Non-prescribed Antibiotics Research Articles

The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation

IntroductionNon-prescription antibiotic dispensing is prevalent among community pharmacies in several low- and middle-income countries. We evaluated the impact of a multi-faceted intervention to address this challenge in urban community pharmacies...

Knowledge, Attitude and Practices Regarding Antibiotics usages among Medical Students at Zawia University

Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Medical students are particularly important since they will be the future leaders in clinic practice, responsible for antibiotic prescription and communication about antibiotic use with their patients. In this study we aimed to understand knowledge, attitude, and practice (KAP) with respect to antibiotic use among medical students in faculty of medicine, Zawia University. This is a cross-sectional design; it was undertaken in Faculty of Medicine during October and November: 2023. The questionnaire was administered to students in (III 3rd and IV 4th grades). All data were analyzed using Statistical Package for Minitab program. Majority of the respondents were female with ages of 22 years. Higher percentage of 4th-grade students (95.5%) correctly accepting the need to stop antibiotic use compared to 3rd-grade students (27.9%, p < 0.001). On other hand with a higher percentage of 4th-grade students reporting using non-prescribed antibiotics rarely compared to 3rd-grade students (46.3% for 4th grade and 69.8% for 3rd grade, p = 0.003). this study exposed an important awareness concerning the separate between medical students’ knowledge about antimicrobial resistance, and appalling attitudes and practices towards antibiotics use. We need for the re-evaluation of the educational curricula especially, teaching of clinical pharmacology courses in clinical years.

Beyond the Prescription Pad—Finding a Window of Opportunity to Prevent Antibiotic Diversion and Non-Prescription Use

Background: Non-prescription antibiotic use is defined as taking antibiotics without medical guidance, which includes using leftover antibiotics, obtaining antibiotics from friends or relatives, or purchasing antibiotics without a prescription. This study aimed to (1) determine the symptoms prompting individuals to use non-prescription antibiotics, identify their sources of acquisition, and document the types of antibiotics utilized, (2) identify any associated side effects, and (3) gain insights into antibiotic storage practices, including whether antibiotics were used beyond their expiration date. Methods: A cross-sectional quantitative survey was conducted from January 2020-June 2021 in waiting rooms of six safety-net primary care clinics and two private emergency departments in Houston, Texas. Participants were read survey questions in English or Spanish by a bilingual research coordinator, and their responses to five questions about antibiotic use were recorded. Descriptive analysis was performed. Results: Among the 564 patients surveyed, the median age was 51 (range 19-92). The majority identified as female (72%), Hispanic/Latinx (47%), Black/African American (33%), held a college education (44%), and received public health insurance, such as Medicaid or County Financial Assistance (56%). Of all patients surveyed, 44% (246) reported taking an antibiotic without a prescription and answered questions about associated symptoms. Of all symptoms/illnesses associated with non-prescription use, the most common were sore throat (18%), dental symptoms (16%), and cold/flu (13%). The most common sources for non-prescribed antibiotics were leftover antibiotics (50%), from friends or relatives (31%), and purchased abroad (13%), although 3% had purchased non-prescription antibiotics from a local store or market (Figure 1). The most common antibiotics used were amoxicillin (38%) and penicillin (7%). The reported side effects were stomach pain/upset (24%), nausea and vomiting (19%), allergic reaction (e.g., rash) (14%), and diarrhea (14%). Among 246 participants reporting antibiotic use, 63% reported that the antibiotic they took had been previously prescribed for the same symptom/illness, and 93% had acquired antibiotics in a container, of which 90% reported that the container had an expiration date. Conclusions: Our survey reveals that 63% of individuals who use non-prescription antibiotics were motivated by having received prescribed antibiotics for similar symptoms previously. Leftover antibiotics were the source for half of all non-prescription use. These observations suggest that outpatient antibiotic stewardship campaigns have a window of opportunity at the time of the initial prescription of antibiotics, to focus on providing the shortest course possible, and to deliver antibiotic safe use information at that time. Acknowledgments: Financial Support AHRQ R01HS026901Disclosure: Barbara Trautner: Stock: Abbvie--sold in December 2023; Abbott Laboratories--sold in December 2023; -Bristol Myers Squibb--sold in December 2023; Pfizer--sold in December 2023; Consultant--Phiogen—consultant. Contracted research through NIAID for STRIVE trial, currently testing Shionogi product; Contracted research--Peptilogics; Contracted research—Genentech

