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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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Youssef A, Amin MEK. Egyptian community pharmacies and self-care: Context, challenges and opportunities. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100384. [PMID: 38146318 PMCID: PMC10749267 DOI: 10.1016/j.rcsop.2023.100384] [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: 11/25/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Community pharmacists are ideally positioned to play a key role in promoting self-care behaviors through judicious use of self-care interventions. As highlighted by the International Pharmaceutical Federation, supporting effective self-care is a key strategy for pharmacists to contribute to the sustainability of healthcare systems. Despite recent positive developments in national health policies, Egypt does not have a clear self-care strategy and policy. It also has no national programs focusing on community pharmacists and self-care, important components that future health policy initiatives should tackle. This commentary explores self-care policies, strategies, and developments in the Egyptian community pharmacy practice context. It describes national research, roles, and challenges within the current model of community pharmacy practice and education concerning self-care. It addresses opportunities that Egyptian community pharmacy has to support self-care in light of the anticipated changes in the Egyptian healthcare system. Noting that success in the delivery of self-care interventions within community pharmacies is associated with key factors, recommendations are suggested for community pharmacy stakeholders to address such factors guided by the World Health Organization's implementation considerations for individuals' health needs and self-care-related health system challenges (agency, availability, quality, cost, information, accessibility, utilization, social support, acceptability, and efficiency).
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Affiliation(s)
- Amr Youssef
- Alamein International University Faculty of Pharmacy, AlAlamein City Main Road, Matrouh, Egypt
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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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Badran AS, Keraa K, Farghaly MM. Applying the Kirkpatrick model to evaluate dental students' experience of learning about antibiotics use and resistance. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:756-766. [PMID: 34939280 DOI: 10.1111/eje.12758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/24/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION "Antibiotic resistance" is of main concern in global health and that it could hinder the achievement of sustainable development goals. One of the reported contributing factors is the irrational prescribing behaviour of healthcare professionals including dentists. Efforts to design and evaluate effective educational programmes for undergraduate dental students about appropriate prescribing behaviour during their early educational years could mitigate the risk of antibiotic resistance. MATERIALS AND METHODS A total of 322 students participated in the study. Their knowledge of antibiotics and antibiotic resistance was assessed. Students received a specially designed, interactive educational programme. The success of the programme was assessed after the educational sessions and 2 years later using Kirkpatrick's four-level evaluation model. RESULTS This study is the first study to use Kirkpatrick model to evaluate an educational programme for dental students. The results of the first level of evaluation showed an overall satisfaction score of 82.1%. The second level revealed an increase in the percentage of correct answers after the educational sessions from 68.3% to 80%, and significant agreement with responsible antibiotics usage (p-value = .020, Effect size = 0.121). The third level showed that the percentage of correct answers 2 years later was 87.5%. The fourth level confirmed the success of the programme as 88.9% of participants reported using the knowledge gained from the programme when prescribing antibiotics. CONCLUSIONS Our study emphasises the success of the used educational programme and highlights the need for educational interventions in the under graduate dental curriculum.
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Affiliation(s)
- Amira Saad Badran
- Associate Professor of Pediatric Dentistry & Dental Public Health, Faculty of Oral & Dental Medicine, Misr International University, Cairo, Egypt
| | - Khaled Keraa
- Biostatistician, Faculty of Oral & Dental Medicine, Misr International University, Cairo, Egypt
| | - Mahassen Mohamed Farghaly
- Professor of Dental Public Health, Vice President of Community Service and Environmental Affairs, Faculty of Oral & Dental Medicine, Misr International University, Cairo, Egypt
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Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study. Antibiotics (Basel) 2022; 11:antibiotics11111529. [DOI: 10.3390/antibiotics11111529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The European Centre for Disease Prevention and Control describes the community pharmacist as the gatekeeper to the quality of antibiotic use. The pharmacist has the responsibility to guard safe and effective antibiotic use; however, little is known about how this is implemented in practice. Aims: To assess the feasibility of a method to audit the quality of antibiotic dispensing in community pharmacy practice and to explore antibiotic dispensing practices in Greece, Lithuania, Poland, and Spain. Methods: The Audit Project Odense methodology to audit antibiotic dispensing practice was adapted for use in community pharmacy practice. Community pharmacists registered antibiotic dispensing on a specifically developed registration chart and were asked to provide feedback on the registration method. Results: Altogether, twenty pharmacists were recruited in four countries. They registered a total of 409 dispenses of oral antibiotics. Generally, pharmacists were positive about the feasibility of implementing the registration chart in practice. The frequency of checking for allergies, contraindications and interactions differed largely between the four countries. Pharmacists provided little advice to patients. The pharmacists rarely contacted prescribers. Conclusion: This tool seems to make it possible to get a useful picture of antibiotic dispensing patterns in community pharmacies. Dispensing practice does not seem to correspond with EU guidelines according to these preliminary results.
