In-home Drug Storage and Self-medication with Antimicrobial Drugs in Basrah, Iraq

Storage practice and wastage of pharmaceuticals in Chinese urban-dwelling households: Description of urban-dwelling households

At-home storage of medications could pose a threat to public health and the environment if not handled appropriately. Excessive storage also creates health care and economic burdens. This study investigated storage practices, waste, and their determinants in China. Data were collected by pharmacy staff of urban-dwelling households via online questionnaires. Descriptions at the household and medicine levels were conducted in Stata 16. Individual and family characteristics were associated with the presence of household medicine storage (84.6%, n = 5290), but storage location was poor. Expiration was the primary reason for discarding medicines. Respondents were inclined to buy medicines in pharmacies without prescription for storage purposes at out-of-pocket expenses, and 60.7% of medicines were purchased at out-of-pocket expenses, despite medical insurance coverage. Regarding wastage, 11.2% of medicines had expired and 38.2% were no longer needed. Purchasing for storage purposes was related to less waste due to expiration, while purchasing for treating acute diseases rather than chronic diseases was related to more waste, due to less for use. Accounting for 12.2% of all medications, antibiotics were associated with expiration and no further need for use. Source-control measures targeting health facilities, pharmacies, and residents are needed under the combined efforts of all relevant departments.

Household storage and disposal of unused and expired medicines in Dessie, Ethiopia: a cross-sectional study

Introduction

Households frequently store unwanted, unused, or expired medicines in their homes indefinitely or discard them through general municipal waste bins, sinks, or flush them into their toilets. Disposing unused or expired medicines through these unauthorized channels can affect the environment and lives of individuals. This study assessed the household storage and disposal practices of unused and expired medicines in the Dessie City Administration in northeast Ethiopia.

Methods

A community-based cross-sectional study was conducted using a semi-structured interview. The data were collected during November 1-30, 2019. A Multistage sampling technique was employed to recruit participants. The data were analyzed using SPSS version 23.

Results

The study found that 62.4% of households stored unused or expired medicines, with analgesics, antibiotics, and cold and flu drugs being the most commonly used. The primary reasons for storing these medicines included future use, discontinuation of medication, and sharing with others, if needed. Most people preferred to dispose of these medicines by trashing them in household garbage, while some disposed of them in their original form and a few diluted them with water before disposal. Multivariate logistic regression analysis identified key factors associated with medicine storage: housewives and government employees were less likely to store unused medicines compared to students and daily workers, and obtaining medicines from private dispensaries was linked to reduced storage. Additionally, households that received advice from physicians were less inclined to store unused medicines.

Conclusion

This revealed the widespread storage of unused medicines, primarily analgesics and antibiotics. Improper disposal practices are common and emphasize the need for public education. Employment status, source of medicines, and healthcare advice influenced storage behaviors. Healthcare providers play a vital role in improving medication management and reducing waste.

Patients' knowledge, attitude, and practices toward unused medications in Qatar: A cross-sectional survey

Background

Global evidence has linked unused medications and their inappropriate disposal to adverse health, economic, environmental, and ethical impacts. However, such evidence is scarce in Qatar. This study explored patients' knowledge and attitude toward unused medications and their practices toward medication supply and disposal (KAP) in Qatar.Materials and methods.

Study design

A cross-sectional survey using a pretested questionnaire was performed between February 2020 and October 2020. Descriptive statistics, Man Whitney U, and Kruskal-Wallis Rank-Sum tests were applied. The Chi square test assessed the association between socio-demographic characteristics and KAP scores. Characteristics that were found significantly associated with KAP (i.e., p-values <0.05) were further included as predictor variables in the multiple linear regression model.

Results

All items pertaining to patients' knowledge were found to be good (mean score > 3), except for "awareness of unwanted medication return policy" (mean score < 3), i.e., the lowest level of patient agreement (31 %) (median (M) = 3, Interquartile Range (IQR) = 3). Their attitude was generally good (mean score > 3). Conversely, their practice toward medication supply was poor (mean score < 3). Possible future use was the most reported reason (79 %) for keeping medications at home, and home trash was the most widely disposing place of unused ones (76 %). Knowledge was significantly higher among non-laborers and other occupations than among patients with no work (p < 0.001) and (p = 0.005), respectively. The attitude was significantly lower among patients with healthcare providers (HCPs) in their household than among those without (p = 0.001). Practices were also significantly lower among those aged 40-49 years and those with HCPs in their household than those aged 18-29 years (p = 0.012) and those without HCPs, (p < 0.001), respectively.

Conclusions

Overall, patients' knowledge and attitude toward unused medications seem good, while their practices toward medication supply and disposal are bad. To mitigate the health, economic, and environmental impacts of unused medications, interventions including rationalizing drug supply, use, disposal, prescribing, manufacturing, and promotion are recommended.

Prevalence and determinants of household medicine storage in Vietnam: A community-based cross-sectional study

Objectives

The COVID-19 pandemic has significantly impacted individual health, potentially increasing the demand for home medicine storage. However, inappropriate household medicine storage can lead to drug waste and unnecessary hazards. This study aimed to explore the prevalence of and identify the factors that predict medicine storage in Vietnamese households.

Methods

A community-based cross-sectional study was conducted with 800 households in Danang, Vietnam. A multi-stage sampling method was applied in this study. The data collection tool was modified from previous studies and consisted of three sections: household head characteristics, household characteristics, and medicine storage practice. Bivariable and multivariable binary logistic regression analyses were used to identify the factors influencing medicine storage at a p-value of less than 0.05.

Results

Among 800 households surveyed, 71.6% stored medicine. Analgesics-antipyretics were the most common type of medicine stored (80.8%). 90.1% of households obtained their medicines from private pharmacies, 68.1% of households stored medicine for future use and 58.8% had a home medicine cabinet. 9.4% of households did not store medicine in the appropriate packaging and 19.4% of households did not check the expiry date of their medicine. Educational level (AOR = 2.74; 95% CI = 1.84-4.06), income (AOR = 11.38; 95% CI = 1.46-88.79), presence of chronic illnesses (AOR = 12.44; 95% CI = 7.20-21.21), presence of children (AOR = 2.36; 95% CI = 1.56-3.58), presence of healthcare professionals (AOR = 2.14; 95% CI = 1.28-3.56) were predictors of the medicine storage.

Conclusions

The current study found a high prevalence of household medication storage and some inappropriate storage behaviors. Therefore, attention should be given to develop effective interventions and policies to promote safe and appropriate storage practices.

Bacterial profile, antimicrobial resistance, and molecular detection of ESBL and quinolone resistance gene of uropathogens causing urinary tract infection in the southeastern part of Bangladesh

Humans frequently contract urinary tract infections (UTIs), which can be brought on by uropathogens (UPs) that are multi-drug resistant. Treatment for UTIs brought on by pathogenic UPs that produce extended-spectrum lactamases (ESBLs) is more costly and potentially fatal. As a result, the objective of this study was to use culture, biochemical, and 16S rRNA sequencing to identify and characterize UPs isolated from outpatients in Noakhali, Bangladesh, who had symptoms of UTIs. ESBL gene identification and quinolone resistance gene typing were then performed on the isolates using polymerase chain reaction (PCR). Throughout the trial's 8-month duration, 152 (76%) of 200 urine samples were positive for the presence of UPs. The overall number of UPs recovered was 210, with 39 individuals having multiple UPs present in their samples. Among all of the isolates, Escherichia coli (45.24%, 95/210; 95% confidence interval (CI): 35.15-57.60%), Enterobacter spp. (24.76%, 52/210; CI: 19.15-35.77%), Klebsiella spp. (20.95%; 44/210; CI: 15.15-30.20%), and Providencia spp. (9.05%; 19/210; CI: 4.95-19.25%) were the four most prevalent bacteria found in the isolates. The UPs displayed a very high level of resistance to piperacillin 96.92% (126/130), ampicillin 90% (117/130), nalidixic acid 77.69% (101/130), cefazolin 70% (91/130), amoxicillin 50% (55/130), cefazolin 42.31% (55/130), nitrofurantoin 43.08% (56/130), and ciprofloxacin 33.08% (43/130), whereas resistance to netilmicin (3.85%), amikacin (4.62%), and imipenem (9.23%) was low. Individually, every species of E. coli and Providencia spp. showed greater ampicillin, amikacin, cefazolin, cefazolin, and nalidixic acid resistance than the others. The bivariate results indicate several antibiotic pairings, and isolates had meaningful associations. All MDR isolates were subjected to PCR, which revealed that blaCTX-M-15 genes predominated among the isolates, followed by the blaTEM class (37%). Isolates also had the qnrS, aac-6´-Ib-cr, and gyrA genes. The findings provide worrying indications of a major expansion of MDR isolates in the study locations, particularly the epidemiological balCTX-M 15, with the potential for the transmission of multi-drug-resistant UP strains in the population.

Assessment of home storage of antimicrobials and its predictors in Mecha demographic surveillance and field research center: a cross-sectional study

BACKGROUND

Home storage of antimicrobials is a worldwide practice. Irrational storage and inappropriate use of antimicrobials should get special attention in low-income countries due to limited information, knowledge, and perceptions. This study was conducted to survey home storage of antimicrobials and assess its predictors in Mecha Demographic Surveillance and Field Research Center (MDSFRC), Amhara region, Ethiopia.

METHODS

A cross-sectional survey was conducted on 868 households. Predeveloped structured questionnaire was used to collect data on sociodemographics, knowledge on antimicrobials and perception about home stored antimicrobials. Data was analyzed using SPSS version 20.0 to execute descriptive statistics, and run binary and multivariable binary logistic regression. P-value < 0.05 was considered significant at 95% confidence level.

