Journal of Research in Pharmacy Practice

Abstract This study aimed to assess the community pharmacists' knowledge of antibiotics, their attitude toward antibiotic usage and antibiotic resistance, and their nonprescription dispensing practices of antibiotics. Methods: A cross sectional-questionnaire-based study was conducted among 75 community pharmacists practicing in a selected city of South India. Data on their age, years of experience, and educational qualifications were obtained. A modified, 33-items, prevalidated structured questionnaire was used to assess the community pharmacists knowledge, attitude, and nonprescription antibiotic dispensing practices knowledge, attitudes and practices (KAP). The responses obtained were expressed in descriptive statistics. The association between years of experience and their KAP was assessed using Pearson's correlation. Findings: Most pharmacists (60%) agreed that antibiotics are used for bacterial infections, and 35% believed that antibiotics could be given for pain and inflammation. Fourty-one percentage of pharmacists agreed that dispensing antibiotics without prescription increases the risk of antibiotic resistance. Seventy-two percentage agreed that they are responsible for taking a prominent role in antimicrobial resistance and infection-control programs in healthcare. Only 46% of pharmacists stated that they always dispensed antibiotics only with a prescription, and 56% dispensed antibiotics for longer than the doctor prescribed. Amoxicillin, metronidazole, and cephalexin were the most commonly dispensed antibiotics without a prescription. The most common reason for dispensing antibiotics without a prescription was the fear of losing customers. Conclusion: The study identified an average KAP interquartile range 1 among community pharmacists, indicating a lack of awareness of antibiotic resistance and dispensing antibiotics without a prescription.

Abstract  Antibiotics are essential with inappropriate use leading to antimicrobial resistance (AMR). Currently, little is known about antibiotic use among hospitals in Kenya, which is essential to tackle as part of the recent national action plan addressing rising AMR rates. Consequently, the objective was to overcome this gap in a leading referral hospital in Kenya. The findings will subsequently be used to develop quality improvement programs for this and other hospitals in Kenya. Methods: This was a point prevalence survey. Data on antibiotic use were abstracted from patient medical records by a pharmacy team. Findings: The prevalence of antibiotic prescribing was 54.7%, highest in the intensive care unit and isolation wards. Most antibiotics were for treatment (75.4%) rather than prophylaxis (29.0%). The majority of patients on surgical prophylaxis were on prolonged duration (>1 day), with only 9.6% on a single dose as per current guidelines. Penicillins (46.9%) followed by cephalosporins (44.7%) were the most prescribed antibiotic classes. The indication for antibiotic use was documented in only 37.3% of encounters. Generic prescribing was 62.5% and empiric prescribing was seen in 82.6% of encounters. Guideline compliance was 45.8%. Conclusion: Several areas for improvement were identified including addressing prolonged duration for prophylaxis, extensive prescribing of broad-spectrum antibiotics, high rates of empiric prescribing, and lack of documenting the indication for antimicrobials. Initiatives are ongoing to address this with pharmacists playing a key role.

Abstract The objective of this study was to evaluate the extent of self-medication of antibiotics and dispensing practices in Kenya. Methods: A cross-sectional study was carried out at three selected pharmacies in Nairobi (Kenya), between January and March 2017, targeting principally antibiotic prescriptions for systemic use issued and dispensed as well as antibiotics sold over-the-counter without a prescription. The quality of antibiotics prescribed and dispensed was assessed against key WHO and other criteria. Benchmarking was used to assess the quality of antibiotics prescribed as there are no predetermined levels, just guidance and the rationale. Key indicators included: utilization of penicillins, percentage utilization of third-and fourth-generation of cephalosporins versus first and second generation, utilization of macrolides including lincosamides and utilization of quinolones as a percent of total systemic antibiotic use. Findings: There was a low level of dispensing of antibiotics without a prescription with over 90% (94.1%) of antibiotics dispensed with a valid prescription. The most common antibiotics dispensed were the penicillins at just over 50% of all antibiotics, the cephalosporins at over 12% (12.6%) and the fluoroquinolones at just under 12% (11.7%). There were concerns with high use of third and fourth generation cephalosporins versus first- and second-generation as well as co-amoxiclav versus other penicillins. Conclusion: Low levels of self-medication of antibiotics and high adherence to quality standards for dispensing are encouraging and provide direction to other countries. Educational initiatives are needed though to address high levels of co-amoxiclav prescribing.