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Bou-Saba AW, Kassak KM, Salameh PR. Public views of community pharmacy services during the COVID-19 pandemic: a national survey. J Pharm Policy Pract 2022; 15:76. [PMID: 36309706 DOI: 10.1186/s40545-022-00474-4] [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: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess public opinion about community pharmacy services in Lebanon during the COVID-19 pandemic. METHOD A cross-sectional study using an online questionnaire was conducted between April and August of 2021. A link was shared randomly among the Lebanese population using WhatsApp and Facebook. Public perceptions were explored within 3 different indicators: general services (B) dispensing (C), and storage (D). Chi-square, Student's test and ANOVA tests were used. p < 0.05 was considered statistically significant. RESULTS Out of 491 responses, only 9.6% scored above the 75th percentile (19.3% for the general services, 2.4% for dispensing indicator and 12.6% for storage indicator). The main concerns focused on lack of medication and reduced opening hours; however, 67.1% of respondents preferred consulting the community pharmacist instead of visiting primary health care centers, doctor's private clinic and hospitals. Higher mean values of indicators B, C and in the overall indicator were significantly found in the presence of a pharmacist compared to the support pharmacy workforce. CONCLUSION The overall public perception was inadequate. Significant difference in terms of quality of services was detected in the presence and absence of a community pharmacist during the crisis. It is recommended that the Order of Pharmacist of Lebanon (OPL) and the Ministry of Public Health (MOPH) undergo further steps mainly to enforce the laws concerning dispensing and storage indicators, improve the services in terms of extending the opening hours, ensure the availability of medicines and increase public awareness.
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Affiliation(s)
- Alein W Bou-Saba
- Doctoral School of Science and Technology, Lebanese University, Hadat, Lebanon. .,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Kassem M Kassak
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Pascale R Salameh
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,Epidémiologie Clinique et Toxicologie, Liban (INSPECT-LB), Institut National de Santé Publique, Beirut, Lebanon.,Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.,School of Medicine, Lebanese American University, Byblos, Lebanon
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Ashour RH, Abdelkader EA, Hamdy O, Elmetwally M, Laimon W, Abd-Elaziz MA. The Pattern of Antimicrobial Prescription at a Tertiary Health Center in Egypt: A Point Survey and Implications. Infect Drug Resist 2022; 15:6365-6378. [PMID: 36337931 PMCID: PMC9635387 DOI: 10.2147/idr.s380693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The misuse of antimicrobials has major consequences, particularly antimicrobial resistance (AMR) and antimicrobials’ related adverse effects. So, the WHO proposed antimicrobial surveillance to improve antimicrobials use. This point prevalence survey (PPS) was conducted to illustrate the prevalence of antimicrobial use at Mansoura University hospitals (MUH), Egypt. Methods The survey process used was adapted from the European survey of antimicrobial resistance with modifications. The survey was conducted from 8 AM to 8 PM daily within 2 weeks. Results A total of 300 patients received antimicrobials and the prevalence rate of antimicrobial prescription was 79.15%. The major indications of antimicrobials were surgical prophylaxis followed by the treatment of community-acquired infection. The most commonly prescribed initial antimicrobial group was Aminopenicillin ± β-lactamase inhibitors. Although the purpose for antimicrobial administration was recorded in all cases, the stop/review history was recorded only in 19.6% and local guidelines were not available for 77.6% of antimicrobial prescriptions. The use of combined antimicrobials was common (46.6%), particularly in orthopedic and cardiothoracic surgery. Conclusion The prevalence of antimicrobial prescription at MUH was high which requires serious actions including reviewing the antimicrobial indication, implementing local prescription guidelines, initiating an antimicrobial stewardship program (ASP), and optimizing infection control measures.