Situations Predisposing Primary Care Patients to Use Antibiotics Without a Prescription in the United States

Background: Using antibiotics without medical guidance (non-prescription use) is a potential safety threat to individual and public health. Patients' situations can impact their intentions to use non-prescription antibiotics in the future (intended use). This survey (1) explores the dimensionality of 13 predefined situations to identify ‘summary factor,’ which include conceptually similar situations that influence patients’ intended use of non-prescription antibiotics, and (2) identifies the sociodemographic predictors associated with these summary factors. Methods: A cross-sectional survey was conducted from January 2020–June 2021 in the waiting rooms of six safety-net primary care clinics and two private emergency departments. We used principal component analysis as a data reduction technique and confirmed the factor structure of the situations (identifying three situational summary factors). Multivariate linear regression identified the sociodemographic predictors (e.g., age, gender, race, education, insurance, healthcare system, language preference, birth country, and health literacy) associated with each summary factor. Results: Of the 564 patients surveyed, the majority were female (72%), Hispanic or Latinx (47%), college-educated (44%), and received public health insurance (e.g., Medicaid or County Financial Assistance) (56%). The largest proportion of patients endorsed intended non-prescription antibiotic use for situations involving high doctor visit costs (29.8%), having leftover prescription antibiotics (50.4%), and experiencing symptom relief with prior use of antibiotics (47.5%) (Figure 1). We identified three situational summary factors: (1) perceived barriers to a doctor visit and receiving a prescription (Cronbach’s alpha [α]=0.96), (2) convenience and accessibility of non-prescription antibiotics (α=0.81), and (3) previous symptom relief with antibiotics (α=0.95). After controlling for gender, race, education, insurance, language preference, birth country, and health literacy, our multivariate regression results revealed that younger patients (P < 0 .04) and patients attending the safety-net health system (P < 0 .001) had more intended use of non-prescription antibiotics for all three summary factors (Figure 2). Conclusions: Our study revealed that younger patients and individuals receiving care from the safety-net clinics had an increased risk of intended non-prescription antibiotic use across all summary factors. Future stewardship interventions should consider the types of situations that drive patients' decisions to use antibiotics without a prescription. Interventions aimed at reducing barriers to healthcare (e.g., high costs and long waits associated with doctor appointments) and educating individuals on the risks associated with inappropriate antibiotic use while providing alternative (non-antibiotic) treatment options may reduce antibiotic use and antimicrobial resistance. Acknowledgments: This work is supported by grant number R01HS026901 from AHRQ and NRSA T-32 (6T32HC10031).Disclosure: Barbara Trautner: Stock: Abbvie--sold in December 2023; Abbott Laboratories--sold in December 2023; -Bristol Myers Squibb--sold in December 2023; Pfizer--sold in December 2023; Consultant--Phiogen—consultant. Contracted research through NIAID for STRIVE trial, currently testing Shionogi product; Contracted research--Peptilogics; Contracted research--Genentech

Antibiotic Misuse during the COVID-19 Pandemic in Lebanon: A Cross-Sectional Study

Background: Over the past 100 years, the discovery of antibiotics is regarded as one of the most significant advances in medical research and has saved millions of lives. However, the emergence of antimicrobial-resistant bacteria has significantly reduced the efficacy of antibiotics against infectious disorders. Antimicrobial resistance is mostly caused by antibiotic misuse for conditions that may be treated with self-care. During the COVID-19 pandemic, antibiotic use has been out of control among the general population. Aim: The objective of this study is to investigate the prevalence of antibiotic misuse during the COVID-19 pandemic in Lebanon. Methods: In January 2024, a descriptive cross-sectional study was conducted amongst students registered at the Islamic University of Lebanon. Individuals who have been infected with COVID-19 at least once were eligible for the study and were selected by a non-random snowball sampling technique. Descriptive and quantitative analyses were performed using SPSS 21. Results: Out of the 478 participants who completed the questionnaire, 40.2% (n = 192) received antibiotics during the COVID-19 infection. A physician’s prescription is mentioned by some participants (51%, n = 98), followed by a pharmacist’s (23.4%, n = 45), self-taken (14.5%, n = 28), and others as family or friends (10.9%, n = 21). Moreover, 59.3% (n = 114) of the respondents respected the antibiotic therapy’s rules, and 40.6% (n = 78) discontinued taking the antibiotic when they felt better. Conclusion: Our results showed that participants were likely to show unsatisfactory compliance and to use non-prescribed antibiotics. Campaigns are urgently needed to promote appropriate antibiotic use.

