Global access to antibiotics without prescription in community pharmacies: a systematic review and meta-analysis

Objective: To estimate the proportion of over-the-counter antibiotic requests or consultations that resulted in non-prescription supply of antibiotics in community pharmacies globally. Methods: We systematically searched EMBASE, Medline and CINAHL databases for studies published from January 2000 to September 2017 reporting the frequency of non-prescription sale and supply of antibiotics in community pharmacies across the world. Additional articles were identified by checking reference lists and a Google Scholar search. A random effects meta-analysis was conducted to calculate pooled estimates of non-prescription supply of antibiotics. Results: Of the 3302 articles identified, 38 studies from 24 countries met the inclusion criteria and were included in the review. All the included countries with the exception of one, classified antibiotics as prescription-only medicines. The overall pooled proportion of non-prescription supply of antibiotics was 62% (95% CI 53 – 72). The pooled proportion of non-prescription supply of antibiotics following a patient request was 78% (95% CI 59 - 97) and based on community pharmacy staff recommendation was 58% (95% CI 48 – 68). The regional supply of non-prescription antibiotics was highest in South America, 78% (95% CI 72 - 84). Antibiotics were commonly supplied without a prescription to patients with symptoms of urinary tract infections (68%, 95% CI 42 – 93) and upper respiratory tract infections (67%, 95% CI 55 - 79). Fluoroquinolones and Penicillins respectively were the most commonly supplied antibiotic classes for these indications. Conclusion: Antibiotics are frequently supplied without prescription in many countries. This overuse of antibiotics could facilitate the development and spread of antibiotic resistance

Management of musculoskeletal pain in retail drug outlets within a Nigerian community: a descriptive study

Objective: This work aimed to describe attitudes and practices of both community pharmacies and patent and proprietary medicine vendor (PPMV) outlets towards over-the-counter (OTC) analgesic use for musculoskeletal pain states within Zaria, Nigeria. Methods: The study was carried out in 2 phases from May to August 2016. Phase one was a cross-sectional survey of 40 retail drug outlets (10 community pharmacies and 30 PPMVs). A simulated patient scenario of a young adult male complaining of acute onset back pain was used to collect data on the type and quality of analgesic recommended, duration of consultation, as well as nature of information provided during the drug dispensing process. The second phase involved semi structured interviews with 7 drug vendors (4 pharmacists and 3 patent medicine vendors). The interviewees were asked questions to assess their knowledge of analgesics as well as what type of analgesic they would recommend in three hypothetical patient scenarios. Results: A wide variety of therapeutic agents were recommended for the simulated patient. Majority of these drugs were oral analgesics and contained NSAIDS either alone or in combination. Less than half of both patent medicine outlets and pharmacies (26.7% and 40% respectively) provided the simulated patient with information on duration of therapy, and asked the patient questions about their past medical and medication history (30% and 33.3% respectively). All analgesics purchased from the pharmacies were registered with the Nigerian drug regulatory agency and had expiry dates compared to only 66.7% and 90% of those bought from patent medicine outlets. Interviewed drug vendors admitted to obtaining a large amount of their knowledge on analgesics from drug information leaflets and prior learning. They also showed some knowledge deficits when questioned on side effects of analgesics and appropriate drug selection in the hypothetical scenarios. Conclusions: There are problems with both the OTC analgesics recommended, and the counselling provided for these medicines by drug vendors within the Zaria community. While both pharmacies and patent medicine outlets had shortcomings in several of the areas assessed by the simulated patient, the pharmacies performed better

Investigating Knowledge of Antibiotics, Antimicrobial Resistance and Antimicrobial Stewardship Concepts Among Final Year Undergraduate Pharmacy Students in Northern Nigeria

Samirah N Abdu-Aguye,1,* Kromdi G Barde,1,* Hadiza Yusuf,2,* Basira Kankia Lawal,3,* Aishatu Shehu,4,* Elijah Mohammed5,* 1Department of Clinical Pharmacy & Pharmacy Practice, Ahmadu Bello University, Zaria, Nigeria; 2Department of Clinical Pharmacy & Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria; 3Department of Clinical Pharmacy & Pharmacy Management, Kaduna State University, Kaduna, Nigeria; 4Department of Pharmacology & Therapeutics, Ahmadu Bello University, Zaria, Nigeria; 5Pharmacists Council of Nigeria, Abuja, Nigeria*These authors contributed equally to this workCorrespondence: Samirah N Abdu-Aguye, Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria, Tel +234 803 201 9135, Email [email protected]: Well trained, knowledgeable and competent pharmacists are indispensable in the fight against antimicrobial resistance (AMR), which is a current global public health problem. The aim of this work was to assess knowledge of antibiotics, antimicrobial resistance and antimicrobial stewardship of fifth year pharmacy students at three universities in Northern Nigeria.Methods: A descriptive cross-sectional study that used a paper-based questionnaire to collect data from July to September 2021 was conducted. The questionnaire was self-administered and divided into four sections. The first section collected information about the demographic data of respondents, while section B explored their knowledge of antibiotics and AMR. Section C contained six questions assessing knowledge of various aspects of antimicrobial stewardship (AMS), while the final part assessed respondents’ preparedness to work with antibiotics and perceptions of their current knowledge of these concepts. Descriptive statistics were used to report the results obtained.Results: A total of 164 questionnaires were retrieved. Majority of respondents were male (58.3%) and aged between 21 and 25 years (53.4%). Most of them had some knowledge of antibiotics and AMR, however several misconceptions with respect to these concepts were identified. Only 80 (48.8%) of respondents indicated that they knew what AMS was, although most of these students were correctly knowledgeable about the goals and scope of AMS and composition of the AMS team. Generally, less than half of respondents agreed that their current knowledge of antibiotics, AMR or AMS was adequate for their future careers, and over 90% of them agreed that they would like more education about these topics.Conclusion: Many of the study’s’ respondents were somewhat knowledgeable about these concepts, although several knowledge gaps were also observed. Improving undergraduate pharmacy education with respect to these concepts is recommended.Keywords: antibacterial agents, antibiotic resistance, antimicrobial stewardship, Nigeria, pharmacy student