Study of the Drivers of Inappropriate Use of Antibiotics in Community Pharmacy: Request for Antibiotics Without a Prescription, Degree of Adherence to Treatment and Correct Recycling of Leftover Treatment

Abstract

Introduction The WHO considered antibiotic resistance as 1 of the 10 greatest threats to global health in 2019. The inappropriate and indiscriminate use of antibiotics, together with the lack of new therapeutic alternatives, may eradicate their effectiveness in the closest future. Objective The general objective is to analyze the different causes attributable to patients, providers and pharmacists that could be drivers of irrational use of antibiotics, and responsible for the appearance of bacterial resistance, in community pharmacies. To this end, the different processes or indicators were studied: patients’ requests of antibiotics at the pharmacy, their degree of adherence, satisfaction with the prescribed treatment and antibiotics’ surplus recycling. Methods This study was observational, descriptive, and cross-sectional, carried out in 2 pharmacy offices, including 333 participants. At the time of dispensing, first phase, surveys to collect patients’, providers’ and pharmacists’ data were carried out over the counter. The second phase, with the aim of checking adherence, degree of satisfaction and recycling. Results There were 333 requests for antibiotic regardless prescription availability, 17% of the patients requested an antibiotic without having one. 38% of patients did not have full adherence to antibiotics. Exploring non-adherence reasons, 24% forgot to take the treatment, 2% experienced adverse effects; 8% improved infection symptoms and 21% had problems to follow schedule. Regarding the recycling habits, 57% of patients had leftover treatments at home, but only 11% recycled it. 10% of medical prescriptions were forced by the patient, and significant gender differences were observed in adherence and knowledge of treatment. Conclusion The results of this study suggested that there may be a significant level of antibiotic inappropriate use locally, potentially related to patients’ sex, finding significant deficiencies in prescription by doctors, in the dispensing act carried out in community pharmacies, and finally in patient compliance with treatment.

Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy

“…Our model originated from cross-sectional studies performed in the hospital that documented a high number of HAIs caused by MDROs given the well-known relationship between antibiotics consumption and the development of resistance and since their misuse is one of the main factors promoting resistance [30,31]. We largely attributed the spread of MDROs to the inappropriate and unverified use of antibiotics over the past few years in our hospital, as reported in previous studies [32,33]. The primary aim of the Antimicrobial Stewardship model was to ensure the optimal use of antibiotics in patients admitted to the G. Giglio Foundation Hospital with infectious bacterial diseases.…”

The Prevalence of Alert Pathogens and Microbial Resistance Mechanisms: A Three-Year Retrospective Study in a General Hospital in Poland

“…Although many medical professionals underestimate the value of ongoing training in this field, such treatment is one of the most challenging branches of pharmacotherapy, as it is influenced by various factors related to the drug, the patient, and the microorganism [35]. Also, it is important to improve patient knowledge about antibiotics and the natural course of infection: patients often fail to comply with medical recommendations in primary care during antibiotic therapy [36].…”

“…For drug resistance to be tackled effectively, a coordinated, multi-sectoral approach is needed [37]. The main areas that require special attention are constant control of nosocomial infections, monitoring of the epidemiological state of the hospital or department, and rational use of antibiotics [36]. However, generally limited data exists regarding bacterial resistance and alert pathogens in hospitals in Central and Eastern Europe.…”

Patient Beliefs on Antibiotic Prescribing in Primary Care: A Cross-Sectional Survey in Saudi Arabia

“…Additionally, patient knowledge about antibiotics and their consequences can influence prescribing practices [3][4][5]. Poor patient understanding of the risks of antibiotic overuse and the development of antibiotic resistance may lead to increased antibiotic prescribing by healthcare providers [5][6][7]. In Saudi Arabia, there is a high prevalence of antibiotic use, with antibiotics being readily available without a prescription [3].…”