Non-prescribed Antibiotics Research Articles

Knowledge, attitude and practice (KAP) survey regarding antibiotic use among pilgrims attending the 2015 Hajj mass gathering.

Overuse and misuse of antibiotics have been reported in Hajj. However, little is known about Knowledge, Attitude and Practice (KAP) of pilgrims themselves in relation to these agents. Adult pilgrims from seven countries attending the 2015 Hajj were interviewed using a structured KAP questionnaire. KAP information was collected from 1476 pilgrims. Misconceptions regarding antibiotics included that they: cure all diseases (24.6%); cure common cold and flu (63.0%); are used to stop fever (47.3%); have no side effects (43.2%). Negative attitudes included prophylactic use (50%), self-medication (43.2%), non-compliance with therapy (63.5%) and storage of left-overs for future use (54.1%). In practice, 87.3% of pilgrims admitted to using non-prescribed antibiotics, only 19.3% use antibiotic as directed by their doctor and 54% do not usually check the expiry date of antibiotics before use. Over 60% brought antibiotics from their home country to KSA and 39.2% acquired non-prescribed antibiotics in Saudi Arabia. KAP scores were higher among the younger age group (≤43 years old) and among those with healthcare-related work or education and increased with increasing levels of education. Multifaceted and multidisciplinary approaches, both in KSA and in pilgrims' countries of origin, are needed to address antibiotic misuse during Hajj.

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

To estimate the proportion of over-the-counter antibiotic requests or consultations that resulted in non-prescription supply of antibiotics in community pharmacies globally. 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. 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. Antibiotics are frequently supplied without prescription in many countries. This overuse of antibiotics could facilitate the development and spread of antibiotic resistance.

A SURVEY OF ANTIBIOTICS PURCHASED WITHOUT PRESCRIPTION AMONG NON-HEALTH SCIENCE STUDENTS IN JEMBER, INDONESIA

Previous research showed that self-medication practice with antibiotics is widespread in developing countries and tertiary students are among these consumers. This study aimed to estimate the prevalence of the use of antibiotics without prescription among non-health science students in Jember and to identify the sources of non-prescription antibiotics. This cross-sectional survey was conducted between April and June 2016 in all non-health science faculties of Universitas Jember. A questionnaire containing four main short questions about antibiotics use and questions related to socio-demographic information was distributed to students who gave consent. A number of 130 (58.5%) respondents admitted to ever acquire antibiotics without the presence of a physician prescription. Self-medication with antibiotics tended to be done by students from rural areas (p=0.04) and without health insurance (p=0.04). The sources of non-prescription antibiotics vary, but pharmacy was the most frequently cited to be the source (n=82; 46.3%). This study showed that the use of antibiotics without prescription among non-health science students and the sale of antibiotics without prescription among pharmacies in Jember are prevalent. Real responses from the government, relevant health professional associations, and education institutions to intervene these problems are significantly needed.

Farmacias prescriptoras de antibióticos y consumidores sin receta médica, combinación que promueve la resistencia antimicrobiana

Introducción: La resistencia bacteriana es el refractariamiento parcial o total de los microorganismos a los antibióticos, es un problema que va en ascenso a nivel mundial el cual aparece en forma natural dado por mutaciones genéticas, sin embargo, este proceso se ve acelerado por el uso indiscriminado de los antimicrobianos; en ocasiones por el propio médico, en otras por vendedores de medicamentos y por los mismos pacientes que los adquieren sin prescripción médica y sin una indicación clara. Objetivos: Determinar la prevalencia de personas que consultan a las farmacias en vez de un médico y la prevalencia con la que estos adquieren antibióticos sin receta en los municipios de Quetzaltenango, San Marcos y San Pedro Sacatepéquez. Proponer una iniciativa de cambio para luchar contra la resistencia bacteriana. Material y métodos: Estudio transversal observacional descriptivo realizado a través de boletas de encuesta a 65 farmacias y 382 pobladores en tres municipios; dos del departamento de San Marcos y uno de Quetzaltenango. Se introdujeron y analizaron los datos en el software Epi Info 7.2.0.1 y excel 2016. Resultados: “problema simple” es la razón principal de que las personas consulten a farmacias, 17 personas presentaron efectos adversos a los medicamentos recetados por farmacias. Conclusiones: La prevalencia de personas que consultaron a farmacias en lugar de un médico fue 60% (IC 95%, 55%-65%) y La prevalencia con la que estos adquieren antibióticos sin receta fue 71% (IC 95%, 65%77%). Los centros para el control y prevención de enfermedades (CDC) proporcionan material informativo para educar a la población sobre cuándo se debe utilizar antibióticos, se incentiva al personal de salud a utilizar este material gratuito.

Assessment of antibiotic use in farm animals in Rwanda

The irrational use of antibiotics in humans and animals is highly related to the emergence and increase of antibiotic-resistant bacteria worldwide. A cross-sectional survey aimed at evaluating the current level of practