Antibiotic-Dispensing Practice in Community Pharmacies: Results of a Cross-Sectional Study in Italy.

Inappropriate use of antibiotics in the community contributes to the development of antibiotic resistance (ABR), one of the most concerning issues in modern medicine. The objectives of the study were to investigate the knowledge and attitudes regarding ABR and dispensing antibiotics without prescription (DAwP) and to assess the extent of the practice of DAwP among Italian community pharmacists (CPs). A nationwide cross-sectional study using an anonymous, structured, validated, and pilot-tested questionnaire was conducted. The five sections gathered data on demographic and professional characteristics, knowledge and attitudes toward ABR and DAwP, practices regarding dispensing antibiotics with or without prescription and their reasons, counselling on the potential antibiotic side effects and the importance of adherence to medication regimen, and the information sources used to update the knowledge about ABR. About 4 in 10 CPs (37.1%) reported being involved in DAwP, although 93.7% knew that it is illegal in Italy. The vast majority affirmed to have always/often asked clients about their drug allergies (95.5%) and about their medication history (82.5%). Two-thirds (66.2%) warned their clients about the potential side effects of the drugs, and 55% informed them about the importance of completing the full course of antibiotics. Complacency with clients who found it difficult to consult the physician was the most significant predictor of DAwP. A considerable proportion of DAwP was described, so it could be easy for patients to misuse these drugs. Future policies need to enhance the enforcement of existing prescription-only regulations and to develop monitoring strategies to ensure their establishment in real-life practices.

Bianco A ，Licata F ，Trovato A ，Napolitano F ，Pavia M ... -  《-》

Community pharmacists' knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): a cross-sectional survey in Makkah Province, Saudi Arabia.

To evaluate knowledge, attitude, and practices of community pharmacists towards dispensing antibiotics without prescription (DAwP) in Makkah Province, Saudi Arabia. A cross-sectional survey was conducted between January and February 2016 using a structured, validated, and pilot-tested questionnaire. A four-step systematic approach was used to recruit community pharmacists who completed a 28-item questionnaire either in English or Arabic language based on their personal preference. Of the 200 community pharmacists approached, 189 completed the questionnaire. More than two-thirds (70.5%) of the pharmacists were not aware that DAwP is illegal practice. Lack of patient willingness to consult a physician for a non-serious infection (69.9%) and an inability to afford a consultation with a physician (65.3%) were the most common reasons cited for DAwP. A statistically significant association was found between the number of antibiotics dispensed and educating patients about the importance of adherence and completion of the full course of antibiotics (p=0.007). In general, community pharmacists have a poor understanding of the regulations prohibiting the over-the-counter sale of antibiotics in Saudi Arabia, explaining the high rate of DAwP in the country. A multifaceted approach consisting of educational interventions and improving the access to and affordability of healthcare facilities for the general public is required to effectively reduce DAwP and its negative consequences on public health.

Hadi MA ，Karami NA ，Al-Muwalid AS ，Al-Otabi A ，Al-Subahi E ，Bamomen A ，Mohamed MM ，Elrggal ME ... -  《-》

Assessment of knowledge, attitudes, and practices among community pharmacists in Lahore regarding antibiotic dispensing without prescription: A cross-sectional study.

