<p>Community Pharmacy Personnel Understanding of Antibiotic Dispensing in Eastern Nepal</p>

Abstract

Background Community pharmacies are easily accessible outlets providing medicines to the general public in Nepal, but it is known that irrational dispensing of antibiotics from such outlets contributes to antimicrobial resistance. Objective To assess the understanding of community pharmacy personnel around antibiotic-dispensing in Eastern Nepal and the relationship between this understanding and their personal characteristics. Methods A cross-sectional survey was conducted on 312 pharmacy personnel working in community pharmacies of three districts within Eastern Nepal using a self-administered questionnaire. Descriptive statistics were used to analyze participants’ characteristics and their understanding of antibiotic dispensing. The relationships between their understanding of antibiotic dispensing and their characteristics were determined using Chi-square tests. Results Most of the pharmacy personnel considered that dispensing antibiotics without a valid prescription is a problem (76.9%), and that it would not be legal to do so (86.9%). In the survey, 34.9% of participants agreed that they had dispensed antibiotics without prescription, and 26.9% disagreed with the assertion that inappropriate dispensing of antibiotics could promote antimicrobial resistance. Most (94.5%) reported that they would advise patients to follow their antibiotic dosage regimen, but 34.3% reported that they believed antibiotics to reduce pain and inflammation. Bivariate analysis showed that the level of understanding about antibiotic indication was significantly associated with age (p<0.001), work experience (p<0.001) and qualifications (p=0.017) of the pharmacy personnel. Work experience and qualifications also had significant but independent relationships with the level of understanding that irrational dispensing of antibiotics promotes antimicrobial resistance (p=0.018 and p=0.004) and is on the need for patient follow-up after dispensing antibiotics (p<0.001 and p=0.042). Conclusion The understanding of community pharmacy personnel about antibiotic dispensing in Eastern Nepal requires significant improvement. Degree of understanding of some aspects of antibiotic dispensing was influenced by age, work experience and qualifications.

Perspectives of pharmacy employees on an inappropriate use of antimicrobials in Kathmandu, Nepal

“…Here, 15% (119/796) of pharmacy operators had neither pharmacy specific education nor training. Previous studies from Nepal (36%, 116/321) and India (75%, 18/24) have also reported on the involvement of unlicensed practitioners in pharmacies, which may directly impact their dispensing practices [6,8]. In our study, 36% of pharmacy respondents agreed that they dispensed non-prescription antimicrobials, which again corresponds with the earlier survey from Nepal [6].…”

“…In our study, only half of the respondents perceived that inappropriate use of antimicrobials was the first important factors driving AMR. The earlier study from Nepal reported that nearly 25% of pharmacy respondents declined that inappropriate use of antimicrobials might facilitate AMR [6]. The extent of knowledge, education, and practice as evidenced in this, and other studies from South Asia reflects into the scenario of highly prevalent inappropriate use of antimicrobials in the community.…”

“…Previous studies from Nepal (36%, 116/321) and India (75%, 18/24) have also reported on the involvement of unlicensed practitioners in pharmacies, which may directly impact their dispensing practices [6,8]. In our study, 36% of pharmacy respondents agreed that they dispensed non-prescription antimicrobials, which again corresponds with the earlier survey from Nepal [6]. A higher percentage of pharmacy dispensers from India (67%; 174/261) [9] and Pakistan (97%,; 342/353) [10], have also reported to have dispensed non-prescription antimicrobials with or without clarification.…”

“…In LMICs in South Asia, because of non-stringent government regulations, pharmacies sticking to virtue may instead be at peril of commercial disadvantage. Sixty three percent of pharmacy employees in a study from Nepal believed that refusal to dispense non-prescription antimicrobials would lead to a commercial loss, and nearly 90% agreed that the patients would somehow obtain the non-prescription antimicrobials by attending an alternative pharmacy [6]. Facts such as these might motivate pharmacy employees to deviate from their professional morals.…”

Counseling Practices of Pharmacists at Medical Stores/Pharmacies in Karachi Pakistan

“…Patient's counseling regarding their medications play a very important role to achieve the high efficacy and proper constancy on therapy. Proper counseling while dispensing antibiotics is essential as they require a full completion of its course of therapy to achieve maximum outcomes otherwise the infection may revert back and it also increases antibiotic resistance [4,5]. Non adherence to the therapy a patient is getting may reduce pharmacotherapy outcomes [6].…”