Irrational Antibiotic Use and Distribution in the Thai Community: a Complex Situation in Need of Integrative Solution - สถานการณ์การใช้และกระจายยาปฏิชีวนะในชุมชนของไทย: ปัญหาซับซ้อนที่ต้องจัดการแบบบูรณาการ (original) (raw)
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Antibiotics’ Use in Thailand: Community Pharmacists’ Knowledge, Attitudes and Practices
Antibiotics
Thailand spends $203 million on antibiotics every year, and patients can still access antimicrobials over the counter without a prescription. Community pharmacy plays a pivotal role in improving access and ensuring the appropriate use of antimicrobials. However, little is known about current practices in this setting. This study aims to assess Thai community pharmacists’ knowledge, attitudes and practices (KAP) regarding antimicrobials’ use and resistance. A cross-sectional study was conducted in Bangkok and Chonburi province in 2017 using an online self-administered questionnaire. The questionnaire was completed by 372 community pharmacists (71.4% response rate). The most commonly encountered infections in the community were upper and lower respiratory tract infections. The most commonly dispensed antimicrobials were broad-spectrum antibiotics including aminopenicillins and fluoroquinolones. Thai pharmacists have a good knowledge, attitude, and practice regarding antimicrobials’ us...
Drug, Healthcare and Patient Safety, 2022
The spread and emergence of antimicrobial resistance is the significant public health concerns over past decades. The major leading cause comes from irrational use of antibiotics. Aim: To explore the characteristics of rational use of antibiotics and identify its predictive factors among public sector living in Nakhon Nayok Province, Thailand. Methods: This project was conducted by using the data-source from Rational Use of Antibiotics (RUA) Survey Project at Nakhon Nayok Province. A cross-sectional community-based study method and face to face interviews were conducted. Two hundred fiftyfour participants were selected by using Quota sampling method. Descriptive statistics were used to describe the sociodemographic and antibiotics use characteristics. Chi-square test were utilized to determine the association between explanatory variables and major outcome while multiple logistic regression was analysed to identify the predictors of antibiotics use behavior. Results: The mean age of the participants was 42 years, those with aged between 35 and 56 had more rational use of antibiotics behavior than those with 13-34 years while older adults (57-78 years) were significantly associated with irrational use of antibiotics [AOR = 0.38; 95% CI (0.17-0.85)] than those with less than 34 years of age. Less than half (45.7%) and about one third of them (31.1%) showed adequate knowledge and appropriate attitude towards antibiotics use. An adequate knowledge [AOR = 3.37; 95% CI (1.92-5.90)], appropriate attitude [AOR = 2.90; 95% CI (1.54-5.43)], not using antibiotics within last 3 months [AOR = 1.89; 95% CI (1.04-3.43)], and not visiting drugstore when having three main diseases [AOR = 2.04; 95% CI (1.06-3.92)] were the significant predictors of rational antibiotics use (p-value <0.05). Conclusion: Strategies development in terms of knowledge and attitude enhancement about antibiotics use particularly at the different ages together with RDU pharmacy encouragement and policy restriction of community drugstores antibiotics sales are the most effective method to promote rational antibiotics use behavior in the public sector.
Knowledge and Practices about the Rational Use of Antibiotics
Decreasing antibiotic effectiveness due to inadequate knowledge and misconceptions on antibiotic usages has been a big threat all over the world including Bangladesh. The aim of the study was to determine the level of knowledge and practice about the rational use of antibiotics among adults in rural area of Rajshahi, Bangladesh. A Community Clinic (CC) based study was performed by involving 600 rural adults. Data were collected from different CC areas in the Rajshahi district, Bangladesh. Knowledge and practice were measured by using composite index. Multistage random sampling and binary logistic regression were used. The study revealed that only 17.2% rural adults had good knowledge about the rational use of antibiotics. The knowledge of proper usages of antibiotics was higher among the young adult compared to older age groups. Adults with primary, secondary and higher educational levels were more likely to have a good knowledge about the rational use of antibiotics compared to illiterate groups. In case of the rural adults, who were secondary and higher educated were more likely to have good practices about the rational use of antibiotics compared with their counterparts. However, majority of the participants (91.0%) had very poor practices in rational use of antibiotic. In this study we found that there was a vast gap of knowledge and practices about the rational use of antibiotics among rural adults in Bangladesh. Consequently, our findings can be considered to make awareness programme about rational use of antibiotic among rural adults in Bangladesh.
