethiopia
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12
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Public knowledge, practices, and awareness of antibiotics and antibiotic resistance in Myanmar: The first national mobile phone panel survey. PLoS One 2022; 17:e0273380. [PMID: 35980986 PMCID: PMC9387831 DOI: 10.1371/journal.pone.0273380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/07/2022] [Indexed: 11/19/2022] Open
Abstract
In 2017, the Myanmar National Action Plan for Containment of Antimicrobial Resistance (AMR) (2017–2022) was endorsed by the Ministry of Health and Sports, Myanmar; one of its objectives was to increase public awareness of AMR to accelerate appropriate antibiotic use. This survey aimed to assess the public knowledge, practices and awareness concerning antibiotics and AMR awareness among adults in Myanmar. We conducted a nationwide cross-sectional mobile phone panel survey in January and February 2020. Participants were randomly selected from the mobile phone panel in each of three groups stratified by gender, age group, and residential area urbanity; they were interviewed using a structured questionnaire. Collected data were weighted based on the population of each stratum from the latest national census and analyzed using descriptive and inferential statistics. Two thousand and forty-five adults from 12 regions and states participated in this survey. Overall, 89.5% of participants had heard about antibiotics; however, only 0.9% provided correct answers to all five questions about antibiotics, whereas 9.7% provided all incorrect answers. More than half of participants (58.5%) purchased antibiotics without a prescription, mainly from medical stores or pharmacies (87.9%); this was more frequent in age group (18–29 years) and those in rural areas (p = 0.004 and p < 0.001, respectively). Only 56.3% were aware of antibiotic resistance and received their information from medical professionals (46.3%), family members or friends (38.9%), or the media (26.1%). Less than half (42.4%) knew that antibiotics were used in farm animals. Most did not know that using antibiotics in farm animals could develop resistance (73.2%) and is banned for the purposes of growth stimulation (64.1%). This survey identifies considerable gaps in the knowledge, practices, and awareness about antibiotics among the general population in Myanmar. Continuous public education and awareness campaigns must be urgently conducted to fulfill these gaps, which would aid in promoting antibiotic stewardship, leading to combating AMR in Myanmar.
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Rabaan AA, Alhumaid S, Mutair AA, Garout M, Abulhamayel Y, Halwani MA, Alestad JH, Bshabshe AA, Sulaiman T, AlFonaisan MK, Almusawi T, Albayat H, Alsaeed M, Alfaresi M, Alotaibi S, Alhashem YN, Temsah MH, Ali U, Ahmed N. Application of Artificial Intelligence in Combating High Antimicrobial Resistance Rates. Antibiotics (Basel) 2022; 11:antibiotics11060784. [PMID: 35740190 PMCID: PMC9220767 DOI: 10.3390/antibiotics11060784] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Artificial intelligence (AI) is a branch of science and engineering that focuses on the computational understanding of intelligent behavior. Many human professions, including clinical diagnosis and prognosis, are greatly useful from AI. Antimicrobial resistance (AMR) is among the most critical challenges facing Pakistan and the rest of the world. The rising incidence of AMR has become a significant issue, and authorities must take measures to combat the overuse and incorrect use of antibiotics in order to combat rising resistance rates. The widespread use of antibiotics in clinical practice has not only resulted in drug resistance but has also increased the threat of super-resistant bacteria emergence. As AMR rises, clinicians find it more difficult to treat many bacterial infections in a timely manner, and therapy becomes prohibitively costly for patients. To combat the rise in AMR rates, it is critical to implement an institutional antibiotic stewardship program that monitors correct antibiotic use, controls antibiotics, and generates antibiograms. Furthermore, these types of tools may aid in the treatment of patients in the event of a medical emergency in which a physician is unable to wait for bacterial culture results. AI’s applications in healthcare might be unlimited, reducing the time it takes to discover new antimicrobial drugs, improving diagnostic and treatment accuracy, and lowering expenses at the same time. The majority of suggested AI solutions for AMR are meant to supplement rather than replace a doctor’s prescription or opinion, but rather to serve as a valuable tool for making their work easier. When it comes to infectious diseases, AI has the potential to be a game-changer in the battle against antibiotic resistance. Finally, when selecting antibiotic therapy for infections, data from local antibiotic stewardship programs are critical to ensuring that these bacteria are treated quickly and effectively. Furthermore, organizations such as the World Health Organization (WHO) have underlined the necessity of selecting the appropriate antibiotic and treating for the shortest time feasible to minimize the spread of resistant and invasive resistant bacterial strains.
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Affiliation(s)
- 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
- Correspondence: (A.A.R.); (N.A.)
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa 31982, Saudi Arabia;
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Alhassa, Al-Ahsa 36342, Saudi Arabia;
- Almoosa College of Health Sciences, Alhassa, Al-Ahsa 36342, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, NSW 2522, Australia
- Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran 34313, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Yem Abulhamayel
- Specialty Internal Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran 34465, Saudi Arabia;
| | - Muhammad A. Halwani
- Department of Medical Microbiology, Faculty of Medicine, Al Baha University, Al Baha 4781, Saudi Arabia;
| | - Jeehan H. Alestad
- Immunology and Infectious Microbiology Department, University of Glasgow, Glasgow G1 1XQ, UK;
- Microbiology Department, Collage of Medicine, Jabriya 46300, Kuwait
| | - Ali Al Bshabshe
- Adult Critical Care Department of Medicine, Division of Adult Critical Care, College of Medicine, King Khalid University, Abha 62561, Saudi Arabia;
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia;
| | | | - Tariq Almusawi
- Infectious Disease and Critical Care Medicine Department, Dr. Sulaiman Alhabib Medical Group, Alkhobar 34423, Saudi Arabia;
- Department of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Manama 15503, Bahrain
| | - Hawra Albayat
- Infectious Disease Department, King Saud Medical City, Riyadh 7790, Saudi Arabia;
| | - Mohammed Alsaeed
- Infectious Disease Division, Department of Medicine, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia;
| | - Mubarak Alfaresi
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa General Hospital, Umm Al Quwain 499, United Arab Emirates;
- Department of Pathology, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates
| | - Sultan Alotaibi
- Molecular Microbiology Department, King Fahad Medical City, Riyadh 11525, Saudi Arabia;
| | - Yousef N. Alhashem
- Department of Clinical Laboratory Sciences, Mohammed AlMana College of Health Sciences, Dammam 34222, Saudi Arabia;
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Urooj Ali
- Department of Biotechnology, Faculty of Life Sciences, University of Central Punjab, Lahore 54000, Pakistan;
| | - Naveed Ahmed
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia
- Correspondence: (A.A.R.); (N.A.)
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14
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Ramnarain P, Singh S. Public healthcare practitioners’ knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use in Pietermaritzburg, KwaZulu-Natal. Health SA 2022; 27:1832. [PMID: 35548063 PMCID: PMC9082215 DOI: 10.4102/hsag.v27i0.1832] [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: 11/02/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is limited published evidence on health workers’ perspectives on trends in oral antibiotic prescription for dental conditions in the public health sector. Aim This study set to determine healthcare practitioners’ knowledge, attitudes and practices related to oral antibiotic prescriptions for dental use. Setting This included two public hospitals in Pietermaritzburg. Methods This was a cross-sectional study using quantitative data. Purposive sampling was used to select medical and dental practitioners from Institution A and B (n = 122). A self-administered questionnaire was developed using open and close-ended questions. Data were collected and analysed using the Statistical Package for Social Sciences (IBM SPSS version 25R). Results The response rate for the study was 72.1%. The majority of study participants (n = 72, 81.8%) indicated awareness of an antibiotic stewardship programme in their respective institutions. However, a significant number (n = 42; 47.7%) of participants were unsure of whether this programme was active. Most participants (n = 80, 90.9%) indicated the need for improving oral antibiotic prescription for dental conditions. Participants indicated prescription of antibiotics for orofacial swellings (n = 52; 59.0%) and dental pain related to irreversible pulpitis (n = 29; 32.9%), reversible pulpitis (n = 33; 37.5%) and dental fillings (n = 15; 17.0%). Antibiotics were also prescribed for pericoronitis (n = 58; 65.9%), periodontitis (n = 57; 64.7%) and impacted teeth (n = 21; 23.8%). All dental practitioners (n = 14) supported the need for antibiotic cover for pericoronitis and periodontitis. Conclusion The results indicated inconsistencies in healthcare practitioners’ reported knowledge, attitudes and practices related to antibiotic prescription patterns. Contribution This study highlights the need for clear evidence-based guidelines for antibiotic prescription for dental conditions.
