Antibiotic prescription patterns for management of acute otitis media in Lebanon

Nasrallah, Ali; Bacharouch, Ali; Jaafar, Fadia; Ayyash, Mariam; Blackwood, R. Alexander

doi:10.1016/j.ijporl.2018.08.014

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…13 From the supply side, pharmacists and healthcare professionals play an active role in dispensing antibiotics without following international guidelines 6 or questioning patients' demands. Some research conducted among Lebanese physicians [14][15][16] showed that many prescribed inappropriate antibiotics. According to a recent systematic review on global access to antibiotics without prescription in community pharmacies, 17 the rate of DAWP was 62%, which increased to 78% when a patient requested these drugs.…”

Section: Introductionmentioning

confidence: 99%

Dispensing and Purchasing Antibiotics Without Prescription: A Cross-sectional Study Among Pharmacists and Patients in Beirut, Lebanon

Kakati

Borrego

Zareef

et al. 2023

INQUIRY

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Antimicrobial resistance is a global public health issue, exacerbated by dispensing and purchasing antibiotics without a prescription, common in low- and middle-income countries, such as Lebanon. This study aimed to (1) describe behavioral patterns underpinning dispensing and purchasing antibiotics without a prescription among pharmacists and patients, (2) describe reasons for, and (3) attitudes toward these behaviors. A cross-sectional study targeted pharmacists and patients, respectively, identified through stratified random sampling and convenience sampling from all 12 Beirut quarters. Questionnaires assessed behavioral patterns, reasons for, and attitudes toward dispensing and purchasing antibiotics without prescription among the 2 samples. A total of 70 pharmacists and 178 patients were recruited. About a third (37%) of pharmacists supported dispensing antibiotics without a prescription, considering it acceptable; 43% of patients report getting antibiotics without a prescription. Reasons for distributing and purchasing antibiotics without prescription include financial costs associated with the drugs and convenience, coupled with inexistent law enforcement. Dispensing antibiotics without prescription was shared among a relatively high proportion of pharmacists and patients residing in Beirut. Dispensing antibiotics without prescription is common in Lebanon, where law enforcement needs to be stronger. National efforts, including anti-AMR campaigns and law enforcement, must be rapidly implemented to avoid the double disease burden, especially when old and new vaccines are available, and superbugs are making preventative public health efforts more difficult.

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Section: Introductionmentioning

confidence: 99%

Dispensing and Purchasing Antibiotics Without Prescription: A Cross-sectional Study Among Pharmacists and Patients in Beirut, Lebanon

Kakati

Borrego

Zareef

et al. 2023

INQUIRY

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“…From the supply side, pharmacists and healthcare professionals play an active role in dispensing antibiotics without following international guidelines [6] or questioning patients' demands. Some research conducted among Lebanese physicians [10][11][12] showed that many prescribed an inappropriate antibiotic. Other studies conducted in European countries attributed the cause of over-dispensation to the pharmacists' nancial bene ts.…”

Section: Introductionmentioning

confidence: 99%

Dispensing and Purchasing Antibiotics without Prescription: A Cross-sectional Study Among Pharmacists and Clients