'You never know when you will need an antibiotic': A qualitative study of structural barriers and cultural assumptions in antibiotic misuse among immigrants in the United States.

The use of nonprescribed antibiotics increases the risk of antibiotic resistance, which is a primary public health concern of the 21st century. This study explores structural and cultural determinants of antibiotic misuse among immigrants living in the United States who arrived from home countries with easier access to antibiotics. Adopting a qualitative approach, we interviewed 34 immigrants living in the United States and who had traveled back to their home countries within 1year of the interview. We followed the steps of constructive grounded theory to analyze the data. We found two primary influences of immigrants' use of nonprescribed antibiotics. The first was structural barriers to health care access in the host country, including insurance coverage, cost of an emergency department visit, cost of missing a paid day of work, complexity of the healthcare system, and communication issues with health care providers. The second was participants' cultural assumptions, including their experiences of antibiotics use, beliefs about antibiotics, a habit of self-medication, and uncertainty about future medical needs. This study informs policymakers concerned with combating antibiotic resistance. Promoting antibiotic stewardship among immigrants from countries with lax antibiotic-prescribing practices and improving access to appropriate channels for preventative and same-day care may reduce the inappropriate use of antibiotics.

The attitude, intention, and related factors of purchasing antibiotics without prescription: a survey in Vietnam.

The abuse of antibiotics is a global problem, and the form of abuse varies among different countries and cultures. The study explored antibiotic self-medication attitudes and intentions to use antibiotics among the public in Can Tho City, Vietnam. Questionnaire survey on a sample of volunteers. Between February and August 2023, a paper-based questionnaire survey was conducted among the public in 4 districts of Can Tho City, Vietnam. The data was analyzed with SPSS version 20.0. Descriptive and analytical statistics using multivariate logistic regression analysis were performed to identify the factors associated with antibiotic self-medication. Of the 414 people interviewed, 56% were female, and the majority were aged 30-45 (48.49%). People with a university pro-fessional degree accounted for 39.4%, of whom 10.6% were the medical staff. The overall average score on attitude was 4.43±1.589 (on a 10-point scale), and 85.7% of people had inappropriate attitudes. Average scores of the indicators (a) Positive attitude towards the use of non-prescription antibiotics, (b) Negative attitude towards the use of non-prescription antibiotics, (c) Subjective norms, (d) Perceived behavioral control, and (e) Intention to purchase antibiotics without a prescription were 3.73±0.043, 2.29±0.944, 4.36±1.45, 3.4±1.027, and 3.63±1.145, respectively. The rate of people intending to buy non-prescribed antibiotics was 63.8%. Factors related to people's intention to purchase antibiotics without a prescription included place of residence, education level, occupation, and income. All three factors, attitude, subjective norm, and perceived behavioral control, impacted the intention to buy non-prescription antibiotics, of which the subjective norm factor had the most substantial impact. The rate of people having incorrect attitudes about antibiotics, leading to the intention to buy antibiotics without a prescription, was relatively high. Factors affecting people's intention to purchase non-prescribed antibiotics included factors related to the impact of other people around them and factors originating from themselves.

Situations predisposing primary care patients to use antibiotics without a prescription in the United States.

Patients' situations can impact their intentions to use antibiotics without medical guidance (non-prescription use) in the future. This survey determines the prevalence of intended (future) use of non-prescription antibiotics for 13 predefined situations and identifies the sociodemographic characteristics associated with intended use for these types of situations. Patient surveys (N = 564) were conducted from January 2020 to June 2021 in the waiting rooms of 6 safety-net primary care clinics and 2 emergency departments in a private healthcare system. We used principal component analysis to identify 3 situational summary factors: barriers to a doctor visit, accessibility of non-prescription antibiotics, and previous symptom relief with antibiotics. Multivariate linear regression identified the sociodemographic predictors associated with each summary factor. The most common situations triggering patients to use non-prescription antibiotics were a perceived high cost of doctor visits (29.8%), having leftover prescription antibiotics (50.4%), and experiencing symptom relief with prior use of antibiotics (47.5%). Multivariate regression results revealed that younger patients (P < 0.04) and patients attending the safety-net health system (P < 0.001) had more intended use of non-prescription antibiotics for all 3 summary factors. Future stewardship interventions should consider the types of situations that drive patients' decisions to use antibiotics without a prescription. Interventions aimed at reducing barriers to health care (eg, high costs and long waits associated with doctor appointments) and educating individuals on medically appropriate, nonantibiotic treatment options may reduce antibiotic use and antimicrobial resistance.