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Affiliation(s)
- Rehab H Ashour
- Clinical Pharmacology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Pharmacology & Toxicology Department, Faculty of Medicine at Al-Qunfudah, Umm Al-Qura University, Al-Qunfudah, Kingdom of Saudi Arabia
- Correspondence: Rehab H Ashour, Clinical Pharmacology Department, Faculty of Medicine, Mansoura University, 60 El-Gomhoria Street, Mansoura, Al-Dakahlia, 35516, Egypt, Tel +2 01005409956, Fax +20 50 2248203, Email ;
| | - Eman A Abdelkader
- Internal Medicine Department, Faculty of Medicine, Mansoura University, Specialized Medical Hospital, Mansoura, Egypt
| | - Omar Hamdy
- Surgical Oncology Department, Faculty of Medicine, Oncology Center Mansoura University “OCMU”, Mansoura, Egypt
| | - Mohamed Elmetwally
- Surgical Oncology Department, Faculty of Medicine, Oncology Center Mansoura University “OCMU”, Mansoura, Egypt
| | - Wafaa Laimon
- Pediatric Endocrinology and Diabetes Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura University Children’s Hospital, Mansoura, Egypt
| | - Mohamed A Abd-Elaziz
- Clinical Pharmacology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abdelrahman Hussain M, Osman Mohamed A, Sandel Abkar A, Siddig Mohamed F, Khider Elzubair H. Knowledge, Attitude and Practice of Community Pharmacists in Relation to Dispensing Antibiotics Without Prescription in Sudan: A Cross-sectional Study. Integr Pharm Res Pract 2022; 11:107-116. [PMID: 35915837 PMCID: PMC9338346 DOI: 10.2147/iprp.s363079] [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: 04/24/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022]
Abstract
Background Dispensing antibiotics without prescription (DAwP) is a widespread practice, especially in developing countries, contributing to antibiotic resistance. Community pharmacists play a significant role in promoting rational use of antibiotics by refraining from DAwP, and providing drug information to patients. This study aimed to evaluate community pharmacists’ knowledge, attitude and practice, and to assess the factors behind DAwP. Methods A cross-sectional study was conducted in 2020 among random sample of community pharmacists in Sudan. Online semi-structured questionnaire was used for data collection. The association between dependent and independent variables was assessed using Chi-square test; a P-value less than 0.05 was considered significant. Results Of the 1217 pharmacists who participated, the majority were female (n = 645, 53%). Most pharmacists have a B. Pharm degree (n = 1026, 84%) and less than 5 years’ experience (n = 718, 59%). Notably, the majority of community pharmacists have good knowledge (n = 735, 61.7%), which is significantly associated with years of experience (P < 0.00). More than half (n = 623, 52.2%) of the pharmacists have above average score of practice. Nearly all the pharmacists who participated have a positive attitude in relation to DAwP (n = 1204, 98.9%). More than half of the pharmacists were DAwP for tonsillitis (n = 817, 67%), wound infection (n = 766, 62.9%), and urinary tract infection (n = 664, 54%). The leading factor behind DAwP was the low socioeconomic status of the patients (n = 624, 51%). Additionally, 47% of the pharmacists (n = 572) thought that they were knowledgeable enough to DAwP. Conclusion Despite their positive attitude and average level of knowledge regarding DAwP, Sudanese community pharmacists frequently are DAwP for tonsillitis. Low patients’ socioeconomic status was the leading factor behind DAwP. Accordingly, extensive work from health authorities to improve the accessibility and affordability of the health system as well as the development of an antibiotic stewardship program are required to diminish DAwP.