RESULTS

The total number of households included in this study were 865. Female respondents represent 62.6%. The mean age (±) of respondents was 36.2 (± 13.93) years. The mean family size (±) of the household was 5.1 (± 2.5). Nearly one-fifth (21.2%) of the households stored antimicrobials at home with a condition similar to any household material. Most commonly stored antimicrobials were: Amoxicillin (30.3%), Cotrimoxazole (13.5%), Metronidazole (12.0%), and Ampicillin (9.6%). The most common immediate source of home stored antimicrobials was discontinuation of therapy (70.7%) either from symptomatic improvement (48.1%) or missing doses (22.6%). Predictors of home storage of antimicrobials with corresponding p-value were: age (0.002), family size (0.001), education status (< 0.001), home distance from the nearby healthcare institution (0.004), counseling while obtaining antimicrobials (< 0.001), knowledge level on antimicrobials (< 0.001), and perception of home stored antimicrobials as a wisdom (0.001).

CONCLUSION

Substantial proportion of households stored antimicrobials in a condition that may exert selection pressure. To reduce home storage of antimicrobials and its consequences, stakeholders should give due attention to predictors variables related to sociodemographics, level of knowledge on antimicrobials, perception of home storage as a wisdom, and counseling service.

A scoping review of global aminoglycoside antibiotic overuse: A potential opportunity for primary ototoxicity prevention

BACKGROUND

Aminoglycosides are widely used, broad-spectrum antibiotics with significant potential for ototoxicity. Global efforts to prevent ototoxicity must account for aminoglycoside overuse and non-prescription use.

OBJECTIVES

The goals of this study were to a) estimate the prevalence of aminoglycoside overuse by synthesizing evidence on self-medication, over the counter (OTC) availability, and household antibiotic storage for later use, and to report the specific aminoglycosides used and the predictors of overuse, and b) leverage this information to comment on potential risk of ototoxicity.

METHODS

Two systematic search strings were conducted to extract peer-reviewed articles published from 2005 to 2020. The first focused on overuse of aminoglycoside antibiotics. The second focused on potentially ototoxic effects of aminoglycosides related to drug overuse.

RESULTS

A total of 26 articles were included (first search string: n = 21; second search string: n = 5). The prevalence of aminoglycoside self-medication was high and household storage and OTC availability of aminoglycosides was common. Gentamicin was the most commonly overused aminoglycoside. No studies provided information on antibiotic dosing or resultant toxicities, including ototoxicity.

CONCLUSIONS

The limited available evidence indicates that antibiotic overuse (self-medication, home storage, and non-prescription availability) is relatively common, especially in low resource settings, and that aminoglycoside antibiotics comprise a variable, but concerning, proportion of non-prescribed antibiotics. Additional evidence is needed to evaluate the relationship between these dispensing patterns and ototoxicity.

Knowledge, attitude and practices of residents toward antimicrobial usage and resistance in Gondar, Northwest Ethiopia

BACKGROUND

Antimicrobials are essential for human and animal health. Drug resistance to an antimicrobial agent follows the introduction of a new antimicrobial agent. Evidence suggests that the public plays an important role in the risk, increase, and spread of antimicrobial resistance. This study aimed to assess the knowledge, attitudes, and practices of the Gondar City residents regarding antimicrobial use and resistance.

METHODS

A cross-sectional study was conducted from April to July 2021 on 400 randomly selected Gondar city residents using a pretested semi-structured questionnaire. The descriptive and chi-square tests were used to analyse the data.

RESULTS

The response rate was one hundred percent. Approximately 75% of respondents were men, with 32% having completed secondary school. Nearly 74% and 35% of participants were married and worked in various government jobs. Furthermore, 48%, 54%, and 50% of respondents, respectively, had moderate knowledge, a positive attitude, and good practice concerning antimicrobial use and resistance. The chi-square analysis revealed a significant (p < 0.05) disparity between knowledge and educational level, marital status, and position in the house. The respondents' attitude levels were also significantly associated (p < 0.05) with their educational level, marital status, occupation, and position in the house. Respondents' practice levels were also significantly associated (p < 0.05) with their educational level and occupation. The study also found a significant relationship between respondents' knowledge and attitude (χ2 = 215.23, p ≤ 0.01), knowledge and practice (χ2 = 147.2, p ≤ 0.01), and attitude and practice (χ2 = 116.03, p ≤ 0.01).

CONCLUSION

This study found that study participants had some misconceptions about antimicrobial use and resistance. As a result, both enforcing antimicrobial regulation and educating people about antimicrobial use are advised.

Evaluation of Prescription Medication Sharing Among Adults in South Korea: A Cross-Sectional Survey

Background: Prescription medication sharing is an inappropriate medication use behavior that can lead to medication errors and adverse drug events, posing a public health threat. The reported prevalence of prescription medication lending and borrowing varies by country, ranging from 6%–23% and 5%–52%, respectively. However, research on medication sharing is scant in Asian countries. Therefore, this study aimed to describe the rate of prescription medication sharing practices and investigate the associated behavioral factors, types of shared medications, and reasons for sharing among adults in South Korea.

Methods: A cross-sectional study was conducted using an online self-administered survey of 1,000 adults (aged 19–69 years; November 2020). A stratified sampling method was used to select survey participants from a nationwide consumer panel, which ensured a representative distribution of the Korean population by age, gender, and region. Descriptive and logistic regression analyses were used to evaluate the information related to sharing behavior.

Results: A total of 1,000 respondents participated in this study. The mean age of the respondents was 44.7 years (standard deviation [SD], 13.4), ranging from 20 to 69 years. The rate of medication sharing was 52.4%. The most prevalently shared medications were analgesic, antipyretic, and antimigraine medications. Prescription medications were shared mostly between family and relatives. Older age was a predictive factor for sharing analgesics. Lower educational level was a predictive factor for sharing ophthalmic medications.

Conclusions: Approximately one in two respondents in our study have experienced medication sharing in their lifetime. Future studies are needed to establish evidence-based strategies for patient education and improve the medication use process. Healthcare professionals should assess patients’ needs for accessing medications and be ready to educate and guide them with specific action plans. Policymakers should consider patient empowerment strategies including public education and campaigns to avoid potential adverse outcomes of medication sharing.

Knowledge, attitude and practice of antibiotics and their determinants in Eritrea: an urban population-based survey

OBJECTIVE

To measure knowledge, attitude and practice of antibiotics and antibiotic resistance (ABR) and their determinants in the Eritrean urban population.

DESIGN

A population-based, nation-wide, cross-sectional study.

SETTING

Urban settings of Eritrea.

PARTICIPANTS

Members of the general public aged ≥18 years and living in 13 urban places of Eritrea. Three-stage stratified cluster sampling was used to select the study participants.

DATA COLLECTION AND ANALYSIS

Date were collected from July 2019 to September 2019 in a face-to-face interview using a structured questionnaire. The collected data were double entered and analysed using Census and Survey Processing system (V.7.0) and SPSS (V.23), respectively. Descriptive statistics, χ² test, t-tests, analysis of variance, factorial analysis and multivariable logistic regression were performed. All analyses were weighted and p<0.05 was considered significant.

PRIMARY AND SECONDARY OUTCOME MEASURES

Main outcome variables were knowledge, attitude and practice of antibiotics and ABR. Secondary outcome measure was the determinants of knowledge, attitude and practice.

RESULTS

A total of 2477 adults were interviewed. The mean score of knowledge and attitude of antibiotics and ABR was 10.36/20 (SD=3.51, minimum=0 and maximum=20) and 22.34/30 (SD=3.59, minimum=6 and maximum=30), respectively. Of those who used antibiotics, the proportion of at least one inappropriate practice (use of antibiotics without prescription and/or discontinuation of prescribed antibiotics before completing the full course) was 23.8%. Young age <24 years (adjusted odds ratio (AOR)=1.61, 95% CI: 1.08 to 2.41), male sex (AOR=1.48, 95% CI: 1.14 to 1.91), higher level of education (AOR=1.76, 95% CI: 1.08 to 2.88), and negative attitude towards appropriate use of antibiotics (AOR=0.95, 95% CI: 0.92 to 0.97) were found to be the significant determinants of inappropriate practice of antibiotics.

CONCLUSION

The gap in knowledge and inappropriate practice of antibiotics in the Eritrean urban population was widespread; requiring immediate attention from policy-makers and healthcare professionals.

Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys

Background

Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.

Methods

Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.

Results

From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.

Conclusions

Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11100-4.

Prevalence of Home Storage of Medicines and Associated Factors in Iraq

BACKGROUND: In most families around the world, medicines can be used to treat chronic or acute diseases. Simple access to medicines at home has led to high drug consumption rates for self-limiting diseases. Incorrect use of these home-stocked medications may also contribute to severe health risks, increase pathogens’ tolerance, prolonged distress, increased adversity, medication reactions, and delays in seeking adequate care if misdiagnosis occurs. Nothing is known about how Iraqi people store their medicines at home. AIM: The purpose of this study is to obtain data on the prevalence and related factors of drug storage in Diyala Governorate, Iraq. METHODS: A community-based cross-sectional descriptive study was conducted in Diyala Province, Iraq in July 2019. A total of 200 students participated in this study. A pre-tested standardized questionnaire was used to collect data and the analysis was performed using descriptive statistical methods. All the participants (100%) enrolled reported to keep medicines at their homes. RESULTS: The average number of drug users per household is 12.32%. Refrigerators are the main storage location (65%), followed by kitchen counters (33%). The majority of stored drugs were prescribed by physicians (78.5%) and the leading source of those drugs is a private pharmacy (55.71%). The most popular medicinal products stored were analgesics (23.1%), followed by antimicrobials (antibiotics, antibacterial, and antifungal) (19.44%). Among all medicines, currently used drugs accounted for 43.34%, remaining drugs accounted for 29.78%, and reserved drugs accounted for 26.87% for future use. The most common dosage forms of these drugs are tablets (21.16%) and capsules (20.95%). Most participants (82.5%) revealed that they always check the expiration date before use, and (37%) admitted to sharing drugs with others. CONCLUSION: The prevalence of drug storage in households in the Diyala Governorate of Iraq is high because all participants keep drugs at home. Regardless of the method used, these drugs should be retained, and proper storage procedures and conditions are rarely observed.

