Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study

AbstractFactors associated with antibiotic use, resistance and safety have been well recognized worldwide in the literature. Nevertheless, only few studies have been conducted in Jordan in this area. The aim of this study was to assess knowledge, behavior and attitude toward antibiotics use among adult Jordanians. The study represents a cross sectional survey using an interviewer administered questionnaire. Data collected from a random sample of 1141 adult Jordanians, recruited at different settings, regarding their knowledge about the effectiveness of, resistance toward, and self medications with antibiotics against bacterial, viral and parasitic diseases. 67.1% believed that antibiotics treat common cold and cough. 28.1% misused antibiotics as analgesics. 11.9% of females showed inadequate knowledge about the safe use of antibiotics during pregnancy and nursing. 28.5% kept antibiotics at home for emergency use and 55.6% use them as prophylaxis against infections. 49.0% use left-over antibiotics without physicians’ consultation while 51.8% use antibiotics based on a relative advice. 22.9% of physicians prescribe antibiotics over the phone and >50.0% routinely prescribe antibiotics to treat common cold symptoms.Our findings indicated that young adults showed unsatisfactory knowledge of proper antibiotic use. Therefore, there is an urge for educational programs using all media means

Phytochemical and biological investigations of plants from the families Euphorbiaceae and Thymelaeaceae

Extracts of forty samples from the plant families Euphorbiaceae and Thymelaeaceae were screened for the presence of biologically active diterpene esters. Plant extracts from Gnidia kraussianus, Lasiosiphone kraussianus, Thymelaea hirsuta and Daphne blagayana (Thymelaeaceae) as well as extracts from Sapium inclicum (Euphorbiaceae) induced intense inflammation. Crude extracts and methanol fractions from the Thymelaeaceae species inhibited TPA-induced differentiation of HL-60 cells. Ether fractions induced platelet aggregation of the human blood at concentrations of 10-50 μg/ml. Biologically active diterpene esters were isolated and identified. These compounds were purified by multistage fractionation procedures. These involved liquid-liquid partition, centrifugal liquid chromatography, column chromatography, preparative adsorption and partition liquid chromatography. Final purification was carried out using HPLC. A series of one and two dimension NMR experiments were carried out to facilitate the structure elucidation of the isolated diterpenes. Mass spectrometry and infrared were used to confirm the chemical structures. Both thin layer and normal phase HPLC proved to be valuable in analysing and purifying small quantities of daphnanes and tiglianes. Thymelaeatoxin-A and resiniferonol-9,13,14-orthophenyl acetate were isolated from the twigs and leaves of Thymelaea hirsuta. The intense irritant effect of Daphne blagayana was partially due to the presence of mezerein. The novel sapintoxin-E, 12-O-(2-methylanminobenzoyl)-4,20-dideoxy phorbol-13-acetate, in addition to sapintoxin-A and sapintoxin-D were isolated from the latex of Sapium indicum. The twigs and leaves of Sapium insigne yielded the semi-synthetic 12-O-(2-methyl aminobenzoyl)-4-deoxy-5-hydroxyphorbol-5,13,20-triacetate. The established technique of irritancy testing was used to assess the potency of selected diterpenes. Compared to tiglianes irritancy induced by daphnanes was rapid and short lasting. Epidermal hyperplasia induced by mezerein was comparable to that induced by TPA. In vitro, the isolated compounds were evaluated for their platelet aggregating activity and for their ability to induce differentiation of HL-60 cells. At doses of 1nM and greater, TPA was the most potent diterpene ester in both in vivo and in vitro assays. For the detection of differentiation of HL-60 cells, a rapid and effective microdilution in vitro assay was developed. This technique was based on quantitation of absorbence of protein-bound eosin dye using a single beam minireader. Irritant daphnanes and tiglianes induced the HL-60 cells to differentiate at doses of 20 nM and greater. Differentiation effect of TPA obtained from the new assay was closely related to the established methods

Active educational intervention as a tool to improve safe and appropriate use of antibiotics

Misconception about antibiotics use among the public has been widely outlined to be a main reason for inappropriate use of antibiotics including failure to complete treatment, skipping of doses, re-use of leftover medicines and overuse of antibiotics. The study was devised to evaluate whether education might be a potential strategy to promote safer use of antibiotics and reducing self-medication. Two hundred seventy one adults were asked to complete two questionnaires; a pre and posteducation. The questionnaires comprised of three parts consisting of 17 statements assessing the knowledge on: appropriate use, safe use and resistance of antibiotics. Knowledge score was estimated by calculating the percentage of correct responses. The mean (SD) knowledge score pre-education was 59.4% (20.3). However, posteducation the score was 65.9% (17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and good. Posteducation, participants within poor and adequate knowledge categories were significantly shifted to the good category describing better knowledge, McNemar-χ2 = 28.7, df = 3, p < 0.001. It is concluded that using tailored education material targeting antibiotic need and use with a major aim of improving the public knowledge about antibiotics can be an effective and feasible strategy. This pilot study could be considered as the starting point for a wider scale public educational intervention study and national antibiotic campaign. However, the improvement in participant’s knowledge might not reflect an actual change in antibiotics–seeking behaviour or future retention of knowledge. Future research should seek to assess the impact of education on participant’s behaviour