Abstract : Irrational use of antimicrobials is a major driver of antimicrobial resistance, exacerbated by dispensing antibiotics without a prescription. Our previous study suggested this was a problem in the Republic of Srpska despite legislation. Since then, a number of activities have been initiated. Consequently, the study aimed to ascertain whether these multiple initiatives had reduced this. Methods: Patients visiting all community pharmacies in the Republic from October 2014 to July 2015 presenting with symptoms typical of an acute, viral, and mostly uncomplicated upper respiratory tract infection, with results compared to the previous study. If an antibiotic was suggested, the maximum allowance was €3/pack. Findings: Self-medication with antibiotics significantly decreased from 58% to 18.5% of pharmacies. In both studies, most patients were offered over-the-counter medication. The most common reason for not dispensing an antibiotic was “antibiotics can be dispensed with a prescription only.” The penicillins were the most dispensed antibiotic. Fewer patients than the previous study were given instructions about antibiotic use and no discussion on their side effects. Conclusion: While encouraging that self-medication decreased significantly, 18.5% were disappointing given recent initiatives. Fewer instructions about antibiotics if an antibiotic was dispensed were also disappointing. This suggests the need for even stronger enforcement of the laws as well as further training of pharmacy personnel to ensure the future appropriate use of medicines.

Abstract Objective: The aim of this study was to assess the knowledge, attitude and practice of 
B.Sc. Pharmacy students about usage and resistance of antibiotics in Trinidad and Tobago.
Methods: This was a cross‑sectional questionnaire‑based study involving B.Sc. Pharmacy 
students. The questionnaire was divided into five components including Demographics data, 
knowledge about antibiotic use, attitude toward antibiotic use and resistance, self‑antibiotic usage 
and possible causes of antibiotic resistance. Data were analyzed by employing Mann–Whitney 
and Chi‑square tests using SPSS version 20.
Findings: The response rate was 83.07%. The results showed good knowledge of antibiotic 
use among students. The overall attitude of pharmacy students was poor. About 75% of 
participants rarely use antibiotics, whereas self‑decision was the major reason of antibiotic 
use (40.7%) and main source of information was retail pharmacist (42.6%). Common cold and 
flu is a major problem for which antibiotics were mainly utilized by pharmacy students(35.2%).
Conclusion: The study showed good knowledge of pharmacy students regarding antibiotic 
usage. However, students’ attitude towards antibiotic use was poor. The study recommends 
future studies to be conducted with interventional design to improve knowledge and attitude 
of pharmacy students about antibiotic use and resistance.

Abstract Objective: The purpose of this study is to analyze the antibiotic sensitivity pattern of 
microorganisms, to study the antibiotic usage pattern, and to conduct a cost‑effectiveness 
analysis (CEA) for the antibiotics prescribed in a tertiary care teaching hospital in south India.
Methods: This prospective study was carried out in the General Medicine and Pulmonology 
departments of the hospital for a period of 6 months. The study was carried out in three 
phases: A prospective analysis to check the sensitivity pattern of microorganisms to various 
antibiotics, data extraction and determining the cost of antibiotics and finally evaluation of 
the sensitivity pattern of microorganisms and the antibiotic usage. A total of 796 documented 
records were analyzed.
Findings: It was found that Escherichia coli was the major organism identified in 36.4% of 
the isolated specimens, followed by Klebsiella sp. (18.9%), Streptococcus pneumoniae (15.8%),
Staphylococcus aureus (12.4%), and Pseudomonas (9.3%). The sensitivity pattern data of the 
prospective study revealed that E.coli was highly sensitive to Amikacin (99.3%), Klebsiella to 
Amikacin (93.8%), Pseudomonas to Meropenem (97.6%), and S. pneumoniae to Ofloxacin (93.8%). 
In the prescribing pattern study, it was found that the most common disease (21.2%) was 
found to be lower respiratory tract infection in 51 patients. Cephalosporins(73%), in particular 
Ceftriaxone (63.5%) was highly prescribed, followed by fluoroquinolones(53.9%). In the CEA, 
it was revealed that Ceftriaxone was the cost‑effective antibiotic with a cost‑effectiveness 
ratio (CER) of 78.27 compared to Levofloxacin, which had a CER of 95.13.
Conclusion: Continuous surveillance of susceptibility testing is necessary for cost‑effective 
customization of empiric antibiotic therapy. Furthermore, reliable statistics on antibiotic 
resistance and policies should be made available.