Development, translation, and validation of a bilingual questionnaire on unused medications in homes

Background

Unused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients’ KAP towards unused medications in homes may help manage the associated risks.

Objective

To develop, translate, and validate a questionnaire for the assessment patients’ KAP towards unused medications in Qatar homes (i.e., QUM-Qatar).

Setting

This cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020.

Method

Nine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach’s alpha. Statistical analyses were performed using STATA 15 statistical software.

Main outcome measure

The psychometric properties of the QUM-Qatar assessment instrument.

Results

An English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach’s alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained.

Conclusion

The QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications.

Impacts on practice.•

There is now a valid and reliable English/Arabic language questionnaire to assess patients’ KAP towards unused medications.

•

Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal.

•

To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment.

Medications disposal and medications storage in Jordan: A cross-sectional study

AIMS

Many concerns arise from the improper disposal of medications, which is associated with a negative impact on health and wildlife. The majority of the consumers of pharmaceutical products remain unaware of the procedures of disposal of unused or expired medicines. This study aimed to explore the practices of Jordanian individuals regarding the disposal and storage of unused or expired medications.

METHODS

A cross-sectional study was conducted in Jordan for the period between July and November 2019 of patients who reported having unused, leftover or expired medications in their homes. The questionnaire tool was constructed based on a number of studies concerning medication recycling and international guidelines about correct and safe disposal of expired, unwanted or unused medication.

RESULTS

A total of 1092 participants were included in the study. Their mean age was 32.4 (SD = 13.6) years and 56.8% (n = 620) were males. More than half of the participants (58.1%, n = 634) reported that they had unused, leftover or expired medications in their homes. The bedroom, kitchen and store room were the three most commonly reported places for the storage of unused, leftover or expired medications. The pharmacist was the main source for information regarding the storage of medications. The three most common reasons reported by the participants regarding having unused/leftover medications at home were change or discontinuation by the doctor (29.4%), self-discontinuation as the illness symptoms improved or resolved (28.2%) and forgetfulness (25.1%).

CONCLUSION

A high percentage of the Jordanian population improperly handles their unused, leftover or expired medications. More restrictions are needed on the prescribing and dispensing of medications by the authorities concerned and there is a need to establish public guidelines regarding the use and correct disposal of pharmaceuticals.

Household Level Drug Utilization and Associated Factors in South Gondar Zone, North Western Ethiopia

Introduction

Methods

Results

Conclusion

Drug-Related Problems Identified at Patients' Home: A Prospective Observational Study in a Rural Area of Thailand

OBJECTIVE

The aim of the study was to examine the prevalence rates, nature, and predictors of drug-related problems (DRPs) experienced in participants living at home in a rural Thailand.

METHOD

A cross-sectional observational study was undertaken during December 2015 to January 2016. Drug-related problems were identified within a rural township having a population of 5256 by means of home visits by pharmacists. All suspected cases were then assessed for severity and preventability by clinical specialists. Drug-related problems were categorized according to Pharmaceutical Care Network Europe classification (revised 2010).v.6.2.

RESULTS

From a systematically recruited cohort of 359 participants, suspected DRPs were identified in 160 participants. After detailed reviews by clinical specialists, 141 cases (39.3%) were deemed to have DRPs. Types of DRPs with prevalence rates were the following: problems of treatment effectiveness (3.7% of DPRs), adverse reactions (15.3%), treatment cost (28.4%), nonadherence to drugs (42.1%), and poor drug storage (10.5%). The most common drug to involve DRPs was those treating cardiovascular disease, especially simvastatin.

CONCLUSIONS

Nearly half of community living participants experienced DRPs, especially nonadherence to drugs, and has implications for other rural elderly persons of low education attainment for similar rural economies around the globe. Appropriate interventions should focus on reducing polypharmacy, providing outreach programs, and rigorous pharmacovigilance.

Pharmacy students' knowledge and practices concerning the storing and disposal of household medication in Saudi Arabia

INTRODUCTION

Pharmacists, and thus pharmacy students, must participate in promoting awareness about proper storage and disposal of expired or unused medications. This study aimed to determine Saudi Arabian pharmacy students' knowledge and personal practices regarding storing and disposing of household medications.

METHODS

This was a descriptive, cross-sectional, questionnaire-based study of pharmacy undergraduates or postgraduates across Saudi Arabia. The online survey was distributed to a convenience sample of participants and supplemented with snowball sampling on social media.

RESULTS

Of 807 pharmacy students who viewed the questionnaire, 464 students completed it (response rate 57.5%). Common reasons for keeping medications included having left-over medication (74%) and self-discontinuation of therapy (63.5%). The majority of students (79%) stored their medication in a bedroom or kitchen. Gender-specific variables revealed a gender difference in storing and disposing of these medications. Many students reported previously discarding medicines in the garbage (89%) or giving them to someone else to use (22%). More than half of the sample (60%) had not received any information on how to store or dispose of medications.

CONCLUSIONS

The current practice and knowledge of Saudi Arabian pharmacy students regarding storage and disposal of household medications was inappropriate. Concerned authorities (e.g., Ministry of Health, Ministry of Education) should provide proper education to all students on the safe storage and disposal of medications, which may necessitate curriculum reform.

Sociodemographic Determinants of Healthcare-Seeking Options and Alternative Management Practices of Childhood Diarrheal Illness: A Household Survey among Mothers in Iraq

Diarrhea remains a significant cause of child morbidity and mortality in Iraq. The objective of this study was to examine the current practices of home-based management of diarrheal illnesses among Iraqi children. We surveyed mothers of children aged less than 5 years to identify the sociodemographic factors associated with maternal healthcare-seeking practices. A total of 500 mother-child pairs were interviewed in a cross-sectional household survey in Thi-Qar Governorate, southeastern Iraq, between March 2016 and February 2017. Logistic and multinomial regression models were used to infer sociodemographic predictors of the healthcare-seeking and alternative management practices adopted by the mothers. The interviewees reported that 35.2% of their children had diarrhea in the 2 weeks before the survey. The least likelihood of reported occurrence of diarrhea was among mother-child pairs where the mothers had received university education, as compared with mothers who were illiterate or received only primary or secondary education. Lower odds (odds ratio = 0.4, P-value < 0.001) of reported childhood diarrhea was revealed among mothers aged > 25 years than among those younger. Self-ordered medicine from a pharmacy was the most preferred alternative management option in almost half (52.4% [262/500]) of the interviewed mothers in Thi-Qar. Interestingly, 69.6% (348/500) of the mothers reported supplying their children suffering from diarrhea with antibiotics. Relative to mothers with university education, those with high school education had more likelihood of selecting medical center (relative risk ratio [rrr] = 2.4) and pharmacy (rrr = 3.7) as against no treatment. Lower maternal educational level, mothers' age < 25 years, and the district of residence were important factors associated with diarrhea occurrence among children younger than 5 years. In light of the findings from this study, intervention aimed at improving healthcare seeking for managing diarrhea in Iraqi children should jointly consider the influence of mothers age, education, as well as the level of economic status of the communities in which mothers of these children reside. The results of this study indicate the need for enhancing public health education to improve the maternal management of diarrheal disease and the avoidance of unnecessary use of antimicrobials.

Towards Medicines Reuse: A Narrative Review of the Different Therapeutic Classes and Dosage Forms of Medication Waste in Different Countries

BACKGROUND

Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. To inch towards medicines reuse, it is important to know more about the different therapeutic classes and dosage forms that make up medication waste. For example, it is helpful to know if medicines being returned are mostly solid-dosage forms and thus have the potential to be reused or are from therapeutic classes that would make medicines reuse cost-effective. Little is known about the therapeutic classes and the dosage forms of wasted medicines. This study aimed to narratively review and report findings from the international literature on the different therapeutic classes and the dosage forms of medicines that are returned by patients to community pharmacies, hospitals, general practitioners' clinics, or collected through waste campaigns. Studies based on surveys without physically returning medicines were also included where relevant.

METHODS

A comprehensive electronic search of databases, including PubMed and Google Scholar, was carried out over one month in 2017 and updated by 5 November 2020, using a combination of carefully created keywords.

RESULTS

Forty-five studies published in English between 2002 and 2020, comprising data from 26 countries were included and reviewed. Oral solid dosage forms (mostly tablets) were the commonly reported dosage form of all wasted medicines in 14 studies out of the 22 studies (64%) that described the dosage form, with percentages ranging from 40.6% to 95.6% of all wasted medicines. Although there was variability among the levels of medication waste reported in different countries, findings from the UK and Ethiopia were relatively consistent; in these, medicines for the cardiovascular system and anti-infective medicines, respectively, were the most common therapeutic classes for medication waste.