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Affiliation(s)
- Prishana Ramnarain
- Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Shenuka Singh
- Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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15
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Perception and practice of self-medication with antibiotics among medical students in Sudanese universities: A cross-sectional study. PLoS One 2022; 17:e0263067. [PMID: 35081149 PMCID: PMC8791537 DOI: 10.1371/journal.pone.0263067] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/11/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction The benefits of antibiotics are under threat by self-medication, which culminated in economic burdening of developing countries, treatment failures, the emergence of antibiotic-resistant strains of bacteria and an increased probability of exposure and infection of the general population by antibiotic-resistant bacterial strains. Objectives This study aimed to evaluate the knowledge and attitude of medical students in Sudan towards the use of antibiotics, the prevalence of self-medication with antibiotics among medical students in Sudan and to identify risk factors which promote self-medication with antibiotics. Materials and methods This was a cross-sectional, descriptive and institution-based study, between November 2020 and May 2021. 1,110 medical students were selected by multistage cluster sampling. Logistic regression was used to identify risk factors of self-medication with antibiotics among the study participants. Results The median knowledge score was 7 out of a maximum of 10 (IQR: 5–8). A moderately positive attitude was observed among the participants (Median: 7/10; IQR: 6–8). Knowledge and attitude scores were significantly associated with academic year and monthly allowance (p < 0.05). 675 (60.8%) self-medicated with antibiotics within the previous 12 months, mostly from community pharmacies (321/675; 47.5%). Antibiotics were most commonly used to treat respiratory tract infections (38.1%) and cough (30.4%). Chi-square analysis demonstrated that self-medication with antibiotics was significantly associated with gender, year of study and monthly income. Conclusions Undergraduate medical students had moderate knowledge and attitude towards antibiotic use and antibiotic resistance, and an alarmingly high prevalence of self-medication with antibiotics. This highlights the urgent need for tighter legislation regarding the sales of antibiotics in community pharmacies by the state and federal health ministries.
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16
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Ortega-Paredes D, Larrea-Álvarez CM, Torres-Elizalde L, de Janon S, Vinueza-Burgos C, Hidalgo-Arellano L, Šefcová MA, Molina-Cuasapaz G, Fernandez-Moreira E, Larrea-Álvarez M. Antibiotic Resistance Awareness among Undergraduate Students in Quito, Ecuador. Antibiotics (Basel) 2022; 11:antibiotics11020197. [PMID: 35203800 PMCID: PMC8868098 DOI: 10.3390/antibiotics11020197] [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] [Received: 01/15/2022] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
The inappropriate use of antibiotics leads to antibiotic resistance, which reduces their efficacy. The education of undergraduates is likely to influence their practices. Assessing awareness is critical in the general effort to confront the spread of antibiotic resistance. This cross-sectional investigation was carried out using the questionnaire “Antibiotic resistance: Multi-country public awareness” developed by the World Health Organization. Students from different backgrounds at the Central University participated in the study (n = 733). The survey comprised five sections: demographics, knowledge, usage, sources of information, and attitudes. The rate of correct answers was 64.88%; differences were detected between programs of study (p < 0.001); effect size analysis showed that these differences cannot be considered large. Individuals from applied sciences scored higher than their counterparts from social studies. Mostly, interviewees were knowledgeable about usage, but mistakenly associated antibiotics with conditions such as cold/flu or viral illnesses; also, they associated antibiotic resistance with the patient and not with bacteria. Despite these misconceptions, positive attitudes were registered overall, and students generally adhered to common practices. They cited doctors/nurses and teachers as sources of information. As a consequence, it is recommended to develop courses that address deficient knowledge regarding antibiotic resistance, especially for individuals affiliated to social disciplines.
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Affiliation(s)
- David Ortega-Paredes
- Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencia a los Antimicrobianos (UNIETAR), Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito 170129, Ecuador; (D.O.-P.); (S.d.J.); (C.V.-B.)
- Laboratorio de Referencia de E. coli, Department of Microbiology and Parasitology, Veterinary Faculty, University of Santiago de Compostela, 27002 Lugo, Spain
- Facultad de Ciencias Médicas Enrique Ortega Moreira, Carrera de Medicina, Universidad Espíritu Santo, Guayaquil 0901952, Ecuador
| | | | - Lilibeth Torres-Elizalde
- School of Biological Science and Engineering, Yachay-Tech University, Hacienda San José, Urcuquí 100650, Ecuador;
| | - Sofia de Janon
- Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencia a los Antimicrobianos (UNIETAR), Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito 170129, Ecuador; (D.O.-P.); (S.d.J.); (C.V.-B.)
| | - Christian Vinueza-Burgos
- Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencia a los Antimicrobianos (UNIETAR), Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito 170129, Ecuador; (D.O.-P.); (S.d.J.); (C.V.-B.)
| | - Luis Hidalgo-Arellano
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito 170129, Ecuador;
| | - Miroslava Anna Šefcová
- Research Unit, Life Science Initiative (LSI), Quito 170102, Ecuador; (C.M.L.-Á.); (M.A.Š.)
| | - Gabriel Molina-Cuasapaz
- Facultad de Ciencias Agropecuarias y Recursos Naturales, Carrera de Medicina Veterinaria, Universidad Técnica de Cotopaxi, Latacunga 050101, Ecuador;
| | - Esteban Fernandez-Moreira
- Facultad de Ciencias Médicas Enrique Ortega Moreira, Carrera de Medicina, Universidad Espíritu Santo, Guayaquil 0901952, Ecuador
- Correspondence: (E.F.-M.); (M.L.-Á.)
| | - Marco Larrea-Álvarez
- School of Biological Science and Engineering, Yachay-Tech University, Hacienda San José, Urcuquí 100650, Ecuador;
- Correspondence: (E.F.-M.); (M.L.-Á.)
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17
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Al-Taani GM, Al-Azzam S, Karasneh RA, Sadeq AS, Mazrouei NA, Bond SE, Conway BR, Aldeyab MA. Pharmacists’ Knowledge, Attitudes, Behaviors and Information Sources on Antibiotic Use and Resistance in Jordan. Antibiotics (Basel) 2022; 11:antibiotics11020175. [PMID: 35203777 PMCID: PMC8868190 DOI: 10.3390/antibiotics11020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 12/07/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious healthcare problem that affects public health globally. Appropriate understanding and knowledge of prudent antimicrobial use and resistance, along with providing evidence-based information sources, are needed for informed antibiotic prescribing practices. This study aimed to assess the knowledge, opportunity, motivation, behavior of pharmacists and their information sources regarding antibiotic use and resistance in Jordan. An online cross-sectional questionnaire was developed and administered to pharmacists during the period of July–September 2021. The survey is an adapted version of the validated European Centre for Disease Prevention and Control (ECDC) survey for antibiotic use and resistance. Pharmacists from all sectors (n = 384), of whom 276 (71.9%) were community pharmacists, completed an online questionnaire. While respondents scored highly (>87%) on knowledge on effective use, unnecessary use, and associated side effects of antibiotics, lower scores were recorded for knowledge on the spread of antibiotic resistance (52.9%). Pharmacists support easy access to guidelines on managing infections in 56% of cases, and easy access to materials advising prudent antibiotic use and resistance in 39.8% of cases. One-third of respondents (37.0%) reported no knowledge of any initiatives on antibiotic awareness and resistance. Pharmacists were aware (13.3%), unaware (36.2%), or unsure (50.5%) of the existence of a national antibiotic resistance action plan. Pharmacists indicated an interest in receiving more information on resistance to antibiotics (55.2%), medical conditions for which antibiotics are used (53.1%), how to use antibiotics (45.1%), prescribing of antibiotics (34.4%), and links between the health of humans, animals, and the environment (28.6%). Findings can inform antimicrobial stewardship with required interventions to improve antibiotic use.
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Affiliation(s)
- Ghaith M. Al-Taani
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid 21163, Jordan;
| | - Sayer Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Reema A. Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Adel Shaban Sadeq
- College of Pharmacy, Al Ain University, Al Ain 64141, United Arab Emirates;
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Stuart E. Bond
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK;
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Correspondence: ; Tel.: +0044-01484-472825
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18
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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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Mitchell J, Purohit M, Jewell CP, Read JM, Marrone G, Diwan V, Stålsby Lundborg C. Trends, relationships and case attribution of antibiotic resistance between children and environmental sources in rural India. Sci Rep 2021; 11:22599. [PMID: 34799577 PMCID: PMC8604955 DOI: 10.1038/s41598-021-01174-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
Bacterial antibiotic resistance is an important global health threat and the interfaces of antibiotic resistance between humans, animals and the environment are complex. We aimed to determine the associations and overtime trends of antibiotic resistance between humans, animals and water sources from the same area and time and estimate attribution of the other sources to cases of human antibiotic resistance. A total of 125 children (aged 1-3 years old) had stool samples analysed for antibiotic-resistant bacteria at seven time points over two years, with simultaneous collection of samples of animal stools and water sources in a rural Indian community. Newey-West regression models were used to calculate temporal associations, the source with the most statistically significant relationships was household drinking water. This is supported by use of SourceR attribution modelling, that estimated the mean attribution of cases of antibiotic resistance in the children from animals, household drinking water and wastewater, at each time point and location, to be 12.6% (95% CI 4.4-20.9%), 12.1% (CI 3.4-20.7%) and 10.3% (CI 3.2-17.3%) respectively. This underlines the importance of the 'one health' concept and requires further research. Also, most of the significant trends over time were negative, suggesting a possible generalised improvement locally.