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Affiliation(s)
- Mohamed Abdelrahman Hussain
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Ahmed Osman Mohamed
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Alsara Sandel Abkar
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Fatima Siddig Mohamed
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
| | - Hana Khider Elzubair
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan
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Belachew SA, Hall L, Selvey LA. Community drug retail outlet staff's knowledge, attitudes and practices towards non-prescription antibiotics use and antibiotic resistance in the Amhara region, Ethiopia with a focus on non-urban towns. Antimicrob Resist Infect Control 2022; 11:64. [PMID: 35488321 PMCID: PMC9052473 DOI: 10.1186/s13756-022-01102-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Some evidence suggests that knowledge and attitudes towards rational antibiotic use influences dispensing practice in community drug retail outlets. However, there is limited evidence in resource limited countries, including Ethiopia. We aimed to assess the knowledge and attitudes surrounding antibiotic use or supply and antibiotic resistance, and the non-prescribed antibiotic dispensing practices in community drug retail outlets in non-urban Ethiopia. METHODS We conducted a cross-sectional survey of community drug retail outlet staff in the Amhara region, Ethiopia with a focus on non-urban towns. An expert validated self-administered questionnaire was used. Following exploratory factor analysis and best items selection, we summarised our findings and assessed factors associated with non-prescribed antibiotic dispensing. The data were analysed using Stata Statistical Software version 17. P-values < 0.05 were considered significant. RESULTS A total of 276 participants from 270 drug outlets completed the questionnaire. The participants median age was 30 (Interquartile range (IQR) = 25-35) years and 79.7% were pharmacy assistants. The majority demonstrated good levels of knowledge about antibiotic use or supply and antibiotic resistance (77.9% and 76% of the participants responded correctly to more than half of the items, respectively). We identified four attitude domains: the role of antibiotics in recovering from diseases regardless of their cause (median score = 2 (IQR = 2-4), beliefs inconsistent with good practice); professional competency to supply non-prescribed antibiotics, and the non-prescribed antibiotics supply (median score for each domain = 4 (IQR = 4-5), attitudes consistent with good practice); and positive attitudes towards actions to prevent antibiotic resistance and promote appropriate antibiotic use (median score = 4 (IQR = 4-5). Fifty eight percent of the participants reported that they had dispensed antibiotics without a prescription. Participants who did not perceive that they were competent to supply non-prescribed antibiotics (adjusted odds ratio = 0.86, 95% confidence interval = 0.78-0.93) were less likely to report non-prescribed antibiotics dispensing. CONCLUSION While most of the participants had appropriate knowledge about and attitudes to antibiotic use and antibiotic resistance, basic knowledge and attitude gaps remain. Despite Ethiopia's regulatory restrictions, the non-prescribed antibiotic provision continues to be a common practice. Our study highlights the need for multifaceted interventions that may include a strict regulatory system, staff training and public education.
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Affiliation(s)
- Sewunet Admasu Belachew
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia. .,School of Pharmacy, Faculty of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Lisa Hall
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Linda A Selvey
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
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El-Defrawy I, Gamal D, El-Gharbawy R, El-Seidi E, El-Dabaa E, Eissa S. Detection of intestinal colonization by carbapenem-resistant Enterobacteriaceae (CRE) among patients admitted to a tertiary care hospital in Egypt. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00295-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The irrational use of carbapenems in the last years lead to the emergence of carbapenem-resistant Enterobacteriaceae (CRE). This study aimed at determining the prevalence of CRE intestinal carriage among admitted patients in a tertiary care hospital in Egypt, to characterize carbapenemase-producing genes and to identify possible risk factors of CRE colonization. One hundred rectal swabs were collected from patients within 48 h of hospital admission. Culture was done on chromogenic media and then identification and antibiotic susceptibility testing were done using Vitek 2 compact system. Carbapenemase production was confirmed by Rapidec Carba NP test and by multiplex PCR for blaOXA-48-like, blaNDM-like, blaVIM-like, blaIMP-like and blaKPC-like.
Results
A total number of 36 CRE isolates were recovered from 28 patients. Thus, the prevalence of CRE colonization was 28%. Escherichia coli (83%), followed by Klebsiella pneumoniae (17%) were the main species. History of recent hospitalization and prior antibiotic intake were statistically significant risk factors predisposing to CRE colonization. Rapidec Carba NP gave positive results in 29/36 CRE isolates, whereas seven isolates gave negative results; six of them harbored blaOXA-48-like. Overall, the blaOXA-48-like was detected in 24/36 (66.7%), followed by blaNDM-like in 11/36 (30.6%) and lastly blaVIM-like in 1/36 (2.8%).
Conclusions
Our findings confirm that CRE colonization is disseminating in our healthcare facility, a fact that should be considered as possible pathogens causing infections in high risk patients. Strict infection control measures should be applied to all CRE carriers at hospital admission and a proper antimicrobial stewardship program should be followed in clinical settings.