CONCLUSION

This narrative review provides insights about the different therapeutic classes and dosage forms of medication waste either returned by patients, collected through waste campaigns, or indicated in survey responses. The findings could help policy makers understand the potential implications of treating most unused medicines as medication waste and whether therefore pursuing a medicines reuse scheme could be environmentally or financially logical. The quality and the safety of these returned medicines using criteria related to the storage conditions (such as heat and humidity), physical shape (such as being sealed, unopened, unused, and in blister packaging), and tampering are other important considerations for a medicines reuse scheme.

Association of knowledge and beliefs with the misuse of antibiotics in parents: A study in Beirut (Lebanon)

Background

Antibiotic resistance is a major public health concern. It has been associated with factors such as uncontrolled consumption, lack of knowledge, beliefs, and sociodemographic characteristics. Lebanon is characterized by high levels of antibiotic misuse, as almost half of the population self-medicates with antibiotics and over 30% of the antibiotics are dispensed without prescription. To-date, no studies determined adequately the association between knowledge, beliefs and antibiotic misuse in Lebanon.

Objective

To assess the association between level of knowledge and beliefs about antibiotics, and antibiotic misuse in Lebanon.

Methods

We conducted a cross-sectional study among 1,421 parents of schoolchildren using an anonymous self-administered Knowledge, Attitude and Practices questionnaire. The participants´ level of agreement with each item of knowledge and beliefs was measured using a Likert-type (0–10) scale. Misuse practices in the last month were detected through a series of questions aimed at determining the level of compliance with physicians´ instructions in terms of dosage and duration. Data were analyzed using logistic regression.

Results

277 participants (16%) acknowledged using antibiotics in the previous month, 41% of whom showed at least one misuse behavior. Misconceptions and beliefs about antibiotics substantially increased the odds of their misuse. For instance, participants who believed that antibiotics were effective in treating viruses, cold, or sore throat infections were twice as likely to misuse antibiotics [Adjusted Interquartile Odds Ratio (aIqOR): 2.08 (95%CI: 1.32, 3.19), aIqOR: 1.81 (95%CI: 1.41, 2.29), aIqOR: 2.19 (95%CI: 1.61, 2.93), respectively]. Parents who usually keep antibiotics at home antibiotics for future use were more likely to misuse antibiotics [aIqOR: 2.44 (95%CI: 1.68, 3.46)].

Conclusions

Our findings indicate that the low level of knowledge and the existence of erroneous beliefs about antibiotics are associated with increased odds of antibiotic misuse. Key elements including rationale prescription and control of dispensing should be addressed when designing educational campaigns against antibiotic misuse.

Consumers' awareness, attitude and associated factors towards self-medication in Hail, Saudi Arabia

Objectives

To determine the factors motivating the consumers towards self-medication, the intended indications and the consumers’ perceptions about complications that may arise due to its use.

Design

Cross-sectional community based prospective study

Place and duration of study

Community pharmacies located at various locations of Hail, Saudi Arabia from January 2019 to March 2019.

Methods

The subjects of this cross-sectional study were people visiting community pharmacies for self-medication. Data on 663 participants was collected through a validated questionnaire prepared on the basis of WHO guidelines for the regulatory assessment of medicinal products for use in self-medication. Two trained data collectors visited the randomly selected community pharmacies, approached and interviewed the consumers purchasing medicines without prescriptions. Data was entered in SPSS and analyzed using descriptive and inferential analyses (alpha level = 0.05).

Results

Out of 663 respondents, 68.6% were university graduates; and 33.9% were healthcare professionals. Consumers preferred self-medication mainly for headache (85.8%), cold and sore throat (80.8%), cough (75.7%) and fever (71.8%) with the justification that these illnesses were minor (90.2%), time saving (82.2%), convenient (74.7%), quicker relief (66.1%), and economical (61.2%). Occupation was significantly associated with the reasons for preferring self-medication (p<0.001). Similarly, age, gender and education were also significantly associated with most of the reasons for opting self-medication. People were quite aware about harmful consequences of self-medication. Multivariate logistic regression analysis showed that the respondents with lower education (AOR = 2.404 [95% CI: 1.579–3.661]), non-healthcare professionals (AOR = 1.712 [95% CI: 1.143–2.565]) and higher monthly income (AOR = 0.376 [95% CI: 0.236–0.599]) preferred self-medication (p <0.001, p = 0.009, p <0.001) respectively.

Conclusion

Self-medication was prevalent among young university graduate males for minor ailments mainly due to convenience and time saving. Despite people beliefs about the harmful consequences of self-medication, its use was omnipresent particularly among the respondents with lower education, non-healthcare professionals and people with higher monthly income.

Self-Medication Practice and Associated Factors Among University of Gondar College of Medicine and Health Sciences Students: A Cross-Sectional Study

PURPOSE

Self-medication is the use of medicines by individuals to treat self-recognized illnesses or symptoms without any medical supervision. Such practices may cause antimicrobial resistance, which causes treatment failure, economic loss, serious health hazards, missed diagnosis, delayed appropriate treatment, drug dependency, and adverse drug effects. However, empirical evidence is limited to the current status of its practices and associated factors among university students. Thus, the aim of this study was to assess the magnitude and associated factors of self-medication practices among medicine and health science students at the University of Gondar.

METHODS

An institution-based cross-sectional study was employed from February to March 2017. A total of 792 randomly selected students were surveyed with a self-administered structured questionnaire. Epi Info version 7 and SPSS version 20 were used for data entry and analysis, respectively. Binary logistic regression analysis was performed. In multivariable analysis, P-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to identify associated factors.

RESULTS

Self-medication practice was found to be 52.4% (95% CI: (49%, 56%)) among university students. For most students, the major reason for using self-medication was taking the illness as less serious (71.1%). Females (AOR: 1.48; 95% CI: 1.08-2.01), income category (USD 44.01-175.87) (AOR: 0.47; 95% CI: 0.29-0.78), sixth year students (AOR: 8.71; 95% CI: 4.04-18.77) and health officer students (AOR: 2.36; 95% CI: 1.20-4.63) were found to be significantly associated with self-medication practice.

CONCLUSION

More than half of the students practiced self-medication, which is moderately higher than other findings. Gender, income, year of study, and field of study were the major factors that affected self-medication. Therefore, interventions that can halt the high magnitude of self-medication and factors associated with it are crucial. Special attention should be given to students who stay in the university for longer years.

Influence of leftover antibiotics on self-medication with antibiotics for children: a cross-sectional study from three Chinese provinces

OBJECTIVES

To investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and pharmaceutical purchases.

DESIGN

A cross-sectional questionnaire study.

SETTING

The participants were approached through kindergartens and primary schools as well as in vaccination clinics.

PARTICIPANTS

A total of 9526 parents from three Chinese provinces whose children were aged 0-13 years completed the survey.

OUTCOME MEASURES

The prevalence of keeping antibiotics at home for children and the proportion of leftover antibiotics from two main sources were measured by a self-administrated questionnaire. Logistic regression models were established to examine the association between keeping antibiotics at home and SMA for children, specifically the risks of leftovers from two main sources.

RESULTS

Overall, 4580 (48.1%) reported keeping antibiotics at home for children. Among those who had leftovers, 2891 (63.1%) reported that their leftovers came from previous prescriptions and 1619 (35.3%) reported that their leftovers came from pharmaceutical purchases. Mothers, older age of child, higher household income, higher education level and medical background were significantly associated with keeping antibiotics at home. Keeping antibiotics at home was significantly associated with SMA for children (adjusted OR=4.91, 95% CI 3.84 to 6.28). Particularly, compared with parents who did not keep antibiotics at home, parents who kept leftover antibiotics from previous prescriptions and those whose leftovers came from pharmaceutical purchases were 3.80 (95% CI 2.89 to 5.00) and 6.45 (95% CI 4.89 to 8.51) times more likely to engage in SMA for children, respectively.

CONCLUSIONS

Keeping antibiotics at home for children was pervasive in China. Most leftovers came from previous prescriptions, while those from pharmacies had a higher risk of SMA for children.

Low dose oral beta-lactamase protects the gut microbiome from oral beta-lactam-mediated damage in dogs

Antibiotics, while lifesaving, damage the gut microbiome and can precipitate proliferation of pathobionts. A strategy to preserve gut microbiome integrity is to eliminate biologically active antimicrobials excreted into the gastrointestinal tract (GI) without negatively affecting antibiotic therapeutic efficacy. Clinical proof of concept was achieved with SYN-004 (ribaxamase), a beta-lactamase enzyme formulated for oral delivery with intravenous penicillins and cephalosporins. Ribaxamase inactivated intestinal ceftriaxone, protected the gut microbiome, and significantly reduced the incidence of Clostridioides difficile disease. For use with oral beta-lactam antibiotics, a delayed release formulation of ribaxamase, SYN-007, was engineered for dissolution in the lower small intestine distal to the site of oral antibiotic absorption. In dogs that received oral amoxicillin, SYN-007 reduced microbiome disruption without interfering with amoxicillin systemic absorption. Here, a study to determine the lowest effective dose of SYN-007 was performed. Dogs received amoxicillin (40 mg/kg, PO, TID) +/− SYN-007 (PO, TID) at three doses, 10 mg, 3 mg, or 1 mg for five days. Serum amoxicillin levels, measured after the first and last antibiotic doses, were not significantly different +/−SYN-007 at all dose levels indicating that SYN-007 did not interfere with amoxicillin systemic absorption. Microbiome analyses demonstrated that amoxicillin significantly reduced bacteria richness and microbiome diversity resulting in altered microbiome composition. However, with all doses of SYN-007, microbiome richness and diversity were not significantly different from pretreatment and changes in microbiome composition were attenuated. These data demonstrate that effective SYN-007 doses can be reduced at least 10-fold while maintaining gut microbiome preservation. The potential to employ low SYN-007 doses to protect the gut microbiota has important implications for enhancing therapeutic outcomes for patients receiving oral beta-lactam antibiotics while simultaneously reducing cost per dose and ultimately, healthcare expenses.