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Affiliation(s)
- Joseph Mitchell
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Manju Purohit
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Pathology, R.D. Gardi Medical College, Ujjain, 456006, India.
| | - Chris P Jewell
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, England, UK
| | - Jonathan M Read
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, England, UK
| | - Gaetano Marrone
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Vishal Diwan
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
- Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR - National Institute for Research in Environmental Health, Bhopal, 462030, India
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
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20
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Attitude, Familiarity and Religious Beliefs about Vaccination among Health Science and Non-Health Science Students in a Malaysian Public University. Eur J Investig Health Psychol Educ 2021; 11:1462-1473. [PMID: 34842641 PMCID: PMC8628736 DOI: 10.3390/ejihpe11040104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
Vaccine hesitancy has surfaced globally within the last few decades, and the fears and misconceptions of people about vaccine safety and effectiveness have been identified as key factors for their under-utilization. The familiarity, attitudes, and religious beliefs of the public and of future healthcare practitioners regarding vaccination are extensive areas needing exploration. The present exploratory cross-sectional study was designed, planned and carried out on students enrolled in health science and non-health science courses in one of the public universities of Malaysia. A research instrument that had been formulated, validated and subjected to reliability testing was used to collect the data, which were analyzed using descriptive and inferential statistics. A response rate of 80.8% (n = 202) was obtained: the majority were female (n = 161, 79.7%), and had been vaccinated before (n = 190, 97.5%), while a mere 2% did not support vaccination for reasons pertaining to safety issues. The vaccine familiarity score was 10.79 ± 1.4, which significantly differed among the study disciplines (p < 0.001). The mean of the total attitude score was 14.95 ± 1.5, with no significant difference among demographics being noted. The mean of the total religious beliefs score was 24.29 ± 2.8 and significantly differed based on gender (p = 0.040) and study disciplines (p < 0.001). The current findings showed that the participants were familiar with vaccines and had generally positive attitudes and positive religious beliefs toward vaccination; thus, one can expect that their inclusion in immunization campaigns will generate positive outcomes of the immunization program. Although the current research reported few knowledge gaps, these may be handled with the introduction of a specialized immunization course at an undergraduate level.
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21
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Aslam A, Zin CS, Ab Rahman NS, Gajdács M, Ahmed SI, Jamshed S. Self-Medication Practices with Antibiotics and Associated Factors among the Public of Malaysia: A Cross-Sectional Study. DRUG HEALTHCARE AND PATIENT SAFETY 2021; 13:171-181. [PMID: 34737648 PMCID: PMC8560071 DOI: 10.2147/dhps.s331427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/06/2021] [Indexed: 12/28/2022]
Abstract
Background Self-medication with antibiotics (SMA) is an important public health issue, which can result in the facilitated development of antibiotic resistance, and may increase the risk of inappropriate utilization of antibiotics. So, the objective of the present study was to estimate the prevalence rate of SMA and to also explore SMA practices among the lay population of Kuala Lumpur (Malaysia). Methods The current study was cross-sectional population-based and used a convenient sampling technique. Moreover, Lorenz’s formula was used to calculate the sample size and the required sample size was 480. Data were collected through face-to-face interviews with a pre-validated questionnaire and the study was conducted in Kuala Lumpur (Malaysia). Descriptive statistics, cross-tabulation, and logistic regression were executed by using SPSS version 24. Results Out of 480 participants, 45.8% were polled male and the prevalence of SMA in this study was found to be 15.1%. The majority of participants 23.1% indicated that they practiced antibiotics at least once in the last six months. The commonly self-medicated antibiotics were amoxicillin-clavulanate 20.6%, ampicillin/cloxacillin 14.2%, and levofloxacin 8.3%. Moreover, 64.8% of participants indicated that they bought their antibiotics from pharmacies. Whereas, most of the participants practice antibiotics to save money 19.2% and time 23.1%. Findings from multivariate logistic regressions showed that predictors of SMA were male gender, (95% CI: 0.300–0.877) occupation (95% CI: 0.122–10.797), health insurance (95% CI: 0.025–0.472), and education (95% CI: 0.084–0.800). Conclusion The results of this study indicate that SMA persists among the community and education level has a significant impact on this behavior. Thus, concerning health management authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of SMA for the future.
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Affiliation(s)
- Adeel Aslam
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, 6720, Hungary
| | - Syed Imran Ahmed
- School of Pharmacy, College of Science, University of Lincoln, Lincoln, UK
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut, Terengganu, 22200, Malaysia
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Kong LS, Islahudin F, Muthupalaniappen L, Chong WW. Knowledge and Expectations on Antibiotic Use Among the General Public in Malaysia: A Nationwide Cross-Sectional Survey. Patient Prefer Adherence 2021; 15:2405-2416. [PMID: 34754181 PMCID: PMC8572111 DOI: 10.2147/ppa.s328890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Identifying knowledge gaps regarding antibiotic use and resistance is important for future interventional strategies. There is limited information on Malaysia's general public's knowledge and expectations on antibiotic use. PURPOSE To assess the knowledge of antibiotic use and resistance, expectations from antibiotic prescription, and identify inappropriate practices related to antibiotic use among Malaysia's general public. MATERIALS AND METHODS A nationwide cross-sectional survey was conducted among Malaysians aged 18 years and above from each state, from May to November 2019. Participants were recruited via quota sampling, followed by convenient sampling. A validated self-administered questionnaire was used to collect data. RESULTS Of the 1971 respondents recruited, 56.6% had engaged in at least one inappropriate practice; particularly, not completing the antibiotic course (48.8%). The mean total knowledge score was 8.57±4.24 (total 20). The majority incorrectly believed that antibiotics work on viral infections (79.1%) and colds and coughs (77.0%). Less than half of them believed that antibiotics could be stopped when symptoms improved (42.8%). Most respondents incorrectly perceived that antibiotic resistance occurs when the body becomes resistant to antibiotics (90.2%) and antibiotic resistance is not an issue in the country (62.9%). More than half the participants expected antibiotics to be prescribed for self-limiting symptoms (fever: 62.9%, sore throat: 57.2%, cold or flu: 50.9%). Respondents with better knowledge were less likely to engage in inappropriate antibiotic use (never engaged: 9.26±4.40 versus had engaged: 8.11±4.00, p<0.001), and expect doctors to discuss with them the need for antibiotics (agree/strongly agree: 9.03±4.25 versus neutral: 6.62±3.91 versus disagree/strongly disagree: 8.29±4.00, p<0.001). CONCLUSION Knowledge gaps in the role of antibiotics and understanding of antibiotic resistance should be considered whtpen designing future educational strategies for the general public.
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Affiliation(s)
- Lai San Kong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Farida Islahudin
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | - Leelavathi Muthupalaniappen
- Department of Family Medicine, Medical Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur, 56000, Malaysia
| | - Wei Wen Chong
- Centre of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
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Cheoun ML, Heo J, Kim WH. Antimicrobial Resistance: KAP of Healthcare Professionals at a Tertiary-Level Hospital in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10062. [PMID: 34639365 PMCID: PMC8532001 DOI: 10.3390/ijerph181910062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Although increasing antimicrobial resistance (AMR) is a substantial threat worldwide, low- and middle-income countries, including Nepal, are especially vulnerable. It is also known that healthcare providers (HCPs) are the major determinants of antimicrobial misuse. A cross-sectional, self-administered survey was conducted among 160 HCPs to assess the knowledge, attitudes, and practices (KAP) of Nepali HCPs regarding AMR and its use. Descriptive statistics and nonparametric tests were performed to evaluate KAP dimensions and investigate subgroup differences. HCPs scored higher on theoretical than practical knowledge. Regarding practical knowledge, men scored higher than women (p < 0.01), and physicians scored higher than nurses (p < 0.001). Participants aged < 25 years scored lower on practical knowledge than older participants (p < 0.001), while those with <3 years work experience scored lower than those with >6 years (p < 0.05). Participants from the medical department scored higher on practical knowledge than those from the surgical department (p < 0.01). AMR control was more accepted in the medical than in the surgical department (p < 0.001). Regarding practices, women and nurses scored higher than men (p < 0.001) and physicians (p < 0.01), respectively. An educational intervention that is tailored to the sociodemographic and professional characteristics of HCPs is necessary to reduce the gap between theoretical and practical knowledge and improve their attitudes and practices.
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Affiliation(s)
- Mee-Lang Cheoun
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Korea;
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Korea;
- National Assembly Futures Institute, 1 Uisadang-daero, Seoul 07233, Korea
| | - Woong-Han Kim
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Korea;
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
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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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Knowledge, Attitude, and Practices on Antimicrobial Use and Antimicrobial Resistance among Commercial Poultry Farmers in Bangladesh. Antibiotics (Basel) 2021; 10:antibiotics10070784. [PMID: 34203195 PMCID: PMC8300693 DOI: 10.3390/antibiotics10070784] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023] Open
Abstract
Antimicrobial resistance (AMR) has become an emerging health issue globally, posing a threat to zoonotic pathogens and foodborne diseases. In Bangladesh, the poultry sector supplies the majority of the demand for animal-source protein. The irrational and excessive use of antimicrobials (AMU) has been observed in the poultry sector. The development of AMR is associated with many factors, including the knowledge and attitudes of poultry farmers. Therefore, AMR reduction requires intervention from all the stockholders, including the farmers who are considered as end users of antimicrobials. This current research conducted a cross-sectional study to assess the knowledge, attitudes, and practices (KAP) of poultry farmers on AMU and AMR in Bangladesh. We determined the KAP of poultry farmers (broiler and layer farmers) of some selected districts of the country using a tested and paper-based questionnaire. The results demonstrated that most of the respondents have insufficient KAP regarding AMU and AMR. The respondents used a variety of antimicrobials primarily in the treatment of various diseases in poultry. One-third of the farmers did not seek antimicrobials from registered vets. Instead, they depended on others or themselves. The factor score analysis further revealed that the farmers’ demographic and socioeconomic variables were significant factors influencing the KAP. An adjusted logistic regression analysis showed that older farmers with 9–12 years of farming experience and graduate-level education, engaging in medium-sized layer farming, were more likely to have correct KAP on AMU and AMR. Further, farmers from the Cox’s Bazar region showed correct knowledge, whereas farmers of the Chattogram region showed a correct attitude towards AMU and AMR. A Spearman’s rank-order correlation revealed a positive association between knowledge–attitudes and knowledge–practices. The findings of the current investigation provide baseline evidence about the KAP of poultry farmers from low-income resources and offer insights into designing interventions and policies for the use of AMU and AMR in Bangladesh.
