Abstract
Inappropriate use of antibiotics, especially for treatment of self-limiting infections remains one of the major drivers of antibiotic resistance (ABR). Community pharmacists can contribute to reducing ABR by ensuring antibiotics are dispensed only when necessary. To assess community pharmacists' management of self-limiting infections. A purposive sample of 75 pharmacies participated in the study. Each pharmacy was visited by an investigator and a trained simulated patient who mimicked symptoms of common cold and acute diarrhoea, respectively. Interactions between the simulated patient and pharmacist were recorded by the investigator in a data collection form after each visit. Descriptive statistical analysis was carried out. Ethics approval was obtained from the state Ministry of Health Research Ethics Committee. For common cold, 68% (51/75) of pharmacists recommended an antibiotic. Azithromycin, amoxicillin/clavulanic acid, and sulphamethoxazole/trimethoprim (43%, 24%, 20%, respectively) were the most frequently dispensed agents. For acute diarrhoea, 72% (54/75) of pharmacists dispensed one antibiotic, while 15% dispensed more than one antibiotic. The most frequently dispensed agent was metronidazole (82%), which was dispensed in addition to amoxicillin or tetracycline among pharmacists who dispensed more than one agent. In both infection scenarios, advice on dispensed antibiotics was ofered in 73% and 87% of the interactions, respectively. This study shows high rate of inappropriate antibiotics dispensing among community pharmacists. There is need for improved awareness of antibiotic resistance through continuing education and training of community pharmacists. Furthermore, the inclusion of antibiotic resistance and stewardship in undergraduate pharmacy curriculum is needed.
Highlights
The most frequently dispensed agent was metronidazole 44/54 (82%), which was dispensed in addition to amoxicillin or tetracycline among pharmacists who dispensed more than one agent
The objective of this study was to assess community pharmacists’ management of common cold and acute diarrhoea, self-limiting infections that do not benefit from treatment with antibiotics
Antibiotics were recommended in 68% of visits for common cold and 72% of visits for acute diarrhoea
Summary
Irrational use of antibiotics, especially for treatment of self-limiting viral infections such as, upper respiratory tract infections (URTIs) and acute diarrhoea (characterised by watery, non-bloody, non-mucoid stool with or without mild fever) contributes to the development of antibiotic resistance.[1,2,3] In low- and middle- countries (LMICs) countries, antibiotic recommendations for viral URTIs ranges from about 40 to 75% and for African Health SciencesAfrican Health Sciences, Vol 21 Issue 2, June, 2021 national medicines regulations, lack of awareness of antibiotic resistance, commercial interest of pharmacists, consumer demand and failure of pharmacists to educate patients on the dangers of self-medication or irrational antibiotic use.[19,20] The pharmaceutical sector (academic, hospital, industrial and community/retail) in Nigeria is regulated by the Pharmacists Council of Nigeria (PCN).[21]. Limited data exist on the community pharmacists’ management of common viral infections in Nigeria. This study sought to assess community pharmacists’ management of symptoms of common self-limiting infections in Akwa Ibom state, Nigeria. Objective: To assess community pharmacists’ management of self-limiting infections. Each pharmacy was visited by an investigator and a trained simulated patient who mimicked symptoms of common cold and acute diarrhoea, respectively. The most frequently dispensed agent was metronidazole (82%), which was dispensed in addition to amoxicillin or tetracycline among pharmacists who dispensed more than one agent In both infection scenarios, advice on dispensed antibiotics was ofered in 73% and 87% of the interactions, respectively. Community pharmacists’ management of self-limiting infections: a simulation study in Akwa Ibom State, South-South Nigeria. Afri Health Sci. 2021;21(2). 576-584. https://dx.doi.org/10.4314/ ahs.v21i2.12
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