Magnitude of dispensing unprescribed antibiotics in community pharmacies in Duhok province; Kurdistan region of Iraq
DOI:
https://doi.org/10.22317/jcms.v9i2.1324Keywords:
Unprescribed antibiotics, community pharmacies, infections, Kurdistan Region, Iraq.Abstract
Objectives: study aims to provide a descriptive overview about the magnitude and frequency of dispensing the unprescribed antibiotics UABs. It furthermore aims, to specify the most dispensed UAB types, the most common infections, signs and symptoms that require dispensing the UABs in community pharmacies of Duhok city and its districts.
Methods: A cross sectional cohort study had been conducted from September to October 2022, private community pharmacies of Duhok province were included in this study. A standardized questionnaire platform was utilized to complete the survey, it included 2 sections, the first of which was related to demographic data and the second part included details of the dispensing unprescribed antibiotics UABs like: what are the most common dispensed UABs, what are the most common illness and symptoms of patients who require dispensing UABs. Results: One hundred fifty pharmacies have been included in this study. The majorities were from Duhok city 46%, and Zakho 28.7%. The prevalence of dispensing UABs was 100%, the three most common dispensed UABs were Amoxicillin 77%, followed by azithromycin 16% and cefixime 7%. The most infections and conditions requiring dispensing UABs were tonsilitis (69.3%), followed by flu and common cold (58.7%), and lower respiratory tract infection (48.7%). Conclusion: This study concluded that dispensing UABs is a frequent practice in Duhok community pharmacies. Viruses are the most common cause of upper respiratory tract infections; hence, antibiotics must be avoided and OTC medicines should be encouraged to alleviate the symptoms. Continuing medical education through training pharmacists on dispensing antibiotics by adhering to the regulations of antibiotic stewardship is crucial.
References
Organization WH. Antimicrobial resistance global report on surveillance: 2014 summary. World Health Organization; 2014.
UN health agency steps up fight against ‘invisible pandemic’ of antimicrobial resistance [Internet]. 2019. Available from: https://news.un.org/en/story/2019/06/1040741.
Organization WH. In the face of slow progress, WHO offers a new tool and sets a target to accelerate action against antimicrobial resistance. 2019.
Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, Mechtler R, Deschepper R, Tambic-Andrasevic A, et al. Self-medication with antimicrobial drugs in Europe. Emerging infectious diseases. 2006;12(3):452.
Cars O, Nordberg P. Antibiotic resistance–The faceless threat. International Journal of Risk & Safety in Medicine. 2005;17(3-4):103-10.
Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen J-A, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. The Lancet. 2016;387(10014):168-75.
Rambliere L, Guillemot D, Delarocque-Astagneau E, Huynh B-T. Impact of mass and systematic antibiotic administration on antibiotic resistance in low-and middle-income countries. A systematic review. International Journal of Antimicrobial Agents. 2021;58(1):106364.
Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrobial Resistance & Infection Control. 2017;6(1):1-8.
Hadi U, Duerink DO, Lestari ES, Nagelkerke NJ, Werter S, Keuter M, et al. Survey of antibiotic use of individuals visiting public healthcare facilities in Indonesia. International Journal of Infectious Diseases. 2008;12(6):622-9.
Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. The Lancet infectious diseases. 2011;11(9):692-701.
Chang J, Xu S, Zhu S, Li Z, Yu J, Zhang Y, et al. Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. The Lancet Infectious Diseases. 2019;19(12):1345-54.
Al-Halawa DA, Sarama R, Abdeen Z, Qasrawi R. Knowledge, attitudes, and practices relating to antibiotic resistance among pharmacists: a cross-sectional study in the West Bank, Palestine. The Lancet. 2019;393:S7.
Alkadhimi A, Dawood OT, Hassali MA. Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study. Pharmacy Practice (Granada). 2020;18(4).
Al-Jumaili AA, Hussein AH, Al-Rekabi MD, Raheem SA, Ernst EJ. Antimicrobial utilization in an Iraqi province: a comprehensive evaluation of antibiotic source and cost. International Journal of Pharmacy Practice. 2017;25(1):81-8.
Batista AD, A. Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro MT. Antibiotic dispensation without a prescription worldwide: a systematic review. Antibiotics. 2020;9(11):786.
Mahmoud MA, Aldhaeefi M, Sheikh A, Aljadhey H. Community pharmacists' perspectives about reasons behind antibiotics dispensing without prescription: a qualitative study. Biomedical Research. 2018;29(21):3792-6.