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Kalam MA, Alim MA, Shano S, Nayem MRK, Badsha MR, Mamun MAA, Hoque A, Tanzin AZ, Khan SA, Islam A, Islam MM, Hassan MM. Knowledge, Attitude, and Practices on Antimicrobial Use and Antimicrobial Resistance among Poultry Drug and Feed Sellers in Bangladesh. Vet Sci 2021; 8:vetsci8060111. [PMID: 34203812 PMCID: PMC8232782 DOI: 10.3390/vetsci8060111] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Poultry production has boomed in Bangladesh in recent years. The poultry sector has contributed significantly to meet the increased demand for animal source proteins in the country. However, increased use of antimicrobials appeared to be a significant threat to food safety in the poultry sector. The poultry drug and feed sellers are at the frontline position involving selecting and delivering the antimicrobials to the poultry farmers. Studies assessing the poultry drug and feed sellers’ knowledge, attitudes, and practices (KAPs) are limited. The current study aimed to assess the community poultry drug and feed sellers’ KAPs of antimicrobial use (AMU) and antimicrobial resistance (AMR) in some selected areas of Bangladesh. We determined the respondents’ (drug and the feed sellers) KAPs of AMU and AMR using a tested and paper-based questionnaire. The study demonstrated that most respondents have insufficient knowledge, less positive attitudes, and inappropriate practices regarding AMU and AMR. The factor score analysis further showed that the type of respondents and their years of experience, level of education, and training on the drug were the significant factors impacting the current knowledge, attitudes, and practices of AMU and AMR. The adjusted logistic regression analysis revealed that the drug sellers who completed their education up to 12th grade and had training on the drug had adequate knowledge of AMU and AMR. The data also showed that the drug sellers belong to the age group 31–35 and 36–40 years and who completed 12th grade had good attitudes on the same. Likewise, the analysis further determined that drug sellers belonging to the age category 18–25 and 26–30 years, and interestingly, the respondents who completed education up to 12th grade, had better practices. Spearman’s rank-order correlation revealed a positive association between each pair of the KAPs scores for the respondents. The correlation was fair between knowledge–attitudes, knowledge–practices, and attitudes–practices. Based on the current study results, we recommend educational interventions and appropriate training for the poultry drug and feed sellers to raise awareness and to upgrade their current knowledge on the appropriate use of antimicrobials. This will ultimately lead to reducing the chances of developing AMR in the poultry sectors of the country.
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Affiliation(s)
| | - Md Abdul Alim
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Shahanaj Shano
- EcoHealth Alliance, New York, NY 10001-2320, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh
| | - Md Raihan Khan Nayem
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Md Rahim Badsha
- Faculty of Food Science and Technology, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Md Abdullah Al Mamun
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Ashraful Hoque
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Abu Zubayer Tanzin
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Shahneaz Ali Khan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Ariful Islam
- EcoHealth Alliance, New York, NY 10001-2320, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka 1212, Bangladesh
- Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong Campus, Geelong, VIC 3216, Australia
| | - Md Mazharul Islam
- Department of Animal Resources, Ministry of Municipality and Environment, Doha P.O. Box 35081, Qatar
| | - Mohammad Mahmudul Hassan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
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Antibiotic-Dispensing Practice in Community Pharmacies: Results of a Cross-Sectional Study in Italy. Antimicrob Agents Chemother 2021; 65:AAC.02729-20. [PMID: 33781998 DOI: 10.1128/aac.02729-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/19/2021] [Indexed: 11/20/2022] Open
Abstract
Inappropriate use of antibiotics in the community contributes to the development of antibiotic resistance (ABR), one of the most concerning issues in modern medicine. The objectives of the study were to investigate the knowledge and attitudes regarding ABR and dispensing antibiotics without prescription (DAwP) and to assess the extent of the practice of DAwP among Italian community pharmacists (CPs). A nationwide cross-sectional study using an anonymous, structured, validated, and pilot-tested questionnaire was conducted. The five sections gathered data on demographic and professional characteristics, knowledge and attitudes toward ABR and DAwP, practices regarding dispensing antibiotics with or without prescription and their reasons, counselling on the potential antibiotic side effects and the importance of adherence to medication regimen, and the information sources used to update the knowledge about ABR. About 4 in 10 CPs (37.1%) reported being involved in DAwP, although 93.7% knew that it is illegal in Italy. The vast majority affirmed to have always/often asked clients about their drug allergies (95.5%) and about their medication history (82.5%). Two-thirds (66.2%) warned their clients about the potential side effects of the drugs, and 55% informed them about the importance of completing the full course of antibiotics. Complacency with clients who found it difficult to consult the physician was the most significant predictor of DAwP. A considerable proportion of DAwP was described, so it could be easy for patients to misuse these drugs. Future policies need to enhance the enforcement of existing prescription-only regulations and to develop monitoring strategies to ensure their establishment in real-life practices.
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Majid Aziz M, Haider F, Rasool MF, Hashmi FK, Bahsir S, Li P, Zhao M, Alshammary TM, Fang Y. Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff's Opinion. Antibiotics (Basel) 2021; 10:482. [PMID: 33922058 PMCID: PMC8143445 DOI: 10.3390/antibiotics10050482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
Community pharmacies are the main channel of antibiotics distribution. We aimed to analyze the dispensing of non-prescribed antibiotics and knowledge of pharmacy staff. We conducted a cross-sectional study in Punjab, Pakistan between December 2017 and March 2018. A self-administered, structured, pretested, and validated bilingual questionnaire was used, and we used chi-square tests in the statistical analysis. A total of 573 (91.7%) pharmacy retailers responded to the survey; 44.0% were aged 31-40 years and all were men. Approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs; 69.3% believed this a contributing factor to antimicrobial resistance. Most (79.1%) respondents believed that this practice promotes irrational antibiotics use, and half (52.2%) considered antimicrobial resistance to be a public health issue. Only 34.5% of respondents reported recommending that patients consult with a doctor prior to using antibiotics, and 61.8% perceived that their dispensing practices reduce patients' economic burden. Approximately 44.9% of pharmacy retailers stated that they have proper knowledge about antibiotics use. Nitroimidazole was the main class of antibiotic dispensed without a prescription. Dispensing of injectable and broad-spectrum antibiotics can be potential threat for infection cure. Poor knowledge of staff is associated with dispensing of non-prescribed antibiotics. This inappropriate practice must be addressed immediately.
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Affiliation(s)
- Muhammad Majid Aziz
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
| | - Fatima Haider
- Ghazi Medical College, Jampur Rd, Dera Ghazi Khan, Punjab 32200, Pakistan;
| | - Muhammad Fawad Rasool
- Departmentof Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University Multan, Punjab 60800, Pakistan;
| | | | - Sadia Bahsir
- Department of Pathology, Quaid e Azam Medical College, Punjab 63100, Pakistan;
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
| | | | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (M.M.A.); (P.L.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Global Health Institute, Xi’an Jiaotong University, Xian, Xi’an 710049, China
- Shaanxi Center for Health Reform and Development Research, Xi’an 710061, China
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Validation of a Questionnaire for Patient Awareness and the Need for a Community-Based Outpatient Antimicrobial Stewardship Program (O-ASP): A Pilot Study. Antibiotics (Basel) 2021; 10:antibiotics10040441. [PMID: 33920828 PMCID: PMC8071141 DOI: 10.3390/antibiotics10040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
An outpatient antimicrobial stewardship program (O-ASP) was developed and implemented to promote appropriate antibiotic therapy in outpatient settings. As active patient involvement is a critical component of an effective O-ASP, this study aimed to develop and validate a questionnaire addressing patient awareness for appropriate antibiotic therapy and the need for pharmaceutical care services (PCS) in the O-ASP in Korea. The questionnaire was drafted based on ASPs and PCS guidelines and validated for content and construct validity using the item-content validity index (I-CVI) and Cronbach’s alpha, respectively. The estimated I-CVI and Cronbach’s alpha were considered excellent or adequate (≥0.8 and 0.70–0.90, respectively) for most of the survey items (17 out of 23 items). The validated questionnaire was utilized in a pilot survey study, including 112 individuals (37% male) with the mean ± SD age of 37 ± 13 years. Among the survey participants, 68% responded that antibiotics had been prescribed appropriately; however, ≥50% showed a lack of knowledge regarding their antibiotic therapy. The participants expressed the need for PCS as part of an O-ASP in the questionnaire (average Likert score ≥3.4/5). In conclusion, our newly validated questionnaire successfully measured patient awareness and knowledge of antimicrobial use and the need for PCS in the O-ASP.
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Zawahir S, Lekamwasam S, Halvorsen KH, Rose G, Aslani P. Self-medication Behavior with antibiotics: a national cross-sectional survey in Sri Lanka. Expert Rev Anti Infect Ther 2021; 19:1341-1352. [PMID: 33792479 DOI: 10.1080/14787210.2021.1911647] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Antibiotic self-medication is common in low- and middle-income countries. This study aimed to evaluate the Sri Lankan public's knowledge about and attitudes toward antibiotic use and self-medication, and factors associated with self-medication. METHODS A national cross-sectional, interviewer-administered, survey of a random household sample (N = 1100) was conducted. Factor analysis of the attitudinal items was conducted to investigate the factors associated with antibiotic self-medication. RESULTS A response rate of ninety-one percent (n = 998) responded. Knowledge about antibiotics was poor (mean = 12.5; SD = 3.5; (scale 0-27)). Half had previously used an antibiotic once in the past three months. About 11% (108/998) had self-medicated the last time they took antibiotics; mostly obtained from a pharmacy (82%; 89/108). Three attitudinal factors were obtained, explaining 56.1% of the variance. Respondents were less likely to self-medicate if they did not support ease of access to antibiotics from pharmacies (p< 0.001) and situational use of antibiotics (p= 0.001); supported appropriate use of antibiotics (p= 0.003); and had greater knowledge about prescription requirements for antibiotics (p= 0.004). CONCLUSION There is limited knowledge about, and a high rate of self-medication with antibiotics.Factors contributing to self-medication could be addressed with appropriate public education campaigns, and policy changes.