Self-Medication with Antibiotics Among Children in China: A Cross-Sectional Study of Parents' Knowledge, Attitudes, and Practices.

Self-medication with antibiotics (SMA) among children is a common practice in low-income and middle-income countries, which has accelerated antibacterial abuse. This study aimed to estimate the prevalence and associated factors of SMA among children in China, including parents' knowledge, attitudes, and practices towards antibiotic use. A cross-sectional study based on a structured questionnaire survey of parents was conducted in Nantong between July and September 2020. A total of 1699 respondents participated. Information on participants' demographic and family characteristics, knowledge, attitudes, and practices towards antibiotics use was collected. Hierarchical binary logistic regression was used to examine the predictors of SMA among children. Among 1699 participants, 23.31% practiced SMA to their children in the past year. Cough (59.6%) was the most common symptom leading to self-medication and penicillins (85.4%) were the most commonly used drugs. Hierarchical regression indicated that parents with higher level of antibiotic knowledge scores (OR=1.163, 95% CI: 1.067-1.268) and buying antibiotics without a prescription from pharmacy (OR=1.475, 95% CI: 1.097-1.983) were more likely to practice SMA to their children both in urban and in rural areas. Storing antibiotics at home resulted in an increased likelihood of self-medication in urban areas but not in rural areas. In addition, there was also a higher probability of non-prescribed antibiotics in children without chronic diseases (OR=1.959, 95% CI:1.072-3.578). The prevalence of SMA in children is high in China. Higher knowledge scores and practices of buying and storing non-prescribed antibiotics behaviors increased parents' antibiotic self-medication in their children. Practical and effective education intervention for children's rational use of antibiotics is urgently strengthened.

Non-prescription antibiotics dispensing by community pharmacies: implications for antimicrobial resistance

Introduction: The non-prescription antibiotics dispensing (NPAD) from pharmacies is on the rise in low- and middle-income countries, which contributes to the emergence of antimicrobial resistance (AMR). This study was conducted with the objective to determine the community pharmacy personnel’s perspectives on NPAD and its implications for AMR. Methods: A questionnaire-based cross-sectional survey was conducted in Pakistan among 336 pharmacies. The data were analyzed using SPSS v21 and MedCalc for Windows v12.3.0. Modified Bloom’s cut-off point was utilized to categorize the participants’ overall knowledge, attitude, and practice. For univariable logistic regression analyses, odds ratio (OR) was calculated at 95% confidence interval (CI). For multivariable logistic regression analyses, adjusted OR was calculated at 95% CI. Spearman’s rank correlation coefficient test was used to assess the relationships among knowledge, attitude, and/or practice scores. Results: The majority of the respondents were staff pharmacists (45.5%). About four-fifths (78.9%) and half (50.9%) of the participants demonstrated moderate to good knowledge and practice, respectively. However, about only one-third (33.1%) had a moderate to good attitude. Staff pharmacists had higher odds of moderate to good knowledge (OR: 2.4, 95% CI: 1.2–4.7) and practice (OR: 2.3, 95% CI: 1.4–3.8). Total knowledge and practice (Spearman’s ρ: 0.280; P &lt;0.001) and total attitude and practice (Spearman’s ρ: 0.299; P &lt;0.001) scores were significantly correlated. Conclusion: The qualified pharmacists had satisfactory knowledge, attitude, and practices toward antibiotics. However, non-pharmacist staff lacked knowledge and had probable NPAD practice, which has a negative impact on public health. Regular refresher training, seminars, and strict enforcement of rules and regulations are essential.

