Pharmacists’ perception of their challenges at work, focusing on antimicrobial resistance: a qualitative study from Bangladesh

Abstract

Background: The indiscriminate use of antimicrobial medicines has contributed to the development of microorganisms' resistance to antibiotics. Antimicrobial resistance (AMR) is a major global health problem and is most acute in countries that have a weak health care and regulatory system and a high burden of infectious diseases, such as Bangladesh. Due to shortages of physicians available to diagnose and prescribe appropriate antibiotics, people with ailments in Bangladesh are forced to contact various types of health care services, including retail pharmacies, that lack supervision by qualified medical personnel. It is unknown how pharmacists perceive the AMR situation and the related challenges they face. Objective: The aim of the study was to understand retail pharmacist's perceptions regarding AMR. Method: A qualitative study design was used, and in-depth interviews were held with retail pharmacists in Dhaka. Results: The participants demonstrated a variety of concerns regarding AMR. They considered that self-medication, old prescriptions, lack of regulations and supervision, and readily available antibiotics were the main factors that contributed to the misuse of antimicrobial medicines and the development of AMR. Conclusions: To control the further spread of AMR in Bangladesh, there is a need to work at several levels of the health system simultaneously. Initiatives could include establishment of the 'Model Pharmacy' programme nationwide, increasing and widening the focus on AMR in pharmacists' education, ensuring the implementation of government guidelines on AMR, increasing public awareness of the consequences of antimicrobial use, and surveillance and monitoring of regulations and progress. A multipronged strategy is necessary not only for better AMR control but also for investment in a system that is well equipped to provide equitable care in the face of both existing and new health challenges.

Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications

“…Consequently, retail drug stores, both licensed and unlicensed in equal numbers, are important in Bangladesh as they are often the principal source of healthcare for patients given their financial circumstances 14,41,53 . A key concern though has been a lack of formal counseling within stores unless pro-actively sought by patients 53,54 , with currently more than 80% of the population in Bangladesh preferentially seeking care from drug stores as well as untrained or poorly trained village doctors 53 . However, there have been recent steps to address concerns with the publication of standards for drug outlets 55 .…”

Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

“…According to results of a study by Horumpende et al antibiotics can easily be obtained without a prescription in up to 92% of pharmacies [ 7 , 8 ]. Even if designated as prescription-only, some pharmacists may dispense antimicrobials without a valid prescription and this issue seems to be more prominent in low- and middle-income countries, but is also widely present in some high-income countries [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. A meta-analysis by Auta et al on 38 studies in 24 countries estimated the overall proportion of antibiotics dispensed without a valid prescription at 62%.…”

Evolution of pharmacy practice and direct patient care roles for pharmacists in Bangladesh

“…10 By law, all retail drug shops in Bangladesh must be registered with the DGDA and have at least a C-level pharmacist in charge. 11 The DGDA, however, estimates there to be approximately 120 000 licensed retail drugs shops in Bangladesh and close to 300 000 unlicensed stores. 12 Although C-levels pharmacists make up the overwhelming majority of drug dispensers who report having formal training, approximately half of retail "pharmacists" report having no formal training at all.…”

“…10 Based on the public's frequent interactions with retail drug shops and resulting perception of drug dispensers as untrained personnel, even highly educated pharmacists are often not recognized as reliable sources of medical information. 11 Central Pharmacy Department (CPD) is responsible for purchase, inventory control, and total material management. 17,18 Based on available pharmacists and/or intern pharmacy students' availability and interest, decentralized pharmacy initiatives had been periodically undertaken over a couple of years to familiarize the medical and nursing staff with direct patient care roles of the pharmacist.…”