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Affiliation(s)
- Shukry Zawahir
- , The University of Sydney School of Pharmacy, Faculty of Medicine and Health, NSW, Australia.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Sarath Lekamwasam
- Population Health Research Centre, Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Kjell H Halvorsen
- Department of Pharmacy, UiT the Arctic University of Norway, Tromsø, Norway
| | - Grenville Rose
- Centre for Social Research in Health, The University of New South Wales, NSW, Australia
| | - Parisa Aslani
- , The University of Sydney School of Pharmacy, Faculty of Medicine and Health, NSW, Australia
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Saleh D, Abu-Farha R, Mukattash TL, Barakat M, Alefishat E. Views of Community Pharmacists on Antimicrobial Resistance and Antimicrobial Stewardship in Jordan: A Qualitative Study. Antibiotics (Basel) 2021; 10:antibiotics10040384. [PMID: 33916855 PMCID: PMC8067308 DOI: 10.3390/antibiotics10040384] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main bases of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convenience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed a good understanding of the causes of antimicrobial resistance. The most important cause reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, included organizational obstacles, resources obstacles, and personal obstacles. In conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.
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Affiliation(s)
- Doaa Saleh
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan; (D.S.); (R.A.-F.); (M.B.)
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan; (D.S.); (R.A.-F.); (M.B.)
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan; (D.S.); (R.A.-F.); (M.B.)
| | - Eman Alefishat
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11937, Jordan
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Correspondence: ; Tel.: +971-5018466
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Malik UR, Chang J, Hashmi F, Atif N, Basir H, Hayat K, Khan FU, Kabba JA, Lambojon K, Fang Y. A Simulated Client Exploration of Nonprescription Dispensing of Antibiotics at Drugstores for Pediatric Acute Diarrhea and Upper Respiratory Infection in Lahore, Pakistan. Infect Drug Resist 2021; 14:1129-1140. [PMID: 33790584 PMCID: PMC7997541 DOI: 10.2147/idr.s301812] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/23/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The excessive consumption of antibiotics is a significant contributor to antimicrobial resistance, especially in children. Children are often advised antibiotics for viral infections. In developing countries, drugstores are a prime source of easy access to nonprescription antibiotics. Moreover, in Pakistan, their irrational use is an "everyday routine". The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics to children. METHODS Using pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan, to explore the antibiotics' ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (χ 2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing. RESULTS Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. A qualified pharmacist was available in only 164 (21.2%) cases. Of the 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits, respectively. There were considerable differences (p-value <0.05) in the practices and antibiotics dispensing between each disease scenario presented. Moreover, antibiotics were less commonly dispensed at pharmacist-supervised drugstores compared to unsupervised ones. CONCLUSION Overall, inappropriate dispensing practices were prevalent to a large extent at the drugstores, and antibiotics were effortlessly obtainable without prescription. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delay, especially in major cities to help curb the felonious use of antibiotics.
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Affiliation(s)
- Usman Rashid Malik
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
| | - Furqan Hashmi
- University College of Pharmacy, University of the Punjab, Lahore, 54000, Pakistan
| | - Naveel Atif
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
| | - Hareem Basir
- Royal Albert Edward Infirmary, Wigan, WN1 2NN, UK
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
| | - Krizzia Lambojon
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China
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Agossa K, Sy K, Mainville T, Gosset M, Jeanne S, Grosgogeat B, Siepmann F, Loingeville F, Dubar M. Antibiotic Use in Periodontal Therapy among French Dentists and Factors Which Influence Prescribing Practices. Antibiotics (Basel) 2021; 10:303. [PMID: 33804145 PMCID: PMC8001084 DOI: 10.3390/antibiotics10030303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/21/2023] Open
Abstract
The aim of the present survey is to investigate the use of antibiotics during periodontal therapy among French dentists with a focus on exploring potential differences between various groups of practitioners. A self-administered questionnaire was distributed to different groups of practitioners including members of (i) the French Society of Periodontology and Implantology; (ii) the College of University Teachers in Periodontology and, (iii) private practitioners participating in the French general dental practice-based research network. 272 questionnaires were included in the analysis. Prescription patterns were globally in line with the current recommendations. Systemic antibiotics are most frequently used as a first-line therapy in necrotizing periodontitis (92%) and aggressive periodontitis (53.3% to 66.1%). However, malpractice still exists, including in the management of periodontal abscesses. Antibiotics are prescribed (i) less frequently for periodontal abscesses and (ii) more frequently for generalized aggressive periodontitis by members of the periodontal society and University college (p < 0.05). Amoxicillin (59.9%) and the amoxicillin + metronidazole (59.6%) combination were the most frequently prescribed molecules. Providing a high number of periodontal treatments per week, being more recently graduated, having a post-graduate certificate in periodontology and holding or having held an academic position/hospital practice were all factors associated with a better knowledge of and/or more adequate antibiotic use.
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Affiliation(s)
- Kevimy Agossa
- University of Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France; (K.S.); (F.S.)
- Department of Periodontology, School of Dentistry, University of Lille, Place de Verdun, 59000 Lille, France; (T.M.); (M.D.)
| | - Kadiatou Sy
- University of Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France; (K.S.); (F.S.)
- Faculté d’Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 69008 Lyon, France;
- Hospices Civils de Lyon, Service d’Odontologie, 69007 Lyon, France
| | - Théo Mainville
- Department of Periodontology, School of Dentistry, University of Lille, Place de Verdun, 59000 Lille, France; (T.M.); (M.D.)
| | - Marjolaine Gosset
- Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496, Université de Paris, F-92120 Montrouge, France;
- Service de Médecine Bucco-Dentaire, AP-HP, Hôpital Charles Foix, F-94200 Ivry-sur-Seine, France
- SFPIO—French Society of Periodontology and Oral Implantology, 44000 Nantes, France
| | - Sylvie Jeanne
- UFR d’Odontologie de Rennes, Bâtiment 15, 2 Avenue du Professeur Léon Bernard, Campus Santé, 35043 Rennes, France;
- Pôle Odontologie, CHU Rennes, 2 Rue Henri Le Guilloux, 35000 Rennes, France
- CNEP—French College of Teachers in Periodontology, 35000 Rennes, France
| | - Brigitte Grosgogeat
- Faculté d’Odontologie, Université de Lyon, Université Claude Bernard Lyon 1, 69008 Lyon, France;
- Hospices Civils de Lyon, Service d’Odontologie, 69007 Lyon, France
- Laboratoire des Multimatériaux et Interfaces, Université de Lyon—Claude Bernard Lyon 1, UMR CNRS 5615, F-69622 Villeurbanne, France
- ReCOL—French Private Dental Practice-Based Research Network, 69007 Lyon, France
| | - Florence Siepmann
- University of Lille, Inserm, CHU Lille, U1008—Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France; (K.S.); (F.S.)
| | - Florence Loingeville
- University of Lille, CHU Lille, ULR 2694—METRICS: Evaluation of Health Technologies and Medical Practices, F-59000 Lille, France;
| | - Marie Dubar
- Department of Periodontology, School of Dentistry, University of Lille, Place de Verdun, 59000 Lille, France; (T.M.); (M.D.)
- University of Lille, Inserm, CHU Lille, UMR-S 1172 JPArc, F-59000 Lille, France
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Giacomini E, Perrone V, Alessandrini D, Paoli D, Nappi C, Degli Esposti L. Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infect Drug Resist 2021; 14:849-858. [PMID: 33688220 PMCID: PMC7937387 DOI: 10.2147/idr.s289741] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of "antibiotic-de-escalation" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | | | - Daniela Paoli
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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Darwish RM, Baqain GN, Aladwan H, Salamah LM, Madi R, Masri RMA. Knowledge, attitudes, and practices regarding antibiotic use and resistance among community pharmacists: a cross sectional study in Jordan. Int J Clin Pharm 2021; 43:1198-1207. [PMID: 33515133 DOI: 10.1007/s11096-021-01234-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
Background Antibiotic resistance is a global threat and burden on healthcare systems. One major factor contributing to this problem is inappropriate use of antibiotics, which comprises suboptimal use, misuse, abuse, and dispensing errors. Another important factor is dispensing antibiotics without medical prescription. Many studies considered pharmacists as healthcare providers accountable for this malpractice. Objectives To investigate community pharmacists' knowledge, attitudes, and practices in relation to antibiotic dispensing, antibiotic resistance and antibiotic stewardship. Setting Community pharmacists selected from different areas in Amman/Jordan. Subjects were selected based on their availability and accessibility. Methods A descriptive cross-sectional survey of community pharmacists was conducted between May to October 2019, using a structured, validated, and pilot-tested questionnaire. A four-part systematic survey consisting of biography, knowledge, practice and attitude domains was used. Main outcome measure community pharmacist knowledge, practices and attitudes regarding antibiotic use and resistance. Results Of 150 community pharmacists approached, 114 completed and returned the questionnaire (response rate 76%). More than 83.3% perceived antimicrobial resistance as a global problem. A substantial percentage (59.7%) educate patients about issues of inappropriate antibiotics use. Almost half the participants (44.7%) agreed that implementing antimicrobial stewardship would result in better outcomes. Conclusion It is crucial to improve the curriculum in schools of pharmacy, emphasizing on interprofessional education and developing customized interventions. Regulations on dispensing antibiotics without prescription should be enforced. Policy makers need to implement antimicrobial stewardship and encourage the use of public educational interventions in community pharmacy.