2190. Lack of Knowledge of Antibiotic Risks Among an Outpatient Population is Associated with Intention to Use Non-Prescription Antibiotics

Abstract Background Antibiotic use without a prescription (non-prescription use) leads to risks for patients and the public, including adverse drug reactions, Clostridoides difficile infections, microbiome disruption, and the development of antimicrobial resistance. We hypothesized that patients’ lack of knowledge of risks associated with antibiotic use would be associated with non-prescription use. Methods We surveyed patients in public clinics and private emergency department waiting rooms in Houston from January 2020 through June 2021. Respondents’ knowledge about risks associated with antibiotic use was assessed with an open-ended question, “Do you know about any risks associated with antibiotic use?” Intended use was defined as endorsing an intention to use antibiotics without a prescription. The effects of age, gender, race/ethnicity, education, and knowledge of the risks associated with antibiotics on intended use were investigated using logistic regression. Results We surveyed 564 individuals (median age of 51), with 72% identifying as female, 46.6% as Hispanic and 33% as Black or African American (Table 1). When asked about knowledge of antibiotic risks, 354 (63%) respondents were able to report at least one risk associated with antibiotics. Risks were categorized into themes that included side effects of antibiotics (270/564, 48%), antibiotic resistance (19%), disruption of the microbiome (5%), drug-drug interactions (4%), fear of taking medication (4%), and other (0.05%) (Table 2). Lack of knowledge of antibiotic risks OR 1.48 (95% CI 1.04-2.10) and younger age (age 18-64 years) OR 2.24 (1.29-3.89) were independently associated with intention to use non-prescription antibiotics (Table 3). Conclusion Over one-third of respondents reported no knowledge of antibiotic-associated risks. Only 19% of respondents were aware of the concept of antimicrobial resistance. Lack of knowledge was associated with the intention to use non-prescription antibiotics, suggesting that further patient education about potential downsides of taking antibiotics is essential to reducing non-prescription antibiotic use. Disclosures Barbara Trautner, MD, PhD, Genentech: Grant/Research Support|Peptilogics: Grant/Research Support

Study on awareness, knowledge, and practices towards antibiotic use among the educated and uneducated people of Khyber Pakhtunkhwa Province, Pakistan

Introduction: Antimicrobial resistance developed through the inadequate use of antibiotics; is an overriding task for global public health. Objective: To explore awareness, knowledge, and practices, and compare the elements associated with antibiotic misuse in different University students and uneducated people of Khyber Pakhtunkhwa Province, Pakistan. Methods: Cross-sectional study was conducted from July to December 2020 using a validated questionnaire. Data were collected from eleven different university students and uneducated people of Khyber Pakhtunkhwa, Pakistan. Results: 3,600 questionnaires were completed, consisting of 56.9% Male and 43.0% Female. 1,999 (55.5%) of the antibiotic users reported through the survey used non-prescription antibiotics within a one-month study period. Out of the participants, 230 (6.3%) were uneducated or their education level was below matric rest were university students. 1999 (55.5%) reported buying Antibiotics with Medical Prescription. Most self-medicated participants (56.9%) stop taking antibiotics when they feel better. More than 90% of the respondents answered that doctors and pharmacist staff do not guide them well that how to use antibiotics. 2,171 (60.03%) respondents mistakenly believed that antibiotics improve restoration from coughs and colds. Only 720 (20%) respondents knew that antibiotics also disturb normal flora and 547 participants (15.9%) agree that unnecessary use of antibiotics causes bacterial resistance. Conclusion: Finding from this study may have important implications for public health policy in Khyber Pakhtunkhwa, Pakistan given the growing global resistance to antibiotics and the reported health issues related to their improper use.

Rising Antimicrobial Resistance In Pakistan: A Call For An Urgent Action.

