Practices, knowledge, and attitude toward dispensing antibiotics without a prescription in Iraqi pharmacies 10.55131/jphd/2023/210102
Article Sidebar
Main Article Content
Abstract
Dispensing antibiotics without a prescription (DAWRx) is a potential threat to global public health and can lead to antimicrobial abuse and resistance development. Further research is required to examine the characteristics of DAWRx practice in Iraq. This study aimed to investigate the practices of DAWRx in Iraqi community pharmacies. A semi-structured, validated, pilot-tested online questionnaire was used to conduct a descriptive cross-sectional study in March 2020 among the members of the Iraqi Pharmacist Syndicate. The questionnaire contained five sections: demographics, antibiotic dispensing knowledge, and the prevalence, sources, and characteristic features of DAWRx practices. The results are presented using descriptive statistics and significant associations were reported. A total of 403 respondents completed the questionnaire and, of them, 363 were analyzed. Despite having a satisfactory knowledge of dispensing (64.7%), the practice of DAWRx was prevalent (98.3%). DAWRx was reported based on the pharmacies’ recommendation (30.58%) and patients’ request for antibiotics. Adults and pediatric patients received antibiotics from pharmacies for various conditions. Injectable antibiotics were also dispensed without a prescription (mainly ceftriaxone, n = 51/72). Moreover, the prevalence and the daily number of antibiotics dispensed were significantly associated with sex, pharmacy attitude toward DAWRx, and DAWRx upon patients’ request. A significant association was noted between the knowledge of dispensing inquiries and the prevalence of and attitude toward DAWRx (p < 0.05). Impactful intervention strategies based on patterns identified in this study should be developed to improve antibiotic dispensing in community pharmacies and safeguard public health from the adverse effects of antimicrobial resistance.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6(1):47.
Hersh AL, Newland JG, Beekmann SE, Polgreen PM, Gilbert DN. Unmet medical need in infectious diseases. Clin Infect Dis. 2012;54(11):1677–8.
Bartlett JG, Gilbert DN, Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56(10):1445–50.
Cars O, Nordberg P. Antibiotic resistance – The faceless threat. Int J Risk Saf Med. 2005;17(3–4):103–10.
Almaaytah A, Mukattash TL, Hajaj J. Dispensing of non-prescribed antibiotics in Jordan. Patient Prefer Adherence. 2015;9:1389–95.
Halboup A, Abdi A, Ahmed M, Al-Qadasi F, Othman GQ. Access to antibiotics without prescription in community pharmacies in Yemen during the political conflict. Public Health. 2020;183:30–5.
Mansour O, Al-Kayali R. Community Pharmacistsꞌ Role in Controlling Bacterial Antibiotic Resistance in Aleppo, Syria. Iran J Pharm Res. 2017;16(4):1612–20.
Zapata-Cachafeiro M, González-González C, Váquez-Lago JM, López-Vázquez P, López-Durán A, Smyth E, et al. Determinants of antibiotic dispensing without a medical prescription: a cross-sectional study in the north of Spain. J Antimicrob Chemother. 2014;69(11):3156–60.
Plachouras D, Kavatha D, Antoniadou A, Giannitsioti E, Poulakou G, Kanellakopoulou K, et al. Dispensing of antibiotics without prescription in Greece, 2008: another link in the antibiotic resistance chain. Euro Surveill. 2010;15(7):19488.
Santa-Ana-Tellez Y, Mantel-Teeuwisse AK, Dreser A, Leufkens HGM, Wirtz VJ. Impact of over-the-counter restrictions on antibiotic consumption in Brazil and Mexico. PLOS ONE. 2013;8(10):e75550.
Grigoryan L, Burgerhof JGM, Degener JE, Deschepper R, Lundborg CS, Monnet DL, et al. Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system. J Antimicrob Chemother. 2008;61(5):1172–9.
Haddadin RN, Alsous M, Wazaify M, Tahaineh L. Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study. PLOS ONE. 2019;14(4): e0216115.
Al-Jumaili AA, Hussain SA, Sorofman B. Pharmacy in Iraq: history, current status, and future directions. Am J Health-Syst Pharm. 2013;70(4):368–72.
Mikhael E. Evaluating the Rationality of Antibiotic Dispensing in Treating Common Cold Infections among Pharmacists in Baghdad – Iraq. Br J Pharm Res. 2014;4:2653–61.
Alkadhimi A, Dawood OT, Hassali MA. Dispensing of antibiotics in community pharmacy in Iraq: a qualitative study. Pharm Pract. 2020;18(4):2095.
Ibrahim IR, Palaian S, Ibrahim MI. Assessment of diarrhea treatment and counseling in community pharmacies in Baghdad, Iraq: A simulated patient study. Pharm Pract (Granada). 2018;16(4):1313.
Hadi MA, Karami NA, Al-Muwalid AS, Al-Otabi A, Al-Subahi E, Bamomen A, et al. Community pharmacists’ knowledge, attitude, and practices towards dispensing antibiotics without prescription (DAwP): a cross-sectional survey in Makkah Province, Saudi Arabia. Int J Infect Dis. 2016;47:95–100.
Majid Aziz M, Haider F, Rasool MF, Hashmi FK, Bahsir S, Li P, et al. Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff’s Opinion. Antibiotics. 2021;10(5):482.
Abuirmeileh A, Samara S, Alkhodari A, Bahnassi A, Talhouni A, Hayallah AM. Antibiotic dispensing without prescription in Jordanian community pharmacies: A pharmacist's perspective. Bull Pharm Sci. 2014; 37(1):51–63.
Al-Taie A, Hussein AN, Albasry Z. A Cross-Sectional Study of Patients’ Practices, Knowledge and Attitudes of Antibiotics among Iraqi Population. J Infect Dev Ctries. 2021;15(12):1845–53.
Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011;11(9):692–701.
Liu J. Tackling the global non-prescription use of antibiotics. Lancet Infect Dis. 2020;20(2):169–70.
Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology--drug disposition, action, and therapy in infants and children. N Engl J Med. 2003; 349(12):1157–67.
Klassen TP, Hartling L, Craig JC, Offringa M. Children are not just small adults: the urgent need for high-quality trial evidence in children. PLOS Med. 2008;5(8):e172.
Muhammed R, Al-Ani A, Yassen A. Self-Medication with Antibiotic among Public Population in Erbil City. J Pharm Res Int. 2021;33:25–33.
Alhomoud F, Aljamea Z, Almahasnah R, Alkhalifah K, Basalelah L, Alhomoud FK. Self-medication and self-prescription with antibiotics in the Middle East-do they really happen? A systematic review of the prevalence, possible reasons, and outcomes. Int J Infect Dis. 2017;57:3–12.
Torres NF, Solomon VP, Middleton LE. Pharmacists’ practices for non-prescribed antibiotic dispensing in Mozambique. Pharm Pract. 2020;18(3):1965.
Al Rasheed A, Yagoub U, Alkhashan H, Abdelhay O, Alawwad A, Al Aboud A, et al. Prevalence and Predictors of Self-Medication with Antibiotics in Al Wazarat Health Center, Riyadh City, KSA. BioMed Res Int. 2016;2016:3916874.
Ibrahim I, Al-Tukmagi H, Wayyes A. Attitudes of Iraqi society towards the role of community pharmacists. Innov Pharm. 2013;4(2):114.