Antimicrobial Resistance and Infection Control, 2017
Background: Antibiotic misuse is widespread in resource-limited countries such as Cambodia where the burden of infectious diseases is high and access to antibiotics is unrestricted. We explored healthcare seeking behaviour related to obtaining antibiotics and drivers of antibiotic misuse in the Cambodian community. Methods: In-depth interviews were held with family members of patients being admitted in hospitals and private pharmacies termed pharmacy attendants in the catchment areas of the hospitals. Nurses who run community primary healthcare centres located within the hospital catchment areas were invited to attend focus group discussions. Nvivo version 10 was used to code and manage thematic data analysis. Results: We conducted individual interviews with 35 family members, 7 untrained pharmacy attendants and 3 trained pharmacists and 6 focus group discussions with 30 nurses. Self-medication with a drug-cocktail was widespread and included broad-spectrum antibiotics for mild illness. Unrestricted access to antibiotics was facilitated by various community enablers including pharmacies or drug outlets, nurse suppliers and unofficial village medical providers referred to as "village Pett" whose healthcare training has historically been in the field and not at university. These enablers supplied the community with various types of antibiotics including broad spectrum fluoroquinolones and cephalosporins. When treatment was perceived to be ineffective patients would prescriber-shop various suppliers who would unfailingly provide them with antibiotics. The main driver of the community's demand for antibiotics was a mistaken belief in the benefits of antibiotics for a common cold, high temperature, pain, malaria and 'Roleak' which includes a broad catch-all for perceived inflammatory conditions. For severe illnesses, patients would attend a community healthcare centre, hospital, or when their finances permitted, a private prescriber. Conclusions: Pervasive antibiotic misuse was driven by a habitual supplier-seeking behaviour that was enabled by unrestricted access and misconceptions about antibiotics for mild illnesses. Unofficial suppliers must be stopped by supporting existing regulations with tough new laws aimed at outlawing supplies outside registered pharmacies and fining registered pharmacist/owners of these pharmacies for supplying antibiotics without a prescription. Community primary healthcare centres must be strengthened to become the frontline antibiotic prescribers in the community thereby enabling the community's access to inexpensive and appropriate healthcare. Community-based education program should target appropriate health-seeking pathways and the serious consequences of antibiotic misuse.
Antibiotic Dispensing Practices at Community Pharmacies in Kathmandu and Lalitpur Districts of Nepal
Indian Journal of Pharmacy Practice
Objectives: Antibiotics are often dispensed irrationally especially in community pharmacies. The present study was conducted to evaluate antibiotic dispensing practices among community pharmacies. Methods: A crosssectional study was conducted in Kathmandu and Lalitpur districts, Nepal from October to November 2018 among the community pharmacies listed in different directories. Systematic random sampling was used to sample 78 community pharmacies based on a 5% margin of error and a 95% confidence level. Data was collected using a structured questionnaire and analyzed using SPSS version 21 for Windows. Results: Out of 78 pharmacies, 54 (69.2%) were in Kathmandu district. Antibiotics were dispensed without a prescription by 67 (85.9%) pharmacies. Brand substitution was seen in 43 pharmacies (55.1%). Antibiotics per prescription were three in 51 cases (65.4), followed by two antibiotics in 27 (34.6%). Advice regarding completing the course of antibiotics was provided by 59 (75.6%) pharmacies and an insufficient course of antibiotics was dispensed in 23 (29.5%) pharmacies. Nine pharmacists (11.5%) replaced prescribed antibiotics with cheaper brands. Azithromycin [69 (22.2%)] was the most dispensed antibiotic followed closely by Amoxycillin [68 (21.9%)]. Conclusion: Dispensing antibiotics without a prescription was seen in most pharmacies which can adversely impact the rational use of antibiotics. The findings of this study may necessitate strengthening the implementation of the framed guidelines for ensuring the safe and rational use of antibiotics.
Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand
Bulletin of the World Health Organization, 2012
The Antibiotics Smart Use (ASU) programme was introduced in Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programme's first phase consisted of assessing interventions intended to change prescribing practices; the second phase examined the feasibility of programme scale-up. Currently the programme is in its third phase, which centres on sustainability. This paper describes the concept behind ASU, the programme's functional modalities, the development of its conceptual framework and the implementation of its first and second phases. To change antibiotic prescription practices, multifaceted interventions at the individual and organizational levels were implemented; to maintain behaviour change and scale up the programme, interventions at the network and policy levels were used. The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major achievement that has led to the programme's expansion na...