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Ragheb SM, Govinden U, Osei Sekyere J. Genetic support of carbapenemases: a One Health systematic review and meta-analysis of current trends in Africa. Ann N Y Acad Sci 2021; 1509:50-73. [PMID: 34753206 DOI: 10.1111/nyas.14703] [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: 05/21/2020] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
Antimicrobial resistance (AMR) is a public health threat globally. Carbapenems are β-lactam antibiotics used as last-resort agents for treating antibiotic-resistant infections. Mobile genetic elements (MGEs) play an important role in the dissemination and expression of antimicrobial resistance genes (ARGs), including the mobilization of ARGs within and between species. The presence of MGEs around carbapenem-hydrolyzing enzymes, called carbapenemases, in bacterial isolates in Africa is concerning. The association between MGEs and carbapenemases is described herein. Specific plasmid replicons, integrons, transposons, and insertion sequences were found flanking specific and different carbapenemases across the same and different clones and species isolated from humans, animals, and the environment. Notably, similar genetic contexts have been reported in non-African countries, supporting the importance of MGEs in driving the intra- and interclonal and species transmission of carbapenemases in Africa and globally. Technical and budgetary limitations remain challenges for epidemiological analysis of carbapenemases in Africa, as studies undertaken with whole-genome sequencing remained relatively few. Characterization of MGEs in antibiotic-resistant infections can deepen our understanding of carbapenemase epidemiology and facilitate the control of AMR in Africa. Investment in genomic epidemiology will facilitate faster clinical interventions and containment of outbreaks.
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Affiliation(s)
- Suzan Mohammed Ragheb
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Usha Govinden
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - John Osei Sekyere
- Department of Microbiology & Immunology, Indiana University School of Medicine-Northwest, Gary, Indiana.,Department of Dermatology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study. Antibiotics (Basel) 2021; 10:antibiotics10020154. [PMID: 33546476 PMCID: PMC7913721 DOI: 10.3390/antibiotics10020154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use.
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Rusic D, Bukić J, Seselja Perisin A, Leskur D, Modun D, Petric A, Vilovic M, Bozic J. Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review. Antibiotics (Basel) 2021; 10:antibiotics10010063. [PMID: 33440609 PMCID: PMC7827930 DOI: 10.3390/antibiotics10010063] [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: 12/28/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/01/2022] Open
Abstract
Community pharmacists recognize the need to implement antimicrobial stewardship activities in community pharmacies. They are in a unique position to provide triage for common primary care indications and to lower the burden of patients at general practitioners’ offices. However, research shows that, in some areas, dispensing of antimicrobials without valid prescription is still highly prevalent. Regardless of training, every community pharmacist can give his contribution to antimicrobial stewardship. One of the basic elements should be antimicrobial dispensing according to regulations, either prescription only, or according to guidelines where pharmacists have prescribing authority. Patient consultation supported with educational materials, such as leaflets, may reduce patients’ expectations to receive antibiotics for self-limiting infections and reduce pressure on general practitioners to prescribe antibiotics on patients’ demand. Treatment optimization may be achieved in collaboration with the prescribing general practitioners or by providing feedback. At last, pharmacists provided with additional training may be encouraged to provide consultation services to long-term care facilities, to introduce point-of-care testing for infectious diseases in their pharmacies or prescribe antimicrobials for uncomplicated infections. These services are welcomed by patients and communities. Expanding pharmacy services and pharmacists’ prescribing autonomy have shown a positive impact by reducing antibiotics consumption, thus ensuring better compliance with treatment guidelines.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
- The Split-Dalmatia County Pharmacy, Dugopoljska 3, 21 204 Dugopolje, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
- Correspondence:
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Chen J, Sidibi AM, Shen X, Dao K, Maiga A, Xie Y, Hesketh T. Lack of antibiotic knowledge and misuse of antibiotics by medical students in Mali: a cross-sectional study. Expert Rev Anti Infect Ther 2020; 19:797-804. [PMID: 33251896 DOI: 10.1080/14787210.2021.1857731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Misuse of antibiotics, especially in low-and-middle-income countries is a major contributor to antimicrobial resistance. Medical students are antibiotic consumers and prescribers in the future. This study aimed to assess antibiotic knowledge and utilization among medical students in the Republic of Mali, and to determine the relationship between knowledge and health-seeking behavior in relation to antibiotic use.Methods: A cross-sectional survey was conducted in the only public medical university in Mali. The questionnaire explored knowledge about antibiotics of medical students, and health behaviors for self-limiting illness. Data were analyzed in SPSS.Results: A total of 446 medical students completed the questionnaire. The average knowledge score was 4.12 out of 10. Students with clinical experience performed higher (4.79 vs 3.74, p< 0.01); 391(87.7%) medical students reported experience of self-limiting diseases in the past year. Of these 197(50.4%) went to see a doctor, 160 (81.2%) of whom were prescribed antibiotics: 151 medical students self-treated, with 121(80.1%) using antibiotics.Conclusions: This study shows poor knowledge and massive misuse of antibiotics among medical students in Mali. Promoting education on the mechanism of antibiotics, antimicrobial resistance and rational antibiotic use among medical students should be a priority in the medical school curriculum.