Postreconstitution Stability of Amoxicillin-Clavulanic Acid Suspensions at Tropical Room Temperature

The storage conditions of reconstituted β-lactam suspensions are of concern, especially in tropical countries. Improper storage conditions after reconstitution lead to administration of a subtherapeutic dose of medication, which in turn leads to treatment failure and antibiotic resistance.

Pediatric Antibiotic Pack Size Compliance With the Dosage Regimen: A Descriptive Study

BACKGROUND

The unavailability of appropriate pediatric drug pack size is a global issue. Antibiotics are the lifesaving and most frequently prescribed therapeutic agents given to pediatrics. The objective of this study was to assess the compliance of pediatric antibiotic pack size with the standard dosage regimen.

METHODS

A descriptive study design was employed. Data were collected from a community pharmacy in Bahawalpur, Pakistan, between August 1, 2017, and September 30, 2017. Five most commonly prescribed antibiotics were selected and calculations were made to check the appropriateness of packaging size by comparing the quantity of product in the available pack with the dosage regimen recommended by the British National Formulary for Children (BNFC).

RESULTS

Only 16 clarithromycin, 9 amoxicillin, 1 cefotaxime, and 1 metronidazole packaging sizes were sufficient to meet the dosage regimen for treatment. None of the available pack sizes for gentamicin matched the recommended duration of treatment. The study findings revealed that the available pack sizes either had leftover or a shortfall of antibiotic formulation. Highly inappropriate dosage forms (containing either excess and less quantity) of antibiotics were intravenous infusions and oral suspensions.

CONCLUSION

The study concluded that the packaging sizes of antibiotics failed to supply the recommended dosage regimen to pediatrics for common indications. This may contribute to development of antibiotic resistance among pediatric patients. Health policy makers should devise strict rules and regulations to ensure the availability of child-specific antibiotic pack sizes.

Childhood Diarrhoea in the Eastern Mediterranean Region with Special Emphasis on Non-Typhoidal Salmonella at the Human⁻Food Interface

Diarrhoeal disease is still one of the most challenging issues for health in many countries across the Eastern Mediterranean region (EMR), with infectious diarrhoea being an important cause of morbidity and mortality, especially in children under five years of age. However, the understanding of the aetiological spectrum and the burden of enteric pathogens involved in diarrhoeal disease in the EMR is incomplete. Non-typhoidal Salmonella (NTS), the focus of this review, is one of the most frequently reported bacterial aetiologies in diarrhoeal disease in the EMR. Strains of NTS with resistance to antimicrobial drugs are increasingly reported in both developed and developing countries. In the EMR, it is now widely accepted that many such resistant strains are zoonotic in origin and acquire their resistance in the food-animal host before onward transmission to humans through the food chain. Here, we review epidemiological and microbiological aspects of diarrhoeal diseases among children in the EMR, with emphasis on the implication and burden of NTS. We collate evidence from studies across the EMR on the zoonotic exposure and antimicrobial resistance in NTS at the interface between human and foods of animal origin. This review adds to our understanding of the global epidemiology of Salmonella with emphasis on the current situation in the EMR.

Molecular Detection and Epidemiological Features of Selected Bacterial, Viral, and Parasitic Enteropathogens in Stool Specimens from Children with Acute Diarrhea in Thi-Qar Governorate, Iraq

Knowledge of etiology causes of diarrheal illness is essential for development and implementation of public health measures to prevent and control this disease syndrome. There are few published studies examining diarrhea in children aged <5 years in Iraq. This study aims to investigate the occurrences and epidemiology of selected bacterial (Salmonella spp. and Campylobacter spp.), viral (adenovirus, norovirus GI and GII, and astrovirus), and parasitic (Entamoeba spp. and Giardia spp.) agents in stool samples from 155 child diarrheal cases enrolled between March and August 2017, in a hospital-based cross-sectional study in Thi-Qar, southeastern Iraq. Using molecular techniques and sequence-based characterization, adenovirus was the most frequently detected enteropathogen (53/155 (34.2%)), followed by Salmonella spp. (23/155 (14.8%)), Entamoeba spp. (21/155 (13.5%)), and Campylobacter spp. (17/155 (10.9%)). Mixed infection with Salmonella spp. and Campylobacter spp. was evident, and the same was revealed between various enteric viruses, particularly adenovirus and norovirus. The most frequent co-infection pattern was between adenovirus and Campylobacter spp., in seven cases (7/155 (4.5%)). Whole-genome sequencing-derived typing data for Salmonella isolates (n = 23) revealed that sequence type 49 was the most prevalent in this sample set (15/23 (65.2%)). To the best of our knowledge, this study provides the first report on detection and identification of floR, bla_CARB-2, and mphA antimicrobial resistance genes in Salmonella isolated from children in the Middle East region. Logistic regression analysis pointed to few enteropathogen-specific correlations between child age, household water source, and breastfeeding patterns in relation to the outcome of detection of individual enteropathogens. This study presents the first published molecular investigation of multiple enteropathogens among children <5 years of age in Iraq. Our data provide supporting evidence for planning of childhood diarrhea management programs. It is important to build on this study and develop future longitudinal case-control research in order to elaborate the epidemiology of enteropathogens in childhood diarrhea in Iraq.

Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review

OBJECTIVES

Self-medication with antibiotics (SMA) is a practice of global concern with a higher incidence within the low- and middle-income countries (LMICs). Despite worldwide efforts to control and promote the rational use of antibiotics, the continuing practice of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and a host of other antibiotic side-effects. This systematic scoping review maps evidence on the factors influencing SMA in these settings.

STUDY DESIGN

Systematic scoping review.

METHODS

The search strategy involved electronic databases including PubMed, Web of science, Science Direct, EBSCOhost, Google Scholar, BioMed Central, and the World Health Organization Library. PRISMA P guidelines and Arksey and O'Malley's framework were used. Thematic analysis was used to identify the factors that influence the practices of SMA in LMICs. The Mixed Method Appraisal Tool (MMAT), version 2011, was used to assess the quality of the included primary studies.

RESULTS

Fifteen studies met the inclusion criteria. Studies included participants from the following LMICs: Guatemala, India, Indonesia, Kenya, Laos, Nepal, Nigeria, Pakistan, Sri Lanka, and Yemen. The findings of the review emphasized a considerable high prevalence of SMA, ranging from 8.1% to 93%, with an association with the level of education, monthly income, and gender of participants. Accessibility, affordability, and conditions of health facilities, as well as the health-seeking behavior, are factors that influence SMA in LMICs. Health conditions such as a sore throat, common cold, cough, headache, toothache, flu-like symptoms, pain relief, fever, runny nose, toothache, upper respiratory tract infections, and urinary tract infection were the major complaints that led to the practices of SMA.

CONCLUSIONS

There is a considerable level of research evidence predominantly in some LMICs from Asia, with less evidence from African LMICs. Sociocultural determinants of health associated with the structure and conditions of health system as well as the health-seeking behavior are the main factors influencing SMA. Contextual and comprehensive studies on the factors influencing the non-prescribed use of antibiotics are needed to enable evidence-based strategies to correctly address the utilization of antibiotics and contain the problem of antimicrobial resistance, especially within the LMICs.

PROSPERO REGISTRATION

CRD42017072954.

Occurrence, antimicrobial resistance and whole-genome sequencing analysis of Salmonella isolates from chicken carcasses imported into Iraq from four different countries

Salmonella is a major cause of human foodborne illnesses worldwide; however, little is known about its occurrence and genomic characteristics in food sources in many developing countries. This study investigates the occurrence, serotypes distribution, antimicrobial resistance, and multilocus sequence types (ST) of Salmonella isolated from 400 imported frozen chicken carcasses sold in the markets of Thi-Qar, south-eastern Iraq. Salmonella was detected in 46 out of 400 tested samples [11.5% (95% confidence interval: 8.5%-15.0%)]. S. Typhimurium was the most abundant (30.4%) among 14 different serotypes recovered from the tested frozen carcasses. Antimicrobial resistance was most frequently detected against tetracycline (84.4%), nalidixic acid (80.4%), streptomycin (69.6%) and trimethoprim/sulfamethoxazole (65.2%). Whole-genome sequencing (WGS) analysis revealed that 18 isolates harbored four β-lactamase resistance genes, with bla_CARB-2 was the most commonly (14/18) detected. It was possible to identify 8 multilocus sequence types from the WGS analysis of 40 out of the 46 Salmonella isolates; with ST-11 (among S. Enteritidis) and ST-19 (among S. Typhimurium) were the most frequently detected. These results add to our understanding of the global epidemiology of Salmonella. Our work stands as one of the first reports on WGS analysis of Salmonella from retail chicken in a Middle-Eastern country. Results from this study could be valuable for guiding an informed import risk analysis aiming at reducing the exposure risk from Salmonella through imported chicken carcasses into Iraq. This work demonstrates the value of WGS as a promising tool for supporting evidence-based food safety hazard characterization.

Pharmacists in humanitarian crisis settings: Assessing the impact of pharmacist-delivered home medication management review service to Syrian refugees in Jordan

BACKGROUND

Refugees all over the world are facing several health-related problems. Chronic diseases among Syrian refugees in Jordan are high. The Home Medication Management Review (HMMR) service could be ideal to optimize refugees' health management.