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Affiliation(s)
- Rula M Darwish
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan.
| | - Ghaida N Baqain
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Hala Aladwan
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Lina M Salamah
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rahaf Madi
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
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Gashaw T, Sisay M, Tesfa T, Baye Y, Amare F. Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia. Infect Drug Resist 2021; 14:193-203. [PMID: 33505162 PMCID: PMC7829130 DOI: 10.2147/idr.s288387] [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: 10/23/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Penicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs). OBJECTIVE This study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016. METHODS A hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. RESULTS Amoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%). CONCLUSION Amoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.
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Affiliation(s)
- Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Microbiology Unit, Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Hayat K, Jamshed S, Rosenthal M, Haq NU, Chang J, Rasool MF, Malik UR, Rehman AU, Khan KM, Fang Y. Understanding of Pharmacy Students towards Antibiotic Use, Antibiotic Resistance and Antibiotic Stewardship Programs: A Cross-Sectional Study from Punjab, Pakistan. Antibiotics (Basel) 2021; 10:66. [PMID: 33445511 PMCID: PMC7827071 DOI: 10.3390/antibiotics10010066] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 12/23/2022] Open
Abstract
Antibiotic resistance (ABR) is a significant issue for public health globally. An adequate understanding of ABR and the approaches used to tackle ABR, including antibiotic stewardship programs, are vital. This study aimed to get an insight into antibiotic use, ABR, and antibiotic stewardship programs among pharmacy students of Punjab, Pakistan. This multicenter study was undertaken among final (fifth) year undergraduate pharmacy students of 7 universities of Punjab, Pakistan. A paper-based self-administered questionnaire comprising 48-items was utilized for data collection. Descriptive and inferential statistics were employed for data analysis. This study included a total of 296 respondents with a response rate of 85.8%. Most of the students had an average understanding of antibiotic use (59.8%), ABR (42.6%), ABR mechanisms (48.0%), and factors of ABR (51.7%). Only 21.6% of students have heard about antibiotic stewardship programs. More than half of the students believed that educating and training healthcare professionals (53.4%) and medical students (57.8%) about the prescribing and judicial usage of antibiotics could reduce the ABR burden. The awareness of most of the pharmacy students about certain aspects of antibiotic use, ABR, and stewardship programs was suboptimal.
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Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Terengganu 22200, Malaysia;
- Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan 25200, Malaysia
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
| | - Noman Ul Haq
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Balochistan, Quetta 87900, Pakistan;
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an 710061, China
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (M.F.R.); (A.U.R.)
| | - Usman Rashid Malik
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an 710061, China
| | - Anees Ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (M.F.R.); (A.U.R.)
| | - Kashif Maqbool Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Centre for Health Reform and Development Research, Xi’an 710061, China
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38
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Torres NF, Solomon VP, Middleton LE. “Antibiotics heal all diseases”; the factors influencing the pratices of self-medication with antibiotics in Maputo City, Mozambique. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01416-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Torres NF, Solomon VP, Middleton LE. Identifying the commonly used antibiotics for self-medication in urban Mozambique: a qualitative study. BMJ Open 2020; 10:e041323. [PMID: 33371035 PMCID: PMC7754657 DOI: 10.1136/bmjopen-2020-041323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The study aimed at identifying the commonly used non-prescribed antibiotics (NPAs) and the main health conditions leading to the practices of self-medication with antibiotics (SMAs) in Maputo city, Mozambique. DESIGN Cross-sectional qualitative study based on individual and group interviews. SETTING The study was conducted in nine pharmacies of three socioeconomic areas of Maputo city, from October 2018 to March 2019. PARTICIPANTS The study included 32 pharmacy clients and 17 pharmacists. The pharmacy clients included men 10 (31%) and women 22 (69%) ranging from 19 to 67 years while the pharmacists included men 6 (35,3%) and women 11 (64,7%) with ages ranging from 24 to 47 years. FINDINGS The majority of the pharmacy clients 30 (93.75%) admitted frequent use of NPAs, 15 (88.2%) out of the 17 pharmacists admitted dispensing NPAs. While the majority of the participants (16) mentioned the use of amoxicillin, also known as 'two colours medicine', 14 mentioned the use of cotrimoxazole and seven mentioned amoxicillin with clavulanic acid. Two to five participants also used tetracycline, ciprofloxacin, azithromycin, doxycycline, erythromycin, metronidazole and phenoxymethylpenicillin. The above mentioned NPAs were used to treat self-perceived sore throat, fever, pain, cough, vaginal discharge, eye problems, the common influenza, urinary infections, respiratory tract infections, wounds and toothaches. CONCLUSIONS Antibiotics are perceived as essential medical resources to manage health and illnesses. While taking an active role in their health-disease process, participants commonly used amoxicillin, 'two colours', cotrimoxazole and amoxicillin with clavulanic acid to manage their health and that of their families. In this sense, the practices of SMAs were perceived as part of the self-care process and not necessarily as misuse of antibiotics. A wideunderstanding of health-seeking beliefs and behaviours regarding the utilisation of antibiotics is needed to inform public health experts, health policymakers and other stake-holders in designing and implementing public health education and health promotion programsat all levels in Mozambique.
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Affiliation(s)
- Neusa F Torres
- Research Unit, Instituto Superior de Ciências de Saúde - ISCISA, Maputo, Mozambique
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vernon P Solomon
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn E Middleton
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kasanga M, Mudenda S, Siyanga M, Chileshe M, Mwiikisa MJ, Kasanga M, Solochi BB, Gondwe T, Kantenga T, L Shibemba A, Chitalu M, Nakazwe R, Wu J. Antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia at a tertiary hospital in Zambia. Future Microbiol 2020; 15:1735-1745. [PMID: 33315486 DOI: 10.2217/fmb-2020-0250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Bloodstream infections and antimicrobial resistance cause global increases in morbidity and mortality. Aim: We evaluated the antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia in humans. Materials & methods: We conducted a retrospective cross-sectional study at the University Teaching Hospitals in Lusaka, Zambia, using Laboratory Information Systems. Results: The commonest isolated bacteria associated with sepsis were Klebsiella pneumoniae. The distribution of bacteria associated with bacteremia in different wards and departments pneumonia. The distribution of bacteria associated with bacteremia in different wards and departments at University Teaching Hospitals was were statistically significant (χ2 = 1211.518; p < 0.001). Conclusion: K. pneumoniae, Escherichia coli, Pantoea agglomerans and Enterococcus species have developed high resistance levels against ampicillin, cefotaxime, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole and a very low resistance levels against imipenem and Amikacin.
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Affiliation(s)
- Maisa Kasanga
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China.,University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Steward Mudenda
- The University of Zambia, School of Health Sciences, Department of Pharmacy, PO Box 50110, Lusaka, Zambia.,The University of Zambia, School of Veterinary Medicine, Department of Disease Control, PO Box 32379, Lusaka, Zambia
| | - Makomani Siyanga
- Zambia Medicines Regulatory Authority, Plot No. 2350/M, Off KK International Airport Road, PO Box 31890 Lusaka
| | - Misheck Chileshe
- Mary Begg Health Services, 56 Chintu Avenue, Northrise, PO Box 72221, Ndola
| | - Mark J Mwiikisa
- Lusaka Trust Hospital, Plot 2190, Nsumbu Rd, Woodlands, PO Box 35852, Lusaka Main, Lusaka, Zambia
| | - Maika Kasanga
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | | | - Theodore Gondwe
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China
| | | | - Aaron L Shibemba
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia.,Directorate of Clinical Pathology & Laboratory Services, Ministry of Health, Lusaka
| | - Mwansa Chitalu
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Ruth Nakazwe
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Jian Wu
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China
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Batista AD, A. Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro MT. Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review. Antibiotics (Basel) 2020; 9:E786. [PMID: 33171743 PMCID: PMC7694985 DOI: 10.3390/antibiotics9110786] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/31/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Antibiotic resistance still remains a major global public health problem and the dispensing of antibiotics without a prescription at community pharmacies is an important driver of this. MEDLINE, Pubmed and EMBASE databases were used to search and identify studies reporting the dispensing of non-prescribed antibiotics in community pharmacies or drugstores that sell drugs for human use, by applying pharmacy interviews/questionnaires methods and/or simulated patient methods. Of the 4683 studies retrieved, 85 were included, of which 59 (69.4%) were published in low-and middle-income countries. Most of the papers (83.3%) presented a percentage of antibiotic dispensing without a prescription above 60.0%. Sixty-one studies evaluated the active substance and the most sold antibiotics without a prescription were amoxicillin (86.9%), azithromycin (39.3%), ciprofloxacin (39.3%), and amoxicillin-clavulanic acid (39.3%). Among the 65 articles referencing the diseases/symptoms, this practice was shown to be mostly associated with respiratory system problems (100.0%), diarrhea (40.0%), and Urinary Tract Infections (30.8%). In sum, antibiotics are frequently dispensed without a prescription in many countries and can thus have an important impact on the development of resistance at a global level. Our results indicate the high need to implement educational and/or regulatory/administrative strategies in most countries, aiming to reduce this practice.