The irrational dispensing practices are responsible for antibiotic abuse and the spread of antibiotic resistance. Thus, the present study aims to evaluate the knowledge, attitudes, and practices of community pharmacists (CPs) regarding dispensing antibiotics without prescription (DAwP). A descriptive, cross-sectional study was conducted between March 1, 2023, and March 31, 2023, in community pharmacy settings of Lahore, Pakistan. A self-administered and pretested questionnaire was used for the data collection. Logistic regression analysis was used to determine the factors associated with the practices of community pharmacists. Data were analyzed using SPSS (version 26) and MS Office (2016). Among 359 respondents, many strongly agreed/agreed with the statements "DAwP is contributing to the development of antimicrobial resistance" (83%, n = 298) and "Antibiotic resistance has become a public health issue" (81.9%, n = 249). Overall, most of the community pharmacists claimed that the unwillingness of patients to visit physicians for non-serious infections (75.2%, n = 270) and good knowledge of pharmacists about the use of antibiotics (51%, n = 183) were the most common reasons attributable to dispensing of antibiotics without prescription. Cephalosporin (n = 260, 72.4%), penicillin (n = 254, 70.8%), and tetracyclines (n = 170, 47.4%) were the most commonly dispensed classes of antibiotics without prescription due to cold, flu and diarrhea. Most community pharmacists never/sometimes warn patients about the potential side effects of medicines (79.1%, n = 284). Logistic regression analysis revealed that community pharmacists 31-40 years of age (OR = 0.568, 95%CI = 0.348-0.927, p-value = 0.024) were significantly less associated with poor practices of dispensing antibiotics without prescription (DAwP) while those who were 'Managers' (OR = 4.222, 95%CI = 2.542-7.011, p-value = <0.001), had 3-5 years of experience (OR = 2.241, 95%CI = 1.183-4.243, p-value = 0.013), dispensed ≤25 antibiotics per day (OR = 12.375, 95%CI = 5.177-29.583, p-value = <0.001), were more likely to be associated with poor practices of dispensing of antibiotics without prescription. The community pharmacists had adequate knowledge, positive attitudes, and poor practices towards DAwP. Demographical factors such as age, job status, and work experience were the determinants of community pharmacists' practices towards dispensing antibiotics without prescription (DAwP). Hence, a multifaceted approach, including educational interventions, is needed to reduce the dispensing of antibiotics without prescription (DAwP).

Nabeel M ，Ali K ，Sarwar MR ，Waheed I ... -  《PLoS One》

Knowledge, Attitude and Practice of Pharmacy Professionals Against Dispensing Antibiotics Without Prescription in Ethiopia.

Antibiotic resistance is a global public health threat that warrants immediate intervention. Dispensing of antibiotics without prescription (DAWP), is an inappropriate practice that contributes significantly to the emergence and spread of antibiotic resistance. The current study aimed to assess the knowledge, attitude and practice of community pharmacists and pharmacy assistants towards DAWP. A cross-sectional study was conducted, and data was collected from community pharmacists and pharmacy assistants during the eighth national pharmacist's day, which was held on December 4, 2021, in Addis Ababa, Ethiopia. A pre-tested self-administered questionnaire comprise of four sections (socio-demographic characteristics, and knowledge, attitude and practice towards DAWP) was used. The data was analyzed using SPSS version 26 and descriptive statistics (mean, percentage, standard deviation) were computed. Binary logistic regression was used to predict determinates of DAWP. A total of 175 community pharmacy professional were invited in the study, with 158 (111 pharmacists and 47 pharmacy assistants) completing the survey for 90.3% response rate. Most of the participants (86.7%) were aware that DAWP is illegal in Ethiopia. Despite their knowledge, the extent of DAWP was found to be 67.7%. The most common reason given by study participants for DAWP was that most patients do not want to consult prescribers unless the infection appears serious (53.2%). Pharmacy professionals with educational background of masters and above (AOR= 0.354, 95% CI: 0.013-0.744, P= 0.045), and with two to five years of working in community pharmacy (AOR= 0.745, 95% CI: 0.595-0.933, P= 0.010) had a lower tendency to DAWP, respectively. Despite majority of pharmacy professional are aware that DAWP is illegal and contributes to antibiotic resistance, they commonly DAWP for common cold and diarrheal diseases. Strict enforcement of existing antibiotic supply policies, and ongoing educational support for community pharmacy professionals on the judicious use of antibiotics is recommended.

Haile KT ，Yabeyu AB 《-》

A cross-sectional national survey of community pharmacy staff: Knowledge and antibiotic provision.

Zawahir S ，Lekamwasam S ，Aslani P 《PLoS One》