OBJECTIVES

To assess the impact of the HMMR service on the type and frequency of Treatment Related Problems (TRPs) among Syrian refugees living in Jordan.

METHODS

This prospective randomized single blinded intervention-control study was conducted in three main cities in Jordan, between May and October 2016. Syrian refugees with chronic conditions were recruited and randomized into intervention and control groups. The HMMR service was conducted for all patients to identify TRPs at baseline. Data were collected via two home visits for all study participants. Clinical pharmacist's recommendations were written in a letter format to the physicians managing the patients in the intervention group only. Physicians' approved recommendations were conveyed to the patients via the pharmacist. Interventions at the patient level were delivered by the pharmacist directly. Patients were reassessed for their TRPs and satisfaction 3 months after baseline.

RESULTS

Syrian refugees (n = 106) were recruited with no significant differences between the intervention (n = 53) and control groups (n = 53). A total of 1141 TRPs were identified for both groups at baseline, with a mean number of 10.8 ± 4.2 TRPs per patient. At follow-up, there was a significant decrease in the number of TRPs among the intervention group (P < 0.001, paired sample t-test) but not among the control group (P = 0.116). Physicians' approval rate of the pharmacist's recommendations was high (82.9%), and more than 70.0% of refugees in the intervention group reported high satisfaction with the HMMR service.

CONCLUSION

Identified TRPs are high amongst Syrian refugees living in Jordan. The HMMR service significantly reduced the number of TRPs, and was highly accepted by the physicians. Refugees reported high satisfaction with this service.

Assessment of the association between drug disposal practices and drug use and storage behaviors

Objective

Keeping unnecessary drugs at home is a situation showing both causes and consequences of irrational use of medicine. This study aimed to evaluate the approaches of a company's employees regarding drug storage, use, and disposal.

Method

This online-based descriptive study was held in a multi-centered private-sector company in a voluntary basis. The survey assessing participants' drug handling and storage behaviors was answered by 1121 employees from across eight provinces of Turkey in 2016. Main outcome measures were storage and disposal of unused/unwanted drugs at home in a rational way.

Results

The percentage of participants who declared that they keep unused/unwanted drugs at home was 28.0%. About one-third of participants disposed their unused/unwanted drugs via the "garbage, sink, toilet, etc.". Participants ≥30 years old and living with <4 household members significantly tended to bring their unused/unwanted drugs to the company's drug-box. Nearly half of all participants (46.5%) stated a recent change in their disposal behavior. The vast majority of participants (94.6%) who previously took drugs back to the company's drug-box stated that they either had, or would, help their contacts adopt such behaviors. These participants were also significantly less likely to dispose of drugs inappropriately, practice self-medication, be unaware of expired drugs at home, or fail to store drugs according to the labelling.

Conclusion

While our findings showed that a substantial number of participants still had unused drugs at home and disposed of them inappropriately, it is understood that they started to exhibit more favorable behaviors in recent years.

Prevalence, risk factors and antimicrobial resistance of Salmonella diarrhoeal infection among children in Thi-Qar Governorate, Iraq

We conducted a hospital-based cross-sectional study among children aged <5 years in Thi-Qar Governorate, south-eastern Iraq, in order to examine the prevalence, risk factors and antimicrobial resistance associated with gastroenteritis caused by Salmonella infection. From 320 diarrhoea cases enrolled between March and August 2016, 33 (10·3%, 95% confidence interval (CI) 8·4-12·4) cases were stool culture-positive for non-typhoidal Salmonella enterica. The most commonly identified serovar was Typhimurium (54%). Multivariable logistic regression analysis indicated that the odds of Salmonella infection in children from households supplied by pipe water was 4·7 (95% CI 1·6-13·9) times higher compared with those supplied with reverse osmosis treated water. Similarly, children from households with domestic animals were found to have a higher odds (OR 10·5; 95% CI 3·8-28·4) of being Salmonella stool culture-positive. The likelihood of Salmonella infection was higher (OR 3·9; 95% CI 1·0-6·4) among children belonging to caregiver with primary vs. tertiary education levels. Lower odds (OR 0·4; 95% CI 0·1-0·9) of Salmonella infection were associated with children exclusively breast fed as compared with those exclusively bottle fed. Salmonella infection was three times lower (95% CI 0·1-0·7) in children belonging to caregiver who reported always washing hands after cleaning children following defecation, vs. those belonging to caregivers who did not wash hands. The antimicrobial resistance profile by disc diffusion revealed that non-susceptibility to tetracycline (78·8%), azithromycin (66·7%) and ciprofloxacin (57·6%) were the most commonly seen, and 84·9% of Salmonella isolates were classified as multi-drug resistant. This is the first study on prevalence and antimicrobial resistance of Salmonella infection among children in this setting. This work provides specific epidemiological data which are crucial to understand and combat paediatric diarrhoea in Iraq.

Pattern and predictors of medicine use among households in Gondar Town, northwestern Ethiopia: a community-based medicine utilization study

Background

Medicine use can be influenced by several factors. Health managers need specific information about irrational use of medicines, in order to identify opportunities to enhance rational use of medicines in their communities. This study aimed to assess the pattern and factors associated with household medicine use in Gondar town, northwestern Ethiopia.

Methods

An interviewer-administered cross-sectional survey was conducted on 771 households, carried out between 5 April and 6 May 2015. The questionnaire contained items focusing on different aspects of medicine use in the households. The analysis involved descriptive summary and binary logistic regression test, which assessed association of independent variables with medicine use.

Results

Of the households interviewed, 22.4% (173/771) disclosed the presence of at least one chronic disease in the family; while 49.2% reported the use of medicine in the one month prior to the study. Almost all of the households (92.6%) reported a habit of discontinuing medicines, and 17.8% disclosed a practice of sharing medicines with household members and others. Level of education, presence of health professionals, and individuals with chronic illness in the households were linked to increased likelihood of reporting medicine use. Discarding leftover medicines with garbage (56.7%) was the principal means of disposal reported by the households.

Conclusions

A high proportion of reported medicine use, together with problems such as sharing with other people and leaving medicines unfinished were found among the households in the study.

Self-medication misuse in the Middle East: a systematic literature review

Regulations usually distinguish between prescription‐only (POM) and over‐the‐counter (OTC) medicines. The former requires medical prescription; the latter are available for SM of common minor or easily treated ailments. However, in the Eastern Mediterranean countries, theoretical prescription medicines can easily be purchased without a prescription, as self‐medication (SM) resulting in potential misuse and unnecessary risk for patients. The magnitude of this activity is uncertain. The aim of this article, therefore, is to undertake a comprehensive review to identify the different types of medicines that can easily be purchased as SM in Middle East and recognized as misused. An extensive review of the published literature (1990–2015) was conducted using Pubmed, web of science, Cochrane, and Google Scholar databases, for OTC medicine misuse in the Middle East. A total of 72 papers were identified. Medicines involved in misuse included: codeine containing products, topical anesthetics, topical corticosteroids, antimalarial, and antibiotics. Self‐medication misuse of medicines seemed widespread. Individual treatment patterns were not clearly identified. Studies were not standardized, limiting the comparability between studies and the estimation of the scale of misuse. Pharmacists, friends, or parents were found to be the main sources of SMs. Knowledge and attitudes are an important contributing factor in the misuse of these medications. Strategies and interventions to limit misuse were rarely identified in literature. In conclusion, a massive problem involving a range of medicines was found in Middle East. Standardization of studies is a prerequisite to the understanding and prevention of misuse of self‐medication.

A household survey of medicine storage practices in Gondar town, northwestern Ethiopia

Background

Household surveys are crucial to get accurate information on how medicines are acquired, and used by consumers, as they provide the best evidence in the area. The objective of this study was to document household medicine storage practices in Gondar town, northwestern Ethiopia.

Methods

A cross-sectional household survey was conducted from April 5 to May 6, 2015. In the study, 809 households were surveyed from four sub-cities in the town selected through multistage sampling with 771 included in the final analysis. Data on the extent of storage, storage conditions, sources of medicines and their current status among others were collected through structured interviews and observations. The data were entered in to Epidata version 3.1, exported to and analyzed using Statistical Packages for Social Sciences (SPSS) version 21.

Results

Of the 771 households in the study, 44.2% stored medicines. Presence of family members with chronic illness(es) and higher levels of household incomes predicted higher likelihood of medicine storage. In the households which allowed observation of stored medicines (n = 299), a mean of 1.85 [SD = 1.09] medicines per household were found. By category, anti-infectives for systemic use (23.9%), medicines for alimentary tract and metabolism (19.2%) and those for cardiovascular system (17.7%) ranked top. Among individual medicines stored, diclofenac (10.7%), paracetamol (9.9%) and amoxicillin (8.0%) were on top of the list. Dispensaries (97.8%) and physicians (83.5%) were almost exclusive sources of medicines and advices/orders for medicines respectively. Nearly two-thirds of the medicines found were on use and a vast majority (76.5%) were stored in chests of drawers. Proportion of expired medicines was very low (3.14%).

Conclusions

The use of physicians’ and pharmacists’ advice to get medicines; use of dispensaries as principal sources, large proportion of medicines being in use and very low proportion of expiry showed good practices. However, storage places of medicines were not purpose built. Encouraging good practices through continued medicine use education and advocating appropriate medicine storage in medicine cabinets is required to improve storage conditions and consequent use of medicines.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4152-8) contains supplementary material, which is available to authorized users.