Kakati

Nakad

Zareef

et al. 2022

Preprint

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Background: Antimicrobial resistance (AMR) is a public health issue with resistance rates increasing worldwide. Major contributing causes of AMR are the behaviors of dispensing and purchasing antibiotics without a prescription (DAWP and PAWP), respectively among pharmacists and clients, especially in low- and middle-income countries. This study aims to investigate behavioral patterns related to DAWP and PAWP among pharmacists and citizens of Beirut, Lebanon.Methods: We conducted a cross-sectional study using questionnaires targeting a stratified random sample of pharmacy managers and a random sample of clients, recruited from public spaces in the Municipal Beirut area. Questionnaires assessed behavioral patterns, reasons for, and attitudes towards DAWP and PAWP. We compared the perceptions and self-reported behaviors related to DAWP and PAWP among the two samples.Results: We recruited 70 pharmacists and 178 citizens. While most pharmacists recognized that AMR is a public health problem and that DAWP is a major contributing factor, about a third (37%) declared supporting DAWP; citizens confirmed this response, as 30% declared they do not usually obtain a prescription before purchasing antibiotics. However, when recalling their last purchase of antibiotics, 43% of clients did not get a prescription. The reasons for this behavior are mostly financial and convenience, coupled with low law enforcement.Discussion: DAWP and PAWP seem to be common practices among a relatively high proportion of pharmacists and citizens of Beirut. Despite being illegal, this practice seems to take ground in a politically and economically weak country and in a semi-privatized healthcare system. National efforts including anti-AMR educational campaigns and law enforcement need to be implemented problem this problem can grow out of proportion and reduce the effectiveness of vaccination campaigns, especially considering the impact of the COVID-19 pandemic.

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“…While appropriate treatment was found to be delivered in a few countries (such as examples in the Middle East), inappropriate prescribing is still prevalent internationally, including a 40% deviation from guidelines found in primary care in a recent European study . In developed countries, antibiotic prescribing for children with otitis media has either remained consistent or has, in some cases, increased .…”

mentioning

confidence: 99%

“…National guidelines for the treatment of Aboriginal and Torres Strait Islander children in the primary health-care setting were released by the Australian Health Department in 2010 and updated in 2017. 25 While appropriate treatment was found to be delivered in a few countries (such as examples in the Middle East), 26,27 inappropriate prescribing is still prevalent internationally, [28][29][30][31] including a 40% deviation from guidelines found in primary care in a recent European study. 32 In developed countries, antibiotic prescribing for children with otitis media has either remained consistent [33][34][35] or has, in some cases, increased.…”

mentioning

confidence: 99%

Assessing the appropriateness of the management of otitis media in Australia: A population‐based sample survey

Clay‐Williams

Stephens

Williams

et al. 2019

J Paediatrics Child Health

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Aim Acute otitis media (AOM) is the most common infectious disease for which antibiotics are prescribed; its management is costly and has the potential to increase the antimicrobial resistance of this infection. This study measured the levels of adherence to the clinical practice guidelines (CPGs) of AOM and otitis media with effusion (OME) management in Australian children. Methods We searched for national and international CPGs relating to AOM and OME in children and created 37 indicators for assessment. We reviewed medical records for adherence to these indicators in 120 locations, across one inpatient and three ambulatory health‐care settings. Our review sample was obtained from three Australian states that contain 60% of the nation's children. Results We reviewed the records of 1063 children with one or more assessments of CPG adherence for otitis media. Of 22 indicators with sufficient data, estimated adherence ranged from 7.4 to 99.1%. Overuse of treatment, particularly overprescribing of antibiotics, was more common than underuse. A frequent lack of adherence with recommended care was observed for children aged between 1 and 2 years with AOM. Adherence varied by health‐care setting, with emergency departments and inpatient settings more adherent to CPGs than general practices. Conclusions Our assessment of a number of indicators in the common settings in which otitis media is treated found that guideline adherence varied widely between individual indicators. Internationally agreed standards for diagnosis and treatment, coupled with clinician education on the existence and content of CPGs and clinical decision support, are needed to improve the management of children presenting with AOM and OME.

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Antibiotic prescription patterns for management of acute otitis media in Lebanon

Cited by 4 publications

References 15 publications

Dispensing and Purchasing Antibiotics Without Prescription: A Cross-sectional Study Among Pharmacists and Patients in Beirut, Lebanon

Dispensing and Purchasing Antibiotics Without Prescription: A Cross-sectional Study Among Pharmacists and Patients in Beirut, Lebanon

Dispensing and Purchasing Antibiotics without Prescription: A Cross-sectional Study Among Pharmacists and Clients

Assessing the appropriateness of the management of otitis media in Australia: A population‐based sample survey

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