Platelet Aggregation Inhibitors from Aerial Parts of Grown in Jordan

From the aerial parts of Ruta chalepensis L., grown in Jordan, two furanocoumarins (bergapten and chalepensin), one flavonoid glycoside (rutin) as well as several minor compounds have been isolated. The structural elucidation of these compounds was established based on spectral data (UV, IR, MS, 1 H-NMR and 13 C-NMR). In Jordan, R. chalepensis is recommended for the treatment of rheumatism, mental disorders and menstrual problems. Fresh and dried leaves are used as flavoring agent in food and beverages. Antiplatelet activities of the crude methanolic and ethylacetate extracts in addition to the three isolated major compounds were measured by the aggrometric method according to Beretz and Casenave. Optical aggregometer connected to dual channel recorder was used for measuring aggregation. Both, ethylacetate and methanol extracts inhibited ADP- induced platelet aggregation (ADP-IA) of human blood. However, only ethylacetate extract was able to induce 50% inhibition of collagen-induced platelet aggregation (Co-IA) platelet rich plasma. Bergapten was more active against ADP-IA compared to chalepensin while the latter was more active against Co-IA compared to bergapten

Phytochemical and Biological Investigation of Aristolochia maurorum L

Aristolochia maurorum L. of Jordanian origin has been investigated phytochemically, quantitatively, and biologically. Three atypical alkaloids, namely aristolochic acid I (1), aristolochic acid II (2) and aristolochic acid IIIa (3), have been isolated and identified. Of these known 1-phenanthrenecarboxylic acids, 2 and 3 are reported for the first time from this species. The identified compounds 1Ð3 were first evaluated biologically as cytotoxic agents against the brine shrimp lethality test (BST), in which compound 1 was found to be the most potent (LC 50 , 4.9 μg/mL). The antiplatelet activity of the methanolic extracts, the acidic fractions of aerial and root parts, and the identified compounds 1Ð3 were evaluated using an automatic platelet aggregometer and coagulation tracer (APACT 2). Using external reference standards, and a reverse-phase isocratic method, the distribution of aristolochic acid I and aristolochic acid II in different plant parts of Aristolochia maurorum L. during flowering stage was analyzed by PDA-HPLC. A quantitative comparison between two previously reported extraction methods was also made. Roots were found to be the main storage of aristolochic acid I and aristolochic acid II during flowering stage with about 0.22 and 0.108% (w/w), respectively

Plants Secondary Metabolites as Blood Glucose-Lowering Molecules

Recently, significant advances in modern medicine and therapeutic agents have been achieved. However, the search for effective antidiabetic drugs is continuous and challenging. Over the past decades, there has been an increasing body of literature related to the effects of secondary metabolites from botanical sources on diabetes. Plants-derived metabolites including alkaloids, phenols, anthocyanins, flavonoids, stilbenoids, saponins, tannins, polysaccharides, coumarins, and terpenes can target cellular and molecular mechanisms involved in carbohydrate metabolism. In addition, they can grant protection to pancreatic beta cells from damage, repairing abnormal insulin signaling, minimizing oxidative stress and inflammation, activating AMP-activated protein kinase (AMPK), and inhibiting carbohydrate digestion and absorption. Studies have highlighted many bioactive naturally occurring plants’ secondary metabolites as candidates against diabetes. This review summarizes the current knowledge compiled from the latest studies published during the past decade on the mechanism-based action of plants-derived secondary metabolites that can target various metabolic pathways in humans against diabetes. It is worth mentioning that the compiled data in this review will provide a guide for researchers in the field, to develop candidates into environment-friendly effective, yet safe antidiabetics

Design, Synthesis and in Vivo Evaluation of Novel Glycosylated Sulfonylureas as Antihyperglycemic Agents

Sulphonylurea compounds have versatile activities such as antidiabetic, diuretic, herbicide, oncolytic, antimalarial, antifungal and anticancer. The present study describes the design, synthesis and in vivo testing of novel glycosylated aryl sulfonylurea compounds as antihyperglycaemic agents in streptozocine-induced diabetic mice. The rational for the introduction of the glucosamine moiety is to enhance selective drug uptake by pancreatic β-cells in order to decrease the cardiotoxic side effect commonly associated with sulfonylurea agents. 2-Deoxy-2-(4-chlorophenylsulfonylurea)-d-glucopyranose was found to be the most potent antihyperglycaemic agents among the synthesized compounds in diabetic mice. This investigation indicates the importance of this novel class as potential antihyperglycaemic agents

In Vitro and In Vivo Antidiabetic Activity, Phenolic Content and Microscopical Characterization of Terfezia claveryi

Terfezia claveryi (T. claveryi) is used by traditional healers in the Middle East region to treat several diseases, including diabetes. The present study evaluated the total phenolic and investigated the blood-glucose-lowering potential of different aqueous extracts of this selected truffle using in vitro and in vivo models. The phytochemical profile was examined using UPLC-MS. The macerate and the microwave-assisted extract were the richest in phenolic compounds. All T. claveryi extracts exhibited a remarkable &alpha;-glucosidase inhibitory effect in vitro, with an IC50 of 2.43, 3.26, 5.18 and 3.31 mg/mL for the aqueous microwave-assisted extract macerate, infusion and decoction, respectively. On the other hand, in the high-fat diet alloxan-induced diabetic mice model, all tested crude aqueous extracts exhibited a significant antihyperglycemic activity (p &lt; 0.05). Four hours after the administration of the 250 mg/kg dose, the macerate was able to induce a 29.4% blood-glucose-lowering effect compared to a 24.8% reduction induced by the infusion, which was sustained for a further two hours. The hypoglycemic effect (29.3% and 32.4%) was also recorded six hours after the administration of the single dose 500 mg/kg of the macerate and the infusion, respectively. Truffle extracts exhibited antidiabetic activity both in vitro and in vivo, providing a rationale for the traditional use as a natural hypoglycemic