Antimicrobial utilization in an Iraqi province: a comprehensive evaluation of antibiotic source and cost

Assessment of antimicrobial drugs employed at government-operated hospitals in central and northern provinces of Iraq

OBJECTIVE

Aim: To document the clinical patterns of antibiotic prescriptions in government hospitals, where the majority of physicians possess a degree-based training.

PATIENTS AND METHODS

Materials and Methods: A Retrospective cross section study carried out between 1/7/2022 and April 2023 that enrolling 300 patients from governmental hospitals from different provinces of Central and northern Iraq. The research form contained 15 fields divided into three sections. The first section contains social information such as age, gender, field of work, Residence and education. The second part consists of diagnosis and lab. Finding. The third part related to antibiotic uses: Number of AB prescribed, duration of using, type of use, route of administration, AB interaction, dose administration of AB, indication of Ab, and Class of AB.

RESULTS

Results: A total of 300 eligible patients, 165 patients (55.0%) were male and 135 (45.0%) were female, patients were <20 years ages were 117 (39.0%), 25 (8.3%) from the 20-29 years age group, 40-49 years ages were 28 (9.3%) and >50 years ages were 105 (35.0%) were which belong to the pediatric population. The 198 patients (66.0%) were used cephalosporins and 106 (53.5%) of them used alone. A 13-19% percentage of patients had used penicillin, carbapenem, anti-fungal, and aminoglycoside in combination form.

CONCLUSION

Conclusions: The implementation of clinical guidelines, the provision of direct instruction, and the regular dissemination of antibiogram data have the potential to encourage a more judicious consumption of antibiotics.

A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study

BACKGROUND

The widespread use and misuse of antimicrobials are the major driving factor for antimicrobial resistance (AMR) that threatens the health of human beings globally. Thus, monitoring antimicrobial consumption at national level is crucial to prevent and contain AMR. Nevertheless, there is no well-established system for recording and reporting of antimicrobial consumption in Ethiopia. Hence, the national antimicrobial consumption survey was conducted to generate evidence for decision-making on the appropriate use of antimicrobials in Ethiopia and tackle AMR.

METHODS

All imported and locally manufactured antimicrobials from 2017 to 2019 were from the Ethiopian Food and Drug Authority and local manufacturers database, respectively. Data were collected and analyzed descriptively in accordance with the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) and defined daily doses (DDD) classification and methodology.

RESULTS

The average DDD/1,000 inhabitants for all antimicrobials was 15.36. The DDD/1,000 inhabitants fell down sharply from 37.03 in 2017 to 4.30 in 2018, before slightly rising to 4.75 in 2019. The majority of the consumed antimicrobials were comprised of oral antimicrobials (98.6%), while parenteral antimicrobials made up 1.4%. Tetracyclines (35.81%), fluoroquinolones (20.19%), macrolides (13.92%), antiretrovirals (10.57%), and cephalosporins (9.63%) were the most frequently consumed classes of antimicrobials during the three years period. About 75.83% of the consumed antimicrobials fall under the WHO AWaRe classification and 67.87% of antimicrobial consumption was from the WHO Access class medications, with Watch and Reserve classes accounting for 32.13% and <1%, respectively. Similarly, about 86.90% of the antimicrobials fall under the Ethiopian AWaRe classification, with Access, Watch, and Reserve accounting for 87.73%, 12.26%, and <1%, respectively.

CONCLUSION

Due to the peculiarities of our settings, our findings may have some similarities and differences with similar studies from other countries. Hence, we recommend for all concerned bodies to work collaboratively to improve monitoring of antimicrobial consumption at different levels of the Ethiopian healthcare tier system. Future work is necessary to establish a strong system of reporting of antimicrobial consumption patterns in Ethiopia.

Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study

Objective

This study aimed to understand the dispensing practice of antibiotics in community pharmacy in Iraq, in addition to explore the community pharmacists' perception about dispensing antibiotics without prescription.

Methods

A qualitative design was conducted on community pharmacists in Baghdad, Iraq. Pharmacists were selected conveniently from different gender, age group, pharmacy type and years of experience. Face-to-face semi-structure interview was used with all the pharmacists to get in-depth understanding about their dispensing practice of antibiotics without prescription in community pharmacy. The data was coded and classified for thematic analysis.