Mansour O, Al-Kayali R. Community pharmacistsꞌ role in controlling bacterial antibiotic resistance in Aleppo, Syria. Iranian journal of pharmaceutical research: IJPR. 2017;16(4):1612.
Mohamed Ibrahim MI, Awaisu A, Palaian S, Radoui A, Atwa H. Do community pharmacists in Qatar manage acute respiratory conditions rationally? A simulated client study. Journal of Pharmaceutical Health Services Research. 2018;9(1):33-9.
Zapata-Cachafeiro M, Piñeiro-Lamas M, Guinovart MC, López-Vázquez P, Vázquez-Lago JM, Figueiras A. Magnitude and determinants of antibiotic dispensing without prescription in Spain: a simulated patient study. Journal of Antimicrobial Chemotherapy. 2019;74(2):511-4.
Khan MU, Hassali MAA, Ahmad A, Elkalmi RM, Zaidi STR, Dhingra S. Perceptions and practices of community pharmacists towards antimicrobial stewardship in the state of Selangor, Malaysia. PloS one. 2016;11(2):e0149623.
Kurdi A, Hasan AJ, Baker KI, Seaton RA, Ramzi ZS, Sneddon J, et al. A multicentre point prevalence survey of hospital antibiotic prescribing and quality indices in the Kurdistan Regional Government of Northern Iraq: The need for urgent action. Expert review of anti-infective therapy. 2021;19(6):805-14.
Al-Mohamadi A, Badr A, Mahfouz LB, Samargandi D, Al Ahdal A. Dispensing medications without prescription at Saudi community pharmacy: extent and perception. Saudi pharmaceutical journal. 2013;21(1):13-8.
Kalungia AC, Burger J, Godman B, Costa JdO, Simuwelu C. Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia. Expert review of anti-infective therapy. 2016;14(12):1215-23.
Damisie G, Hambisa S, Yimam M. Over the counter sale of antibiotics at drug stores found in Mizan-Aman Town, Southwest Ethiopia: a cross-sectional simulated client visit study. Journal of pharmaceutics. 2019;2019.
Cavalcanti AB, Zampieri FG, Rosa RG, Azevedo LC, Veiga VC, Avezum A, et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19. New England Journal of Medicine. 2020;383(21):2041-52.
Merza MA, Al Mezori AAH, Mohammed HM, Abdulah DM. COVID-19 outbreak in Iraqi Kurdistan: The first report characterizing epidemiological, clinical, laboratory, and radiological findings of the disease. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(4):547-54.
Hussein NR, Daniel S, Salim K, Assafi MS. Urinary tract infections and antibiotic sensitivity patterns among women referred to Azadi teaching hospital, Duhok, Iraq. Avicenna journal of clinical microbiology and infection. 2017;5(2):27-30.
Hasan TH, Alasedi KK, Aljanaby AAJ. A Comparative Study of Prevalence Antimicrobials Resistance Klebsiella pneumoniae among Different Pathogenic Bacteria Isolated from Patients with Urinary Tract Infection in Al-Najaf City, Iraq. Latin American Journal of Pharmacy. 2021;40:174-8.
Hasan SA, Najati AM, Abass KS. Prevalence and antibiotic resistance of “pseudomonas aeruginosa” isolated from clinical samples in Kirkuk City, Iraq. Eurasia J Biosci. 2020;14(1):1821-5.
Ibrahim IR, Palaian S, Ibrahim MI. Assessment of diarrhea treatment and counseling in community pharmacies in Baghdad, Iraq: A simulated patient study. Pharmacy Practice (Granada). 2018;16(4).
Zawahir S, Lekamwasam S, Aslani P. Antibiotic dispensing practice in community pharmacies: A simulated client study. Research in Social and Administrative Pharmacy. 2019;15(5):584-90.
ABDULLAH IM. Multiple drugs resistance among urinary tract infection patients in Duhok city–Kurdistan Region–Iraq. Duhok Medical Journal. 2019;13(1):22-31.
Abubakar U, Tangiisuran B. Knowledge and practices of community pharmacists towards non-prescription dispensing of antibiotics in Northern Nigeria. International journal of clinical pharmacy. 2020;42(2):756-64.
Alrasheedy AA, Alsalloum MA, Almuqbil FA, Almuzaini MA, Aba Alkhayl BS, Albishri AS, et al. The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia. Expert review of anti-infective therapy. 2020;18(1):87-97.
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