2018
Background: An estimated two-thirds of global sales of antimicrobials occur over the counter without a prescription. Furthermore, antimicrobials are the most commonly sold medicines in developing countries. The overuse, misuse, or inappropriate use of antimicrobials are major contributing factors to the emergence of antimicrobial resistance. This does not only lead to failure of therapy, increased morbidity and mortality, and rise in healthcare costs, but it puts these countries on a fast track to the pre-antibiotic era. Thailand is experiencing soaring antimicrobial resistance. A few studies suggest that inadequate knowledge, incorrect attitudes and malpractices of healthcare professionals and patients regarding the use of antimicrobials and reducing the emergence of antimicrobial resistance may be fuelling this crisis. Pharmacists in particular, may have a key role in rationalising the use of antimicrobials in community and reducing the emergence of resistance. Aim This study aims to assess pharmacists' knowledge, attitudes and practices regarding antimicrobials use over the counter and antimicrobial resistance. Methods A cross-sectional descriptive study was conducted using online self-administered questionnaire for pharmacists in Bangkok and Chonburi province in Thailand between May and July 2017. The self-administered questionnaire was developed following a review the literature relating to pharmacists and healthcare professionals using the Knowledge, Attitude and Practices (KAP) model regarding antimicrobial use and resistance. The questionnaire was validated by an expert panel and its validity and reliability was tested in a pilot study. Statistic Package for the Social Science (SPSS) software version 24 was used for statistical analysis. The Cronbach's alpha and Interclass correlation coefficients (ICC) were used to test of reliability. Kolmogorov-Smirnov Test was used for normal distribution testing. Descriptive data were examined by the median, interquartile range (IQR), Chi-squared test. Mann-Whitney U Test and Kruskal-Wallis test were used to describe associations between demographics with knowledge, attitude and practice of participants. Relationships between knowledge, attitude and practice dimensions were analysed by regression equations and Spearman's correlation coefficient statistic. Qualitative data were coded and presented as percentages. Results 372 pharmacists completed the questionnaire obtaining a response rate of 71.4%. The community pharmacists age average was 32.02 (± 5.81) years. Most participants hold a bachelor degree in pharmacy (77.2%), and work at individual/ independent drug stores (62.6%). The average experience in community pharmacy is 5.46 (± 4.31) years. 69.4% of the participants work in Bangkok and 30.6% work in Chonburi. More than 90% of pharmacists have good knowledge, attitude and practice in antimicrobial use and resistance. However, there is only a slight correlation between attitude and practice score at rho = 0.149, p-value 0.004. The most commonly encountered infections are respiratory infections and Aminopenicillin is the main drug provided in pharmacies. The main reported reason of pharmacists to provide antimicrobials without a prescription was their confidence in their competency. Conclusion Respiratory infections were the most commonly encountered infections in community in Thailand, with Aminopenicillin being the most commonly dispensed antibiotic. Community pharmacists in Thailand report competence as the main reason for them providing antimicrobials without a prescription. This study shows that over 90% of them have good knowledge, attitude, and practice regarding antimicrobial use and resistance. Pharmacists in Thailand could sustain their competence through continuing education, adherence to antimicrobials guidelines, collaboration with other healthcare providers, and raising public awareness regarding antimicrobial use and resistance. Pharmacy associations could support pharmacists to improve pharmacy services through research, training, campaigning, professional standards and guidelines, and increasing inter-professional collaboration in fighting antimicrobial resistance. Further, government and policy makers could enhance pharmacists' role in ensuring the appropriate use of antimicrobial and combatting antimicrobial resistance through the provision of national databases and surveillance programmes, research funding and healthcare regulations. iii ACKNOWLEDGEMENTS My dissertation success has been supported by my principal supervisor, Dr Ilhem Berrou and co-supervisor, Dr David Griffiths. I am very grateful for the opportunity to study at the University of Hertfordshire and the continuous feedback and encouragement to develop my research skills. This study might not have been successful without my panel of experts, Dr Somying Pumthong, Dr Suphannika Prateepjarassaeng and Mrs Suneerat Kittikun; who gave suggestions and validated the questionnaire of the study. Also, thank you to all participants in Thailand who were very generous with their time to participate in this study. Many thanks to the Faculty of Pharmaceutical Sciences, Burapha University for the financial support Finally, thank you to my parents for their ongoing encouragement, and for financially supporting me. Contents CHAPTER 1 INTRODUCTION .