Results

This study found that dispensing of antibiotics without prescription was a common practice in community pharmacy. Pharmacists' perception towards dispensing antibiotics without prescription was associated with the medical condition, safety and efficacy of antibiotics, patients request antibiotics by name, emergency cases, regular customer, promotions from pharmaceutical companies, saving time and cost, brand medications, and poor healthcare services. In addition, there were inadequate knowledge about antibiotic resistance and lack of awareness about antibiotic stewardship leading to inappropriate dispensing practice.

Conclusions

Community pharmacists have poor perception towards dispensing antibiotics without prescription. Educational interventions about antibiotics use focusing on community pharmacists are needed. This will help to optimize the practice of dispensing of antibiotics in the community. In addition, training programs about antibiotic resistance are important to enhance pharmacists' understanding about antibiotic stewardship.

Evaluating Factors Related to the Abuse of Oral Corticosteroids among Community Pharmacy Customers: Using Theory of Reasoned Action

Introduction:

Although it is discouraged, community pharmacy customers can obtain oral corticosteroids (OCSs) without prescriptions from some community pharmacies in Iraq. Medication abuse is defined as the use of medication for non-medical reasons.

Objectives:

The study aimed to determine demographics, beliefs, and perceptions associated with the abuse of oral corticosteroids for non-illness reasons among community pharmacy customers.

Methods:

This cross-sectional study was conducted in fall 2018 in four provinces in Iraq. Customers of 19 community pharmacies asking for OCSs for themselves without a prescription were administered a paper survey. This study used the Theory of Reasoned Action (TRA) to measure the relationship between the motivational factors and the abuse of OCSs. Logistic regression analysis was conducted to evaluate the relationships between the use of OCSs for non-illness and six TRA factors: Normative belief, behavioral belief, evaluation of the behavior, motivation to comply, subjective norms and attitude toward behavior.

Results:

The study enrolled 141 participants (98 women and 43 men) taking asking for OCSs without prescription. Dexamethasone was the most commonly used OCSs (59.6%). Friends were the primary recommenders for corticosteroids abuse (28.4%). The main reasons for using OCSs were to increase appetite and gain weight (53.9 %). Approximately one-third (36.2 %) of the participants gained weight after using OCSs. The regression analysis of the TRA variables showed two factors were significantly related to the abuse of OCSs. Age had a significant inverse relationship with the abuse of OCSs and the "good appearance" belief had a significant positive association with OCS abuse.

Conclusion:

Some Iraqi community pharmacy customers use non-prescribed oral corticosteroids to increase appetite and gain weight. Improve body appearance represents the dominant incentive that urges people to use OCSs without prescription. Health officials and healthcare practitioners need to promote people's awareness about the risks of misusing OCSs through education programs and advertisements in public health settings, media, and social media.

Influence of Pharmacy Characteristics and Customer Quality of Life on Satisfaction of Community Pharmacy Customers

OBJECTIVES

The study objectives were to evaluate customer satisfaction with community pharmacy services and measure the relationships between customer satisfaction and pharmacy/pharmacist characteristics and customer quality of life.

METHODS

This was a cross-sectional survey of a convenience sample of customers at 20 community pharmacies in 10 different geographical areas in Baghdad city between May and September 2018. We used the satisfaction items which were developed by Paterson and colleagues in 2013. The survey also assessed customer quality of life (QoL) with 12 QoL items.

RESULTS

The study recruited 400 pharmacy customers. Overall, customers reported good satisfaction with community pharmacy services. The most three satisfying aspects were the professional appearance of the pharmacy, the professionalism of pharmacy staff and explanations of possible adverse medication effects. Three customer characteristics were associated with high satisfaction rates including male gender, buying medications without a prescription, and seeking services for themselves. Three pharmacy characteristics increased the customer satisfaction rate including the availability of female pharmacists, having more than one pharmacist, and whether the pharmacy is open full time. For quality of life, patients who had a limitation in their activities and those who accomplished less than they would like were less satisfied with pharmacy services.

CONCLUSIONS

To improve pharmacy services, pharmacists need to enhance their professional appearance, allocate more time for patient counselling, help patients to manage their medications and extend their working hours to meet customer needs.