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Affiliation(s)
- Jie Chen
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Xiaohui Shen
- Institute for Global Health, University College London,London, UK
| | - Kalo Dao
- Department of Tropical Infectious Diseases, University of Science, Technique and Technologies of Bamako, Bamako, Mali
| | - Alain Maiga
- Department of Tropical Infectious Diseases, University of Science, Technique and Technologies of Bamako, Bamako, Mali
| | - Ying Xie
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Therese Hesketh
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China.,Institute for Global Health, University College London,London, UK
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Phenotypic and Genotypic Features of Klebsiella pneumoniae Harboring Carbapenemases in Egypt: OXA-48-Like Carbapenemases as an Investigated Model. Antibiotics (Basel) 2020; 9:antibiotics9120852. [PMID: 33260700 PMCID: PMC7760040 DOI: 10.3390/antibiotics9120852] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
This study aimed at the characterization of carbapenem-resistant Klebsiella pneumoniae isolates focusing on typing of the blaOXA-48-like genes. Additionally, the correlation between the resistance pattern and biofilm formation capacity of the carbapenem-resistant K. pneumoniae isolates was studied. The collected isolates were assessed for their antimicrobial resistance and carbapenemases production by a modified Hodge test and inhibitor-based tests. The carbapenemases encoding genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48-like) were detected by PCR. Isolates harboring blaOXA-48-like genes were genotyped by Enterobacterial Repetitive Intergenic Consensus-Polymerase Chain Reaction (ERIC-PCR) and plasmid profile analysis. The discriminatory power of the three typing methods (antibiogram, ERIC-PCR, and plasmid profile analysis) was compared by calculation of Simpson's Diversity Index (SDI). The transferability of blaOXA-48 gene was tested by chemical transformation. The biofilm formation capacity and the prevalence of the genes encoding the fimbrial adhesins (fimH-1 and mrkD) were investigated. The isolates showed remarkable resistance to β-lactams and non-β-lactams antimicrobials. The coexistence of the investigated carbapenemases encoding genes was prevalent except for only 15 isolates. The plasmid profile analysis had the highest discriminatory power (SDI = 0.98) in comparison with ERIC-PCR (SDI = 0.89) and antibiogram (SDI = 0.78). The transferability of blaOXA-48 gene was unsuccessful. All isolates were biofilm formers with the absence of a significant correlation between the biofilm formation capacity and resistance profile. The genes fimH-1 and mrkD were prevalent among the isolates. The prevalence of carbapenemases encoding genes, especially blaOXA-48-like genes in Egyptian healthcare settings, is worrisome and necessitates further strict dissemination control measures.