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Affiliation(s)
- Ana Daniela Batista
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Daniela A. Rodrigues
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; (D.A.R.); (F.R.)
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.F.); (M.Z.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), 15702 Santiago de Compostela, Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, 15702 Santiago de Compostela, Spain; (A.F.); (M.Z.-C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), 28001 Madrid, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), 6300-559 Guarda, Portugal; (D.A.R.); (F.R.)
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
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42
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Fetensa G, Wakuma B, Tolossa T, Fekadu G, Bekuma TT, Fayisa L, Etafa W, Bekela T, Besho M, Hiko N, Bayou Bekele M, Worku D, Yadesa G, Tsegaye R. <p>Knowledge and Attitude Towards Antimicrobial Resistance of Graduating Health Science Students of Wollega University</p>. Infect Drug Resist 2020; 13:3937-3944. [PMID: 33177844 PMCID: PMC7650017 DOI: 10.2147/idr.s264481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Antimicrobial resistance is a worldwide concern due to the inappropriate and irrational use of antibiotics. Thus, this study was aimed at determining the knowledge and attitude of graduating health science students of Wollega University towards antimicrobial resistance. Methods An institution-based cross-sectional study design was employed from June to July 2019. Epi-data version 3.1 was used to receive data and exported to SPSS version 25 for further analysis. Both bivariable and multivariable logistic regression analysis were done to find factors associated with attitudes of students towards antibiotic consumption and resistance at a 95% confidence level. The strength of association was measured with the odds ratio. Variables with a p-value of <0.05 at multivariable analysis were considered to be a significant variable. Finally, texts and simple frequency tables were used to present the findings. Results Out of 249, 232 students were included in this survey yielding a response rate of 93.6%. Hundred fifty-eight (68.1%) of them had adequate knowledge about antibiotic identification, role, side effects, and resistance. Students with a family member who works in health and related professions had a lower probability of stopping antibiotics when they feel better (AOR = 0.50, 95% CI: 0.28–0.90) and using leftover antibiotics (AOR = 0.51, 95% CI: 0.28–0.92) compared to their counterparts. Conclusion Students' knowledge on antibiotic identification, role, side effects, and resistance was suboptimal, and the attitude of students towards antibiotic consumption was unfavorable. Respondents having a family member in a health-related field showed a good attitude. Respondents with three years of study also had a good attitude, female gender showed good attitude, and urban residence were independent predictors of attitude toward antibiotic consumption. Training on antimicrobial resistance should be arranged for graduating class nursing and medical students, as they are the future prescribers.
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Affiliation(s)
- Getahun Fetensa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Correspondence: Getahun Fetensa Department of Nursing, Institute of Health Sciences, Wollega University, P.O Box 395, Nekemte, EthiopiaTel +251-910344425Fax +251-576617980 Email
| | - Bizuneh Wakuma
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tariku Tesfaye Bekuma
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lamma Fayisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Werku Etafa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tilahun Bekela
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Merga Besho
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Nesru Hiko
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Marga Bayou Bekele
- Department of Nursing, College of Health Science, Arsi University, Arsella, Ethiopia
| | - Deressa Worku
- Department of Nursing, College of Health Science, Arsi University, Arsella, Ethiopia
| | - Girma Yadesa
- Department of Nursing, College of Medical and Health Science, Dirre Dawa University, Dirre Dawa, Ethiopia
| | - Reta Tsegaye
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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43
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Mengesha Y, Manaye B, Moges G. Assessment of Public Awareness, Attitude, and Practice Regarding Antibiotic Resistance in Kemissie Town, Northeast Ethiopia: Community-Based Cross-Sectional Study. Infect Drug Resist 2020; 13:3783-3789. [PMID: 33144831 PMCID: PMC7594193 DOI: 10.2147/idr.s280036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Antibiotic resistance is increasing to dangerously high levels globally with subsequent higher medical costs, prolonged hospital stays and increased levels of mortality. Ensuring patients' knowledge, attitude, and proper use of antimicrobials is one of the strategies to control resistance. The aim of this study is to evaluate the public awareness, attitude, and practice regarding antimicrobial use and resistance in Kemissie Town, Northeast Ethiopia. METHODS A community-based, cross-sectional study was conducted on 385 adults selected using systematic random sampling in Kemissie town from March 1 to May 1, 2019. A home-to-home visit interview was done using a structured interview guide. The data were coded individually and entered into a computer using Epi-info version 3.5.1 and then exported to SPSS version 23.0 for analysis. Univariate analyses were used to describe the categorical variables. RESULTS Of the 345 respondents who took antibiotics, three quarters (74.78%) received antibiotics with a prescription. Of the total respondents, 17.7% of the participants believed unnecessary use of antibiotics enhances resistance to bacteria. Of those who took antibiotics, the majority (72.5 %) finished the full course of treatment. Out of the total 374 respondents, 41.6% had awareness on the fact that antibiotics resistance can affect the development of resistance in the whole community. More than half (51.9%) of the respondents believed that the rational use of antibiotics can reduce the risk of antimicrobial resistance. CONCLUSION The majority of the respondents were still unaware of antibiotic resistance and its implications. This requires close attention from policy-makers and healthcare professionals. The community of Kemissie town had a positive attitude towards finishing antibiotic regimens. This study also identified crucial gaps in the practices of the community about the use of antibiotics.
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Affiliation(s)
- Yohannes Mengesha
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bekele Manaye
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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44
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Increasing relevance of Gram-positive cocci in urinary tract infections: a 10-year analysis of their prevalence and resistance trends. Sci Rep 2020. [PMID: 33077890 DOI: 10.1038/s41598-020-7483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide. There is increasing appreciation for the pathogenic role of Gram-positive cocci (GPC) in UTIs, as they have a plethora of virulence factors, maintaining their pathogenicity and high affinity for the epithelial cells of the urinary tract. The study was carried out using microbiological data collected corresponding to the period between 2008 and 2017. Antimicrobial susceptibility testing was performed using the disk diffusion method and E-tests. The age range of patients affected from the outpatient and inpatient groups differed significantly (43 [range 0.7-99] vs. 68 [range 0.4-99] years; p = 0.008). 3962 GPCs were obtained from inpatient and 4358 from outpatient samples, corresponding to 20.5 ± 2.8% (range 17.5-26.8%) and 20.6 ± 2.6% (range 17.8-26.0%) of all positive urine samples (p > 0.05); in both groups, Enterococcus spp. were the most prevalent (outpatients: 79.6%; inpatients: 88.5%). High-level aminoglycoside resistance in enterococci was noted in 31.0-46.6% of cases. A pronounced increase in the number of MRSA was seen in the second half of the study period (0.6-1.9% vs. 9.8-11.6%; p = 0.038). The ratio of VRE isolates was 0.16%, no VISA/VRSA isolates were detected.
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45
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Feng Z, Hayat K, Huang Z, Shi L, Li P, Xiang C, Gong Y, Chang J, Jiang M, Yang C, Zhao M, Ji W, Fang Y. Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China. Expert Rev Anti Infect Ther 2020; 19:529-536. [PMID: 32945697 DOI: 10.1080/14787210.2021.1826307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs). METHODS We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests. RESULTS A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P < 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443-878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies. CONCLUSIONS The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor.
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Affiliation(s)
- Zhitong Feng
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Li Shi
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Pengchao Li
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Cheng Xiang
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Yilin Gong
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Minghuan Jiang
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Caijun Yang
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Mingyue Zhao
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Wenjing Ji
- 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological 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 Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
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46
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Gajdács M, Ábrók M, Lázár A, Burián K. Increasing relevance of Gram-positive cocci in urinary tract infections: a 10-year analysis of their prevalence and resistance trends. Sci Rep 2020; 10:17658. [PMID: 33077890 PMCID: PMC7573585 DOI: 10.1038/s41598-020-74834-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide. There is increasing appreciation for the pathogenic role of Gram-positive cocci (GPC) in UTIs, as they have a plethora of virulence factors, maintaining their pathogenicity and high affinity for the epithelial cells of the urinary tract. The study was carried out using microbiological data collected corresponding to the period between 2008 and 2017. Antimicrobial susceptibility testing was performed using the disk diffusion method and E-tests. The age range of patients affected from the outpatient and inpatient groups differed significantly (43 [range 0.7–99] vs. 68 [range 0.4–99] years; p = 0.008). 3962 GPCs were obtained from inpatient and 4358 from outpatient samples, corresponding to 20.5 ± 2.8% (range 17.5–26.8%) and 20.6 ± 2.6% (range 17.8–26.0%) of all positive urine samples (p > 0.05); in both groups, Enterococcus spp. were the most prevalent (outpatients: 79.6%; inpatients: 88.5%). High-level aminoglycoside resistance in enterococci was noted in 31.0–46.6% of cases. A pronounced increase in the number of MRSA was seen in the second half of the study period (0.6–1.9% vs. 9.8–11.6%; p = 0.038). The ratio of VRE isolates was 0.16%, no VISA/VRSA isolates were detected.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6, Szeged, 6720, Hungary.