Madam, Antibiotic resistance is a growing global concern. Pakistan is a developing nation in South Asia with a high rate of antibiotic resistance, posing a serious concern on a global and regional scale1 In Pakistan in recent years, both extensively drug-resistant (XDR) and multi-drug-resistant. (MDR) microorganisms have been found2.From January 2017 to June 2021, a total of 14,360. XDR-TF cases were reported in Karachi, according to the National Institute of Health (NIH) Islamabad's Weekly Field Epidemiological Report2.Only three antimicrobials: azithromycin, carbapenems, and tigecycline(parenteral) are effective against the XDR strains3. However, after Covid-19, the misuse of Azithromycin has increased manifold, which is worrisome. Pakistani public’s lack of awareness about the harms of antibiotic self-prescription and the widespread presence of quacks in the society has posed a great threat to rational use of antimicrobials4. According to a cross-sectional survey of pharmacy staff’s opinion ,approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs5. The chicken industry of Pakistan is excessively using important antimicrobials in their bird feed6. According to a surveillance survey done in 2019 in Pakistan; among the antimicrobials used for therapeutic or prophylactic purposes in animals; colistin, tylosin, enrofloxacin, and doxycycline were the most frequently used6.This calls for an urgent action in Pakistan to prevent a public health crisis. It is a dire need of the hour to implement the National Drug Policy (NDP) of Pakistan. There should be a national action plan on how to curb this menace of the misuse of therapeutically important antimicrobials in Pakistan. Special units should be devised by Drug regulatory Authority of Pakistan (DRAP) and The Ministry of Health (MoH) to rein back those chemist stores involved in selling of prescription only antimicrobials without the advice of a medical doctor. These teams should catch quacks working in all provinces of Pakistan. Quackery should be made illegal. The sale of large flocks of antimicrobials to animal keepers and broiler industry people should be immediately stopped and the involved people should be fined and their licenses cancelled. Talks and sessions should be held in schools, colleges and public places about the correct use of antibiotics. A medical doctor’s stamp with a registration number should be mentioned on each prescription of an antimicrobial. ---Continue

Prevalence and related factors of non-adherence to antibiotics among the general public: a cross-sectional study in China

ABSTRACT Objectives This study aims to assess the prevalence and associated factors of non-adherence to antibiotics (NAA) during COVID-19. Methods A cross-sectional study was conducted from 28 October 2022 to 6 November 2022. A structured questionnaire was widely distributed on an online survey platform. Of the 8664 respondents, 7730 were included in the final analysis. Logistic regression analysis was used to examine the associated factors of NAA. Results Of the 7730 participants, 17.83% reported antibiotic use in the past month, of which 53.05% had NAA. Those who aged over 60 years old, perceived their economy as good, had moderate or good antibiotic knowledge, and with high convenience to medical services and medicines were less likely to NAA (p < 0.05); while those with chronic diseases, living in Western or Northeastern China, and those who used non-prescription antibiotics were more likely to NAA (p < 0.05). Conclusion The prevalence of NAA remains at high levels in the general public. Targeted health education needs to be conducted in communities, pharmacies and health facilities to overcome misconceptions about antibiotics and to encourage people to seek formal medical care when ill, in order to improve public adherence to antibiotics.

Comparison of bacterial culture with BioFire® FilmArray® multiplex PCR screening of archived cerebrospinal fluid specimens from children with suspected bacterial meningitis in Nigeria

BackgroundDiagnosis of bacterial meningitis remains a challenge in most developing countries due to low yield from bacterial culture, widespread use of non-prescription antibiotics, and weak microbiology laboratories. The objective of this study was to compare the yield from standard bacterial culture with the multiplex nested PCR platform, the BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire ME Panel), for cases with suspected acute bacterial meningitis.MethodsFollowing Gram stain and bacterial culture on cerebrospinal fluid (CSF) collected from children aged less than 5 years with a clinical suspicion of acute bacterial meningitis (ABM) as defined by the WHO guidelines, residual CSF specimens were frozen and later tested by BioFire ME Panel.ResultsA total of 400 samples were analyzed. Thirty-two [32/400 (8%)] of the specimens were culture positive, consisting of; three Salmonella spp. (2 Typhi and 1 non-typhi), three alpha hemolytic Streptococcus, one Staphylococcus aureus, six Neisseria meningitidis, seven Hemophilus influenzae, 11 Streptococcus pneumoniae and 368 were culture negative. Of the 368 culture-negative specimens, the BioFire ME Panel detected at least one bacterial pathogen in 90 (24.5%) samples, consisting of S. pneumoniae, N. meningitidis and H. influenzae, predominantly. All culture positive specimens for H. influenzae, N. meningitidis and S. pneumoniae also tested positive with the BioFire ME Panel. In addition, 12 specimens had mixed bacterial pathogens identified. For the first time in this setting, we have data on the viral agents associated with meningitis. Single viral agents were detected in 11 (2.8%) samples while co-detections with bacterial agents or other viruses occurred in 23 (5.8%) of the samples.ConclusionsThe BioFire® ME Panel was more sensitive and rapid than culture for detecting bacterial pathogens in CSF. The BioFire® ME Panel also provided for the first time, the diagnosis of viral etiologic agents that are associated with meningoencephalitis in this setting. Institution of PCR diagnostics is recommended as a routine test for suspected cases of ABM to enhance early diagnosis and optimal treatment.