Knowledge, awareness, and attitudes toward antibiotic use and antimicrobial resistance among Saudi population

Background Inappropriate use of antibiotics is a public health problem of great concern. Objective To evaluate knowledge of antibiotics, race, gender and age as independent risk factors for self-medication. Setting Residents and population from different regions of Saudi Arabia. Methods We conducted a cross sectional survey study among residents. Data were collected between June 2014 to May, 2015 from 1310 participants and data were recorded anonymously. The questionnaire was randomly distributed by interview of participants and included sociodemographic characteristics, antibiotics knowledge, attitudes and behavior with respect to antibiotics usage. Main outcome measure Population aggregate scores on questions and data were analyzed using univariate logistic regression to evaluate the influence of variables on self-prescription of antibiotics. Results The response rate was 87.7 %. A cumulative 63.6 % of participants reported to have purchased antibiotics without a prescription from pharmacies; 71.1 % reported that they did not finish the antibiotic course as they felt better. The availability of antibiotics without prescription was found to be positively associated with self-medication (OR 0.238, 95 % CI 0.17-0.33). Of those who used prescribed or non-prescribed antibiotics, 44.7 % reported that they kept left-over antibiotics from the incomplete course of treatment for future need. Interestingly, 62 % of respondents who used drugs without prescription agreed with the statement that antibiotics should be access-controlled prescribed by a physician. We also found significant association between storage, knowledge/attitudes and education. Conclusions The overall level of awareness on antibiotics use among residents in Saudi Arabia is low. This mandates public health awareness intervention programs to be implemented on the use of antibiotics.

Self-medication among health workers in a tertiary institution in South-West Nigeria

INTRODUCTION

Inappropriate self-medication results in wastage of resources, resistance to pathogen and generally entails serious health hazard. This study was undertaken to determine the knowledge, practice and reasons for practice of self-medication among health workers in a Nigerian tertiary institution.

METHODS

This was a cross-sectional descriptive study conducted among staff of Federal Medical Center Ido-Ekiti, Nigeria. Simple random sampling technique was used to select 305 respondents that were interviewed via a pretested semi-structured questionnaire. Analysis was done using SPSS version 15 and while chi-square test was used to test significance between variables, significant (p value set<0.05).

RESULTS

Among the 305 respondents interviewed, the age range was 18-52yrs with greater proportion being males (51.8%). Majority of respondents were aware of self-medication (94.8%), but only 47.2% had good knowledge of it. Reasons for practicing self-medication were financial problem (10.8%), mild sickness (10.8%), lack of time (13.4%), knowledge of diagnosis (5.6%), convenience (2.3%) and non-availability of doctors (3.0%). The drugs used by respondents without prescription included analgesics (38.2%), antibiotics (19.0%) anti-malaria drugs (13.3%), and others (29.4%). Conditions for which respondents self-medicated were body pains (14.9%), catarrh (14.9%), headache (14.3%), sore throat (11.5%), diarrhea (11.2%), fever (9.0%) and toothache (5.6%).

CONCLUSION

The study demonstrates that the prevalence of self-medication is relatively high. There is need for health education on the implication and danger of self-medication. There is also need for government to pass and enforce law to restrict free access to drugs.

Utilization of Medicines Available at Home by General Population of Rural and Urban Set Up of Western India

INTRODUCTION

In India, medicines are procured with prescription or without prescription by patients, which are kept at home and often are utilized in inappropriate manner. It may remain unused, get expired or may be repeated in the way of self medication. So there remains an increase chance of self-medication compared to prescribed drugs.

AIM

This study was aimed to explore the utilization pattern of medicines available at home with special attention to the types of medicine (with or without prescription) and their appropriate utilization (dosage compliance) and intended self-medication.

MATERIALS AND METHODS

A cross-sectional study was conducted in Anand district of Gujarat, India during the year 2012- 2014 after Human Research Ethics Committee (HREC) approval. Data were collected from 800 houses, 400 each from urban and rural areas and then analysed for the details of medicines available in the house as: (i) number of homes having medicines; (ii) number of formulations with and without prescriptions; (iii) number of formulations with package inserts & expired formulations; (iv) Dosage forms of medicines; (v) pharmacological class wise distribution of medicines; (vi) status of the medicine use whether for current use, future use or leftover; and (vii) Appropriateness of medicines with and without prescription in relation to dose and duration of treatment.

RESULTS

Medicines were available in 93.75% houses. More medicine formulations (16.76%) were found without prescription in urban area than in rural (11.82%). Highest number of dosage forms found, were that of tablets (62%). Among the prescribed medicines, majority of medicines were from cardiovascular disease (19.88%) and from without prescription medicines, Non-Steroidal Antiinflammatory Drugs (NSAIDs) were the major group available at houses (35.13%). The leftover medicines with prescription were 20.39% and without prescription medicines were 13.37%. Appropriate dose and duration of medicines were followed more significantly by urban people than the rural. Only 2.91% medicines were found along with package inserts and 2.94% crossed the expiry dates.

CONCLUSION

The evaluation of utilization of medicines, in urban and rural population describes high drug storage, higher leftover medicines and inappropriate use of medicines and many self medicated by patients which suggests the need to educate the patients about proper and rational use of medicines.

Potential of lactoferrin to prevent antibiotic-induced Clostridium difficile infection

Objectives

Clostridium difficile infection (CDI) is a global healthcare problem. Recent evidence suggests that the availability of iron may be important for C. difficile growth. This study evaluated the comparative effects of iron-depleted (1% Fe³⁺ saturated) bovine apo-lactoferrin (apo-bLf) and iron-saturated (85% Fe³⁺ saturated) bovine holo-lactoferrin (holo-bLf) in a human in vitro gut model that simulates CDI.

Methods

Two parallel triple-stage chemostat gut models were inoculated with pooled human faeces and spiked with C. difficile spores (strain 027 210, PCR ribotype 027). Holo- or apo-bLf was instilled (5 mg/mL, once daily) for 35 days. After 7 days, clindamycin was instilled (33.9 mg/L, four times daily) to induce simulated CDI. Indigenous microflora populations, C. difficile total counts and spores, cytotoxin titres, short chain fatty acid concentrations, biometal concentrations, lactoferrin concentration and iron content of lactoferrin were monitored daily.

Results

In the apo-bLf model, germination of C. difficile spores occurred 6 days post instillation of clindamycin, followed by rapid vegetative cell proliferation and detectable toxin production. By contrast, in the holo-bLf model, only a modest vegetative cell population was observed until 16 days post antibiotic administration. Notably, no toxin was detected in this model. In separate batch culture experiments, holo-bLf prevented C. difficile vegetative cell growth and toxin production, whereas apo-bLf and iron alone did not.

Conclusions

Holo-bLf, but not apo-bLf, delayed C. difficile growth and prevented toxin production in a human gut model of CDI. This inhibitory effect may be iron independent. These observations suggest that bLf in its iron-saturated state could be used as a novel preventative or treatment strategy for CDI.

Prevalence and Cause of Self-Medication in Iran: A Systematic Review and Meta-Analysis Article

BACKGROUND

Nowadays self-medication is one of the most common public health issues in many countries, as well as in Iran. According to need to epidemiological information about self-medication, the aim of this study was to systematic review and meta-analysis of prevalence and cause of self-medication in community setting of Iran.

METHODS

Required data were collected searching following key words: medication, self-medication, over-the-counter, non-prescription, prevalence, epidemiology, etiology, occurrence and Iran in Google Scholar, PubMed, Scopus, Magiran, SID and IranMedex (from 2000 to 2015). To estimate the overall self-medication prevalence, computer software CMA: 2 applied. In order to report the results, forest plot was employed.

RESULTS

Out of 1256 articles, 25 articles entered to study. The overall prevalence of self-medication based on the random effect model was estimated to be 53% (95% CI, lowest= 42%, highest=67%). The prevalence of self-medication in students was 67% (95% CI, lowest=55%, highest=81%), in the household 36% (95% CI, lowest=17%, highest= 77%) and in the elderly people 68% (95% CI, lowest=54%, highest=84%). The most important cause of self-medication was mild symptoms of disease. The most important group of disease in which patients self-medicated was respiratory diseases and the most important group of medication was analgesics.

CONCLUSION

The results show a relatively higher prevalence of self-medication among the Iranian community setting as compared to other countries. Raising public awareness, culture building and control of physicians and pharmacies' performance can have beneficial effects in reduce of prevalence of self-medication.

Household Storage of Medicines and Associated Factors in Tigray Region, Northern Ethiopia

Introduction

The presence of medicines in households is a risk factor for irrational drug use. This study aimed at investigating the prevalence and factors associated with home storage of medicines in Tigray Region, Ethiopia.

Method

A community based cross-sectional study was conducted in April 2013 in Tigray Region, Ethiopia. A total of 1034 participants were enrolled in the study. A multi-stage sampling method was employed to select households. Data were collected with the help of a pre-tested structured questionnaire and analyzed using descriptive statistics and bivariate and multivariate logistic regression.

Result

Of the total households visited, 293(29%) stored drugs. The mean number of drugs per household was 1.73. The most common classes of drugs found in households were analgesics 149(29%) and antibiotics 128(25%). Most of the medicines kept in households were used for ongoing treatments 316(62%) and available in tablet dosage form (70%). More than half of the medications kept at homes were not adequately labeled while drawer 180(36%) were reported as the main place of drug storage. The proportion of home storage of medicines in rural area (AOR = 0.56, 95% CI: 0.39–0.81) was lower than that of urban area. However, households having family member(s) working in health facilities (AOR = 2.03, 95% CI: 1.09–3.77) were associated with an increased home storage of medicines.

Conclusion

Most drugs kept at home were not appropriately labeled and stored in a safe place. Residence area (rural versus urban) and the presence of health professional(s) in the households affects household drug storage. Hence, public education campaign should be considered as an intervention to improve the storage condition of medicines in the households.

Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries

BACKGROUND

Antimicrobial self-medication is common in most low and middle income countries (LMICs). However there has been no systematic review on non-prescription antimicrobial use in these settings. This review thus intended to establish the burden, risk factors and effects of antimicrobial self-medication in Low and Middle Income Countries.

METHODS

In 2012, we registered a systematic review protocol in PROSPERO (CRD42012002508). We searched PubMed, Medline, Scopus, and Embase databases using the following terms; "self-medication", "non-prescription", 'self-treatment', "antimicrobial", "antimalarial", "antibiotic", "antibacterial" "2002-2012" and combining them using Boolean operators. We performed independent and duplicate screening and abstraction of study administrative data, prevalence, determinants, type of antimicrobial agent, source, disease conditions, inappropriate use, drug adverse events and clinical outcomes of antibiotic self-medication where possible. We performed a Random Effects Meta-analysis.

RESULTS

A total of thirty four (34) studies involving 31,340 participants were included in the review. The overall prevalence of antimicrobial self-medication was 38.8 % (95 % CI: 29.5-48.1). Most studies assessed non-prescription use of antibacterial (17/34: 50 %) and antimalarial (5/34: 14.7 %) agents. The common disease symptoms managed were, respiratory (50 %), fever (47 %) and gastrointestinal (45 %). The major sources of antimicrobials included, pharmacies (65.5 %), leftover drugs (50 %) and drug shops (37.5 %). Twelve (12) studies reported inappropriate drug use; not completing dose (6/12) and sharing of medicines (4/12). The main determinants of antimicrobial self-medication include, level of education, age, gender, past successful use, severity of illness and income. Reported negative outcomes of antimicrobial self-medication included, allergies (2/34: 5.9 %), lack of cure (4/34: 11.8 %) and causing death (2/34: 5.9 %). The commonly reported positive outcome was recovery from illness (4/34: 11.8 %).

CONCLUSION

The prevalence of antimicrobial self-medication is high and varies in different communities as well as by social determinants of health and is frequently associated with inappropriate drug use.

Knowledge, attitude and practice towards antibiotic use among the public in Kuwait

Background

The emergence and spread of bacterial resistance to antibiotics is a growing problem worldwide, which presents a significant threat to public health globally in the 21^st century. A substantial evidence has shown that the general community plays a role in the increase and spread of antibiotic resistance. The present study was designed to determine knowledge, attitude and practice towards antibiotic use.

Methods

A cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 770 randomly selected Kuwaiti individuals. Descriptive and multivariate logistic regression analysis were used in data analysis.

Results

The response rate was 88.3%. Nearly three-quarters (72.8%) of respondents had been prescribed antibiotics within 12 months prior to the study period, and 36% of them had not finished the course of treatment. Over one-quarter (27.5%) were self-medicated with antibiotics to treat mainly common cold, sore throat and cough. Self-medication was more prevalent among those who were prescribed antibiotics and those who had attitudes towards using and accessing antibiotic inappropriately. Almost 47% of participants had low knowledge regarding action, use, safety and resistance of antibiotics. Forty one percent of respondents had attitudes towards using and accessing antibiotic inappropriately. Better knowledge was found to be a predictor for positive attitude. Respondents level of agreement that doctors often prescribe antibiotics to meet the patient’s expectation, and that doctors often take time to consider carefully the need for an antibiotic were 52.7% and 35.3%, respectively.

Conclusions

These findings will aid in the assessment of the adequacy of present public educational campaigns. Also, it will provide further insight in designing future multifaceted interventions to promote specific messages to rationalize antibiotic use, and compensate for knowledge and attitude gaps as an effort towards preventing development of antibiotic resistance.

An analysis of unused and expired medications in Mexican households

BACKGROUND

Unsafe storage of unused medications at home leads to an increased risk of toxicity, accidental childhood poisoning or risk for suicide, whereas an improper disposal of unwanted/expired medications from household raises concern about environmental pollution.

OBJECTIVE

The aim of the study was to characterize expired medications collected according to the types of therapeutic groups, pharmaceutical dosage forms, expiration dates and were prescribed or over the counter drugs, and whether they came from Mexican health system or purchased by patients themselves.

SETTING

The study was conducted in the metropolitan area of Monterrey during a 12-month period from March 2012 to February 2013.

METHOD

Unused/expired drugs were collected according to the collection and disposal of expired medication program instituted by the Department of Health of the State of Nuevo León. Pharmacists and students from The Autonomous University of Nuevo León recorded types of therapeutic groups, total of medicines in each group, among other classification criteria.

MAIN OUTCOME MEASURE

The proportion of every collected therapeutic group, type of dosage forms, and expiration date.

RESULTS

The amount of medications classified was 22,140 items corresponding to a 30 % of the total collected medications in that period of time; most of them belonged to the non-steroidal anti-inflammatory drugs (16.11 %). According to the pharmaceutical dosage forms, results showed that a high percentage were solid dosage forms (73.39 %), of the total unused/expired medications, most of them were prescription drugs (91 %) which were purchased at private pharmacies. Expiration date of medications ranges from 1995 to 2016, being 2011 the outstanding year (36.66 %).

CONCLUSION

Addressing the aspect of unused drug disposition constitutes a challenge for Mexican government, due to health implications related to inadequate disposition. No matter how efficient the programs of collection and disposal of expired drugs are, none of them can collect all unused or expired drugs, that is the reason why the best approach might be to prevent this need.

Factors predicting home storage of medicines in Northern Uganda

BACKGROUND

Medicines are kept in households Worldwide for first aid, treatment of chronic or acute disease conditions. This promotes inappropriate use of medicines and hence the associated risks. The study explored the factors which predict availability and utilization of medicines in households of Northern Uganda.

METHOD

A cross sectional survey of 892 households was performed from November-to-December 2012. Five data collectors administered the questionnaires, respondents were requested to bring out any medicines present in their households. Demographic characteristics, drug name, quantity, source, formulation, legibility of drug labels and reasons why the medicines were being kept at home was collected. Data was analyzed using STATA 12.0 at 95% level of significance.

RESULTS

Of the households visited, 35.1% (313/892) had drugs. Paracetamol (11.8%), coartem (11.3%), cotrimoxazole (10%), amoxicillin (9.2%) and metronidazole (8.2%) were the major medicines found. Antibacterial drugs were the most commonly (40.1%) kept type of drugs. The medicines present in households were for on-going treatment (48%); 'leftover' (30.5%) and anticipated future use (21.6%). Symptoms of malaria (34.1%) were common in households which had drugs. The medicines kept in homes were mainly from the private sector 60.5% (497/821). The rate of home drug storage was higher 85.3% (267/313) amongst the educated individuals. There was high prevalence 76% (238/313) of self-medication among respondents in households which stored drugs. The average number of medicines in each household was 6 ± 5 with majority (68.1%) having between 1-10 drugs. Previous successful treatment (OR: 1.3; 95% CI: 0.95-1.77), regular income (OR: 1.8; 95% CI: 1.2-2.6) and sex (OR: 0.63; 95% CI: 0.5-0.9) predicted storage of medicines in households in northern Uganda.

CONCLUSION

Over a third of households in Northern Uganda store medicines with antibacterial agents being the most common. Self-medication is common among individuals in households which keep drugs. Past successful treatment, regular income and sex predict community home drug storage.

Pharmaceuticals safety practices-a comparative pilot study

INTRODUCTION

The safety of medicine is essential for the safety of patients. Inappropriate drug storage, expiration dates, sharing prescription drugs, self medication habits and misuse of some drugs are contributing factors affecting medication safety. One or more of these factors may lead to serious health complications and even death.

OBJECTIVES

The purpose of this study was to highlight the common errors and pharmaceutical malpractices that people usually engage in on a daily basis and to correlate these to culture, gender and educational levels. This may spread awareness in an easy and understandable manner and provide certain guidelines to drug consumers ensuring that pharmaceutical preparations are used correctly and safely.

METHODS

Two hundred questionnaires were randomly distributed in two countries; Saudi Arabia and India. The collected data were statistically analyzed.

OUTCOMES AND CONCLUSION

Results showed that alarming percentages of various participants were using pharmaceuticals inappropriately due to carelessness, unawareness or intentional mistakes. Therefore, active participation by health care professionals is essential for the prevention of drug misuse. Increasing population awareness about self medication, products expiration, pharmaceuticals labels and optimum storage conditions would minimize the adverse effects and may even be life saving.

Development of pH-sensitive pectinate/alginate microspheres for colon drug delivery

The purposes of this study were to develop and evaluate calcium pectinate/alginate microspheres (PAMs) and to exploit their pH-sensitive properties for colon-targeted delivery of encapsulated cisplatin. PAMs were prepared using an electrospraying method. The PAMs, as cores, were then coated with Eudragit S100 using a polyelectrolyte multilayer coating technique in aqueous solution. The morphology of the microspheres was observed under scanning electron microscopy. In vitro drug release studies were performed in simulated gastrointestinal fluid, and the results indicated that approximately 5 % of the cisplatin was released from the Eudragit S100-coated PAMs, and 51 % of the cisplatin was released from the uncoated PAMs at 1 h. The release of cisplatin from the Eudragit S100-coated PAMs was more sustained in simulated gastric fluid than in simulated intestinal fluid due to the increased solubility of the coating polymer in media with pH >7.0. Drug release from the Eudragit S100-coated PAMs was best described by the Higuchi's square root model. From these results, it was concluded that Eudragit S100-coated PAMs are a potential carrier for delivery of cisplatin to the colon.