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6, Szeged, 6725, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6, Szeged, 6725, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6, Szeged, 6725, Hungary.,Department of Medical Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, 6720, Hungary
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47
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Wogayehu B, Adinew A, Asfaw M. Knowledge on Dispensed Medications and Its Determinants Among Patients Attending Outpatient Pharmacy at Chencha Primary Level Hospital, Southwest Ethiopia. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:161-173. [PMID: 33117663 PMCID: PMC7547130 DOI: 10.2147/iprp.s274406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background According to World Health Organization (WHO) drug use indicators manual, the patients' knowledge on dispensed medication is a crucial patient care indicator. There is a dearth of studies about patients' knowledge of dispensed medication at the primary health care facility. The objective of this study was to assess the knowledge of dispensed medication and associated factors among patients attending in the outpatient pharmacy of Chencha primary level hospital, Southwest Ethiopia. Methods A facility-based cross-sectional study was employed among 403 patients attending in the outpatient pharmacy of Chencha primary level hospital. The data collection techniques were observation of dispensing process and face-to-face interview by using WHO patient care indicators and a structured questionnaire, respectively. Descriptive statistics, univariable and multivariable logistic regression were determined using the SPSS version 20. Results A total of 403 patients participated which make the response rate 100%. Fifty-three (13.2%) patients had adequate knowledge on dispensed medication. The findings of multivariable logistic regression indicated that tertiary levels of education (AOR = 3.87; 95% CI [1.25, 11.96]), being private employee (AOR = 10.98; 95% CI [3.25, 37.04]), having severe perception of illness (AOR =3.77; 95% CI [1.43, 9.94]), having three or more visits (AOR =3.20; 95% CI [1.21, 8.44]) and being counseled by pharmacist (AOR = 10.02; 95% CI [4.45, 22.56]) significantly increased the odds of having a "adequate knowledge of medicines." Conclusion This study showed inadequate level of knowledge of dispensed medicine among patients attending in outpatient pharmacy of Chencha primary level hospital. Patient education, employment status, number of visits, perception of illness, dispenser qualification and experience were the factors for knowledge of dispensed medicine. Dispensers need into account patients' perception of their illness of illness and frequency of visits during counseling.
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Affiliation(s)
- Biruk Wogayehu
- Pharmacy Department, Arbaminch College of Health Sciences, Arbaminch Town, Southern State, Ethiopia
| | - Ayalew Adinew
- Pharmacy Service, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mulugeta Asfaw
- Pharmacy Service, Regional Health Bureau, Hawassa, Southern State, Ethiopia
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48
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Torres NF, Solomon VP, Middleton LE. Pharmacists' practices for non-prescribed antibiotic dispensing in Mozambique. Pharm Pract (Granada) 2020; 18:1965. [PMID: 32922571 PMCID: PMC7470239 DOI: 10.18549/pharmpract.2020.3.1965] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Antibiotics are the most frequently used medicines worldwide with most of the countries defining these as prescription-only medicines. Though, dispensing non-prescribed antibiotics represent one of the chief causal factors to the irrational use of antibiotics that paves the way to the development of antimicrobial resistance. Objective We aimed at describing the practices and the enablers for non-prescribed antibiotic dispensing in Maputo city, Mozambique. Methods A qualitative study was conducted, between October 2018 and March 2019, in nine private pharmacies randomly selected across Maputo city. Eighteen pharmacists were contacted and seventeen enrolled through snowball sampling. In-depth interviews were conducted, audiotaped, and transcribed verbatim. Transcripts were coded and analysed though thematic analysis with guidelines from Braun and Clark. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong, 2007) was performed. Results Out of seventeen, fifteen pharmacists admitted non-prescribed dispensing of antibiotics. Common antibiotic dispensing practices included; dispensing without prescription, without asking for a brief clinical history of patients, without clear explanation of the appropriate way of administering, without advising on the side effects. Reasons for non-prescribed antibiotic dispensing are linked to patients' behaviour of demanding for non-prescribed antibiotics, to the patients expectations and beliefs on the healing power of antibiotics, to the physicians' prescribing practices. Other reasons included the pressure for profits from the pharmacy owners, the fragile law enforcement, and absence of accountability mechanisms. Conclusions The practices of non-prescribed antibiotic dispensing characterize the 'daily life' of the pharmacists. On the one hand, the patient's demand for antibiotics without valid prescriptions, and pharmacist's wish to assist based on their role in the pharmacy, the pressure for profits and on the understanding of the larger forces driving the practices of self-medication with antibiotics - rock. On the other hand, pharmacists are aware of the legal status of antibiotics and the public health consequences of their inappropriate dispensing practices and their professional and ethical responsibility for upholding the law - hard place. Highlighting the role of pharmacists and their skills as health promotion professionals is needed to optimizing antibiotic dispensing and better conservancy in Mozambique.
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Affiliation(s)
- Neusa F Torres
- Higher Institute for Health Sciences (ISCISA). Maputo (Mozambique).
| | - Vernon P Solomon
- MSc (Clin Psychol). Discipline of Pharmaceutical Sciences School of Health Sciences, University of KwaZulu Natal. Durban (South Africa).
| | - Lyn E Middleton
- Phd (Nurs & Educ). Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal. Durban (South Africa).
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Khan FU, Khan FU, Hayat K, Chang J, Saeed A, Khan Z, Ashraf M, Rasheed UM, Atif N, Ji W, Aziz MM, Fang Y. Knowledge, attitude and practices among consumers toward antibiotics use and antibiotic resistance in Swat, Khyber-Pakhtunkhwa, Pakistan. Expert Rev Anti Infect Ther 2020; 18:937-946. [PMID: 32516001 DOI: 10.1080/14787210.2020.1769477] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Inappropriate use of antibiotics is one of the main causes of antibiotic resistance around the globe. The present study was aimed to assess the knowledge, attitude, and practices toward antibiotics and antibiotic resistance among consumers. Methods: A cross-sectional study was conducted from April 2019 to September 2019. The participants visiting community pharmacies to buy the antibiotics were approached by data collectors. The descriptive analysis, Kruskal Wallis, and Mann-Whitney statistical tests were used for data analysis through SPSS. Results: 399 participants at three pharmacies with male (n = 352, 88.2%), age (years) group between 34 to 41(n = 138, 34.6%), uneducated (n = 128, 32.1%), and higher education (n = 76, 19.0%) level of the participants were noted. Poor to moderate knowledge were observed; participants were unaware of the risk and misuse of antibiotics at all three pharmacies. By some means, a positive attitude noted, but the storage of antibiotics at home (Median = 2, IQR = 2) was preferred to use when needed. Most of the respondents didn't follow the actual dosage regimen as prescribed (n = 266, 66.7%, p < 0.05). Conclusion: A lack of knowledge and malpractices toward antibiotics use among consumers were observed. Education and awareness of the public about antibiotic resistance is the need of the hour.
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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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an, China.,Shaanxi Centre for Health Reform and Development Research , Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Amna Saeed
- 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Zakir Khan
- Departmentof Pharmacy, Quaid-i-Azam University Islamabad , Pakistan.,Institute of Health Sciences, Department of Pharmacology, Cukurova University , Adana, Turkey
| | - Muhammad Ashraf
- Department of Pharmacy, University of Malakand , Khyber Pakhtunkhwa, Pakistan
| | - Usman Malik Rasheed
- 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Naveel Atif
- 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Wenjing Ji
- 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
| | - Muhammad Majid Aziz
- 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological 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 Centre for Health Reform and Development Research , Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor , Xi'an, China
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50
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Hamza DA, Abd-Elsalam RM, Nader SM, Elhariri M, Elhelw R, El-Mahallawy HS. Pathways of Methicillin-Resistant Staphylococcus aureus in Animal Model: New Insights Regarding Public Health. Infect Drug Resist 2020; 13:1593-1600. [PMID: 32606810 PMCID: PMC7283488 DOI: 10.2147/idr.s252332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Staphylococcus aureus is considered one of the major threats regarding food safety worldwide. Methicillin-resistant S. aureus (MRSA) strains in livestock, companion animals, and wild animals continue to be a potential risk to people working with them. Aim The current research aims to investigate the potential pathways of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) strains in the body after oral infection using the experimental mouse model. Methods Seven groups of SPF male mice were purchased and housed. On day 1, six groups of mice were infected orally by the sterile gastric probe using 100 μL/mice of LA-MRSA bacterial suspension (1 × 108 colony-forming units (CFU)/mL). The remaining group was kept as negative controls. Over 15 days, these animals have been monitored. Fresh fecal samples were screened for LA-MRSA at day 0, day 7 and day 14 following oral administration of MRSA strains. All animals were sacrificed at day 15, and internal organs (liver, lung, kidney, and intestine) were harvested aseptically and divided into two sections. The first part was histopathologically investigated, while the other half has been tested for LA-MRSA re-isolation. Result The oral challenge of mice by MRSA strains showed that MRSA was re-isolated from feces and intestines of all inoculated mice groups and from internal organs (liver, lung, kidney and intestine) of most mice. Results were confirmed by the detection of the bacteria in gram-stained tissue sections and changes in H&E-stained histopathological tissue sections from these organs. Conclusion Data from the present study indicate the possible colonization of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in internal organs following oral infection and thus posing a risk for food-borne infection of MRSA. Infected animals could pass LA-MRSA through feces again, resulting in increased dispersion and environmental contamination.
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Affiliation(s)
- Dalia A Hamza
- Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Reham M Abd-Elsalam
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Sara M Nader
- Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Mahmoud Elhariri
- Department of Microbiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Rehab Elhelw
- Department of Microbiology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Heba S El-Mahallawy
- Department of Animal Hygiene, Zoonoses and Animal Behaviour and Management, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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