Acculturation and Subjective Norms Impact Non-Prescription Antibiotic Use among Hispanic Patients in the United States.

Using antibiotics without medical guidance (non-prescription antibiotic use) may contribute to antimicrobial resistance. Hispanic individuals are a growing demographic group in the United States (US) with a high prevalence of non-prescription antibiotic use. We investigated the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: (1) markets in the United States (not legal), (2) other countries (abroad), (3) leftovers from previous prescriptions, and (4) friends/relatives. We surveyed self-identified Hispanic outpatients in eight clinics from January 2020 to June 2021 using the previously validated Short Acculturation Scale for Hispanics (SASH). Of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to use antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to use non-prescription antibiotics from friends/relatives (p = 0.034). Other predictors of intention to use non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic. Antibiotic stewardship interventions in Hispanic communities in the United States should consider the sociocultural and healthcare barriers influencing non-prescription use and promote language-concordant healthcare.

“Handing out non-prescribed antibiotics is storing up trouble for the next generation!” Unpacking multistakeholder views of drivers and potential solutions in Ethiopia

BackgroundAntibiotic resistance is a global health crisis, with inappropriate antibiotic use often being linked to non-prescribed antibiotic dispensing practices. This study aimed to examine the perspectives of multiple stakeholders on the drivers and potential solutions for non-prescribed antibiotic dispensing in Ethiopian community drug retail outlets (CDROs). Despite the prescription only use policies, the practice remains prevalent in Ethiopia. Many factors are thought to contribute to this issue, although little research is available for non-urban settings.MethodsA phenomenological qualitative study was conducted. Pharmacy professionals (owners or employees) working in non-urban towns CDROs were selected through a simulated client study, which identified CDROs that had dispensed antibiotics without a prescription. Some high-level decision makers in the Ethiopian health system were also purposively selected. Interviews were conducted in-person and over the phone or via Zoom. The interview data were transcribed verbatim, translated to English, and thematically analysed. NVivo 12 software was used to assist with coding.ResultsCDRO pharmacy professionals (n = 18) and five decision makers were interviewed. Most professionals (61%) were pharmacists working in drug stores, with one to 11 years of work experience. Several contributing factors were identified at the level of patients, CDRO staff, and the healthcare system. These included economic interests, inadequate knowledge and inappropriate attitudes about antibiotic use or supply, and issues within the healthcare system included inaccessibility and insufficient capacity, absence of or a weak enforcement of prescription-only regulations or service supervision. Additionally, patient-related factors included a lack of knowledge and inappropriate attitudes about antibiotics use and their supply, previous successful treatment experience and a culture of seeking out antibiotics.ConclusionsA complex set of modifiable factors related to patients, CDRO staff and healthcare system were identified that contribute to the non-prescribed supply of antibiotics. Due to this complexity, a single solution will not resolve the issues. Therefore, a range of multifaceted solutions have been suggested, including stricter regulation, increasing availability and accessibility of healthcare services, collaboration, and local consensus-building among CDROs, regular training for CDRO staff, and using community social events to educate the public about responsible use of antibiotics.

Using Simulated Patients to Understand Non-Prescription Antibiotic Dispensing in Indonesia: A Systematic Review

Background: Dispensing antibiotics without a prescription at community pharmacies is a significant contributor to the ongoing global public health issue of antibiotic resistance. Objectives: To estimate the proportion of antibiotics that are dispensed without a prescription in community pharmacies in various Indonesian cities. Methods: A literature review was conducted via PubMed, Science Direct, Google Scholar, Garuda, and Neliti for articles published between January 2007 and December 2022 combined with Boolean operators. The literature search keywords were (simulated patientsOR mystery shopper OR sample patients OR dummy patients) AND ("antibiotics without prescription OR non-prescription antibiotics OR self-medication of antibiotics). The keywords are also used in Indonesian language (Bahasa), including “simulasi pasien” OR “sampel pasien” AND “antibiotik tanpa resep” OR “swamedikasi antibiotik”. Results: Seven studies from various cities have complied with the inclusion criteria and were considered when reviewing 199 articles. The findings of our studies were consistent with the extensive use of non-prescription antibiotics throughout the review. A simulation patient study design was used in all seven studies in this review. Amoxicillin recorded the highest percentage of dispensing without a prescription, while other drugs often purchased include chloramphenicol, ciprofloxacin, and cefadroxil. Among the studies reviewed, one study utilized the pre-test and post-test methods, while the others did not. Conclusion: The lack of prescriptions for antibiotics dispensing has often occurred in community pharmacies throughout Indonesia. The community pharmacist's role is needed as the final gate of pharmaceutical services in providing rational treatment and controlling the dispense of antibiotics without a prescription.