Tropical Medicine and International Health, 1997
A survey on the use of antibiotics purchased through retail pharmacies was conducted in the Badinh district of Hanoi, Vietnam. T h e survey found that purchasers visit a pharmacy when they o r those who felt they needed antibiotics had minor symptoms such as cough (34.1%), sore throat ( 3 2 . 5 % ) , stomach upsets (lo.oo/oj and diarrhoea (8.8% j. The most often purchased :intibiotics were ampicillin ( 3~. 1 % ) , amoxyllin (~6 . 7 % ) , cotrimoxazol (11.6"/0), tctracycline (j.z'%) ,ind cephalexin (4.8%). T h e median of the purchased quantity was 10 tablets, the mean 11.34 tablets (95%CI 9.65-12.97). About 30% of the purchasers intended to take antibiotics for three days or less. T h e mean cost of a antibiotic purchase was US$1.27 (qj%CI 1.06-1.39). The main reason for not taking a full course of antibiotics was not economic constraint, but the purcliascrs' poor knowledge about antibiotics. Logistic regression analysis indicates that agc o f purchasers, length of symptoms and kinds of treatment used before visiting a pharmacy could be used a s predictive variables for the decision to buy antibiotics in prefcrence to alternative drugs. Antibiotics are used when illness lasts longer than one week and antibiotics have not yet been taken. Antibiotics arc also purchased by young rather than old people. The study documents the need for better health education about the rational use of antibiotics in the general public.
INDIAN RESEARCH JOURNAL OF PHARMACY AND SCIENCE, 2020
Antimicrobial resistance and irrational use of antibiotics are two concerning issues in the present world especially in lower-and-middle income countries. Bangladesh is one of the worst untrained drug store salespersons are involves with dispensing drug. This aimed to understand the differential perception of trained and untrained pharmacists on role of irrational antibiotics use in emergence of antimicrobial resistance. A qualitative study was designed with in in Dhaka. The participants demonstrated a significant difference in knowledge, awareness, attitude and practice regarding antimicrobial resistance and dispensing practice of antibiotics along with diff and professional training. Grade C and untrained pharmacists working in the local small drug shops were found reluctant and unaware about antimicrobial resistance and rational use of antibiotics influenced by various factors li workplace environment, client demands, marketing by pharmaceutical companies and ignorance about the existing. However, grade A and B pharmacists were found working in bigger corporate and hospital pharmacies confined to managing and dispensing drugs with limited decision multidisciplinary approach with a strong regulatory body is required to control the situation in Bangladesh.
Clinical Infection and Immunity, 2017
Background: Bangladesh is not exempted from the grave dangers of antibiotic resistance and the other problems arising from its misuse. The prevalent aberrations in the practice of using antibiotics in Bangladesh include self-medication, prescription by quacks and nonphysicians, non-registered "village doctors", irrational prescription, etc. The resultant rises in resistant strains of several bacteria are also seen, and probably much is yet unseen and unnoticed. Methods: This observational descriptive study attempted to describe the actual scenario. A total of 155 patients (60% male and 40% female) were included in this study with consecutive purposive sampling who took antibiotics prior to coming to the primary health care facility. Results: Most common problems were common cold symptoms, only fever with or without body ache but without any other specific features and gastrointestinal upset (constipation/diarrhea/abdominal pain) with/without fever. Most (67.9%) of the patients also had taken some antibiotics in the past year for similar reasons, most common of which is "mixed reasons", followed by common cold. Most of the time, the antibiotic was prescribed by drug seller at medicine store (89, 57.4%), followed by quack/village doctor (29, 18.7%). In mere 14.2% of cases, the antibiotic was prescribed by registered Bachelor of Medicine and Bachelor of Surgery (MBBS) doctors (22, 14.2%). Most have no clear idea about the definition of a doctor, and most (137, 89%) consider non-medical as doctors and think them to be qualified enough to prescribe antibiotic. About 80% of the respondents had no idea or flawed idea about importance of regularity in taking antibiotics, or completion of the course or the concept and threat of antibiotic resistance. Most commonly taken antibiotic was ciprofloxacin (38, 24.7%), followed by cefixime (30, 19.5%), and azithromycin (26, 16.9%). Patients had already spent from a minimum of 12 Bangladeshi Taka (BDT) to a maximum of 675 BDT, average being 166.61 BDT and a median of 117 BDT, before they came for consultation. So the economic impact is also not negligible. Conclusion: This study shows that gross misuse of antibiotics is being done in Bangladesh. Most of the responsibilities of gross misuse belong to two parties, non-physicians, illegal medical practitioners, quacks, and lack of awareness among the patients.