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Goswami N, Dahal P, Shrestha S, KC B, Mallik SK. <p>Community Pharmacy Personnel Understanding of Antibiotic Dispensing in Eastern Nepal</p>. Healthc Policy 2020; 13:1513-1522. [PMID: 32982509 PMCID: PMC7490080 DOI: 10.2147/rmhp.s264192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Nikita Goswami
- Purbanchal University College of Medical and Allied Sciences, Purbanchal University, Sundar Haraicha, Gothgaun, Morang, Nepal
| | - Prasanna Dahal
- Purbanchal University College of Medical and Allied Sciences, Purbanchal University, Sundar Haraicha, Gothgaun, Morang, Nepal
- Correspondence: Prasanna Dahal Purbanchal University College of Medical and Allied Sciences, Purbanchal University, Sundar Haraicha, Gothgaun, Morang56611, NepalTel +9779852049828 Email
| | - Shakti Shrestha
- School of Pharmacy, Pharmacy Australia Center of Excellence, The University of Queensland, Brisbane, QLD4102, Australia
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan47500, Bandar Sunway Selangor Darul Ehsan, Malaysia
| | - Shyam Kumar Mallik
- Purbanchal University College of Medical and Allied Sciences, Purbanchal University, Sundar Haraicha, Gothgaun, Morang, Nepal
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Abdelaal Ahmed Mahmoud A, Mahmoud HE, Mahran MA, Khaled M. Streptokinase Versus Unfractionated Heparin Nebulization in Patients With Severe Acute Respiratory Distress Syndrome (ARDS): A Randomized Controlled Trial With Observational Controls. J Cardiothorac Vasc Anesth 2020; 34:436-443. [DOI: 10.1053/j.jvca.2019.05.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 02/08/2023]
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18
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Khan AU, Shell WS, Melzer F, Sayour AE, Ramadan ES, Elschner MC, Moawad AA, Roesler U, Neubauer H, El-Adawy H. Identification, Genotyping and Antimicrobial Susceptibility Testing of Brucella spp. Isolated from Livestock in Egypt. Microorganisms 2019; 7:microorganisms7120603. [PMID: 31766725 PMCID: PMC6955977 DOI: 10.3390/microorganisms7120603] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/14/2019] [Accepted: 11/16/2019] [Indexed: 02/07/2023] Open
Abstract
Brucellosis is a highly contagious zoonosis worldwide with economic and public health impacts. The aim of the present study was to identify Brucella (B.) spp. isolated from animal populations located in different districts of Egypt and to determine their antimicrobial resistance. In total, 34-suspected Brucella isolates were recovered from lymph nodes, milk, and fetal abomasal contents of infected cattle, buffaloes, sheep, and goats from nine districts in Egypt. The isolates were identified by microbiological methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Differentiation and genotyping were confirmed using multiplex PCR for B. abortus, Brucella melitensis, Brucella ovis, and Brucella suis (AMOS) and Bruce-ladder PCR. Antimicrobial susceptibility testing against clinically used antimicrobial agents (chloramphenicol, ciprofloxacin, erythromycin, gentamicin, imipenem, rifampicin, streptomycin, and tetracycline) was performed using E-Test. The antimicrobial resistance-associated genes and mutations in Brucella isolates were confirmed using molecular tools. In total, 29 Brucella isolates (eight B. abortus biovar 1 and 21 B. melitensis biovar 3) were identified and typed. The resistance of B. melitensis to ciprofloxacin, erythromycin, imipenem, rifampicin, and streptomycin were 76.2%, 19.0%, 76.2%, 66.7%, and 4.8%, respectively. Whereas, 25.0%, 87.5%, 25.0%, and 37.5% of B. abortus were resistant to ciprofloxacin, erythromycin, imipenem, and rifampicin, respectively. Mutations in the rpoB gene associated with rifampicin resistance were identified in all phenotypically resistant isolates. Mutations in gyrA and gyrB genes associated with ciprofloxacin resistance were identified in four phenotypically resistant isolates of B. melitensis. This is the first study highlighting the antimicrobial resistance in Brucella isolated from different animal species in Egypt. Mutations detected in genes associated with antimicrobial resistance unravel the molecular mechanisms of resistance in Brucella isolates from Egypt. The mutations in the rpoB gene in phenotypically resistant B. abortus isolates in this study were reported for the first time in Egypt.
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Affiliation(s)
- Aman Ullah Khan
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (A.U.K.); (F.M.); (M.C.E.); (A.A.M.); (H.N.)
- Institute for Animal Hygiene and Environmental Health, Free University of Berlin, 14163 Berlin, Germany;
- Department of Pathobiology, College of Veterinary and Animal Sciences, 35200 Jhang, Pakistan
| | - Waleed S. Shell
- Central Laboratory for Evaluation of Veterinary Biologics, Agricultural Research Center, 11517 Abbasaia-Cairo, Egypt;
| | - Falk Melzer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (A.U.K.); (F.M.); (M.C.E.); (A.A.M.); (H.N.)
| | - Ashraf E. Sayour
- Department of Brucellosis, Animal Health Research Institute, Agricultural Research Center, 12618 Dokki-Giza, Egypt;
| | - Eman Shawkat Ramadan
- Animal Reproduction Research Institute, Agricultural Research Center, 12556 Al Ahram-Giza, Egypt;
| | - Mandy C. Elschner
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (A.U.K.); (F.M.); (M.C.E.); (A.A.M.); (H.N.)
| | - Amira A. Moawad
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (A.U.K.); (F.M.); (M.C.E.); (A.A.M.); (H.N.)
- Institute for Animal Hygiene and Environmental Health, Free University of Berlin, 14163 Berlin, Germany;
- Provincial Laboratory, Institute of Animal Health Research, 35516 Mansoura, Egypt
| | - Uwe Roesler
- Institute for Animal Hygiene and Environmental Health, Free University of Berlin, 14163 Berlin, Germany;
| | - Heinrich Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (A.U.K.); (F.M.); (M.C.E.); (A.A.M.); (H.N.)
| | - Hosny El-Adawy
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institut, 07743 Jena, Germany; (A.U.K.); (F.M.); (M.C.E.); (A.A.M.); (H.N.)
- Faculty of Veterinary Medicine, Kafr Elsheikh University, 33516 Kafr El-Sheikh, Egypt
- Correspondence:
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The Knowledge, Attitudes, and Practices of Community Pharmacists in their Approach to Antibiotic Use: A Nationwide Survey in Italy. Antibiotics (Basel) 2019; 8:antibiotics8040177. [PMID: 31591303 PMCID: PMC6963544 DOI: 10.3390/antibiotics8040177] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/20/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
Background: This investigation has been carried out to evaluate the knowledge, attitudes, and practices toward antibiotic resistance and antibiotic use among community pharmacists in Italy and to investigate their influencing factors. Methods: A cross-sectional telephone survey using a semi-structured interview was performed between September 2018 and April 2019 among a random sample of community pharmacists. Results: Almost two thirds (61.5%) correctly answered that the overuse of antibiotics in primary care, hospital settings, and veterinary medicine is a significant cause of antibiotic resistance. Males, those who worked a lower number of hours per week, and those who acquired information through scientific journals and educational activity were more likely to know that the overuse of antibiotics causes antibiotic resistance. More than two thirds of those pharmacists (70.8%) often or always inform the public about the risks of antibiotic resistance. Those who have been practicing for a higher number of years were more likely to act in that way, whereas pharmacy directors and those who did not need additional information on antibiotic resistance were less likely to inform the public. Conclusions: Pharmacists need to be aware of the issue of antibiotic resistance and policy makers should promote the implementation of antibiotic use public educational interventions in this setting.
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Abdelaziz AI, Tawfik AG, Rabie KA, Omran M, Hussein M, Abou-Ali A, Ahmed ASF. Quality of Community Pharmacy Practice in Antibiotic Self-Medication Encounters: A Simulated Patient Study in Upper Egypt. Antibiotics (Basel) 2019; 8:E35. [PMID: 30939797 PMCID: PMC6627069 DOI: 10.3390/antibiotics8020035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 12/21/2022] Open
Abstract
Antibiotic misuse, either by patients or healthcare professionals, is one of the major contributing factors to antimicrobial resistance. In many Middle Eastern countries including Egypt, there are no strict regulations regarding antibiotic dispensing by community pharmacies. In this study, we examined antibiotic dispensing patterns in Egyptian community pharmacies. About 150 community pharmacies were randomly chosen using convenience sampling from the five most populous urban districts of Minia Governorate in Egypt. Two simulated patient (SP) scenarios of viral respiratory tract infection requiring no antibiotic treatment were used to assess the actual antibiotics dispensing practice of. Face-to-face interviews were then conducted to assess the intended dispensing practice. Descriptive statistics were calculated to report the main study outcomes. In 238 visits of both scenarios, 98.3% of service providers dispensed amoxicillin. Although stated otherwise in interviews, most pharmacy providers (63%) dispensed amoxicillin without collecting relevant information from presenting SPs. Findings showed high rates of antibiotic misuse in community pharmacies. Discrepancies between interviews and patient simulation results also suggest a practice‒knowledge gap. Corrective actions, whether legislation, enforcement, education, or awareness campaigns about antibiotic misuse, are urgently needed to improve antibiotic dispensing practices in Egyptian community pharmacies.
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Affiliation(s)
- Abdullah I Abdelaziz
- Department of Pharmaceutics, Faculty of Pharmacy, Minia University, Minia 61519, Egypt.
| | - Abdelrahman G Tawfik
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Deraya University, Minia 61512, Egypt.
| | | | | | - Mustafa Hussein
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
| | - Adel Abou-Ali
- Global Safety Officer at Sanofi Pasteur, Toronto Area, ON M2R 3T4, Canada.
| | - Al-Shaimaa F Ahmed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt.
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