Protocol for a randomized controlled trial on community education and surveillance on antibiotics use among young children in Nepal

BackgroundAntimicrobial resistance (AMR) is one of the top ten threats to global health. There exists limited empirical evidence on effective approaches to address this threat. In low- and middle-income countries (LMICs), one of the primary drivers of AMR is easy access to antibiotics without prescriptions, in particular from community pharmacies. Interventions to reduce non-prescribed use of antibiotics and surveillance systems to track such usage are critically needed. This protocol describes a study that aims to test the effect of an educational intervention targeted to parents of young children on non-prescribed antibiotics consumption in Nepal and to track such consumption using a phone-based application. MethodsThe study is a clustered randomized controlled trial, in which we randomly assign 40 urban wards of Kathmandu Valley to either treatment group or control group, and randomly select 24 households in each ward. Households in the treatment group will receive an education intervention consisting of an “AMR pitch” (an in-person interaction that lasts up to an hour) by community nurses, videos and text messages on AMR every two weeks, and a brochure. We will conduct a survey at baseline with the parents of children ages 6 months to 10 years and track consumption of antibiotics and health care use among these children for a period of 6 months using a phone-based application. ConclusionWhile the study will primarily inform future policy and programmatic efforts to reduce AMR in Nepal, the study—both the education intervention and the surveillance system—can serve as a prototype for tackling AMR in other similar settings.

Identifying nonprescription antibiotic users with screening questions in a primary care setting

Background: Antibiotic use without a prescription (nonprescription use) leads to antibiotic overuse, with negative consequences for patient and public health. We studied whether screening patients for prior nonprescription antibiotic use in the past 12 months predicted their intentions to use them in the future. Methods: A survey asking respondents about prior and intended nonprescription antibiotic use was performed between January 2020 and June 2021 among patients in waiting rooms of 6 public clinics and 2 private emergency departments in economically and socially diverse urban and suburban areas. Respondents were classified as prior nonprescription users if they reported previously taking oral antibiotics without contacting a doctor, dentist, or nurse. Intended use was defined as answering “yes” or “maybe” to the question, “Would you use antibiotics without contacting a doctor, nurse, or dentist?” We calculated the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of prior nonprescription antibiotic use in the past 12 months for future intended nonprescription use. Bayes PPV and NPV were also calculated, considering the prevalence of nonprescription antibiotic use (24.8%) in our study. Results: Of the 564 patients surveyed, the median age was 51 years (SD, 19–92), with 72% of patients identifying as female. Most were from the public healthcare system (72.5%). Most respondents identified as Hispanic or Latino(a) (47%) or African American (33%), and 57% received Medicaid or the county financial assistance program. Prior nonprescription use was reported by 246 (43%) of 564 individuals, with 91 (16%) reporting nonprescription use within the previous 12 months. Intention to use nonprescription antibiotics was reported by 140 participants (25%). The sensitivity and specificity of prior nonprescription use in the past 12 months to predict the intention to use nonprescription antibiotics in the future were 75.9% (95% CI, 65.3–84.6) and 91.4% (95% CI, 87.8–94.2), respectively. After the Bayes’ adjustment, the PPV and NPV of prior use to predict future intention were 74.5% (95% CI, 66.7–80.9) and 92.0% (95% CI, 88.7–94.4) (Table 1). Conclusions: These results show that prior nonprescription antibiotic use in the past 12 months predicted the intention to use nonprescription antibiotics in the future (PPV of 75%). As a stewardship effort, we suggest clinicians use a simple question about prior nonprescription antibiotic use in primary-care settings as a screening question for patients at high risk for future nonprescription antibiotic use.Financial support: HSQR-R 5R01HS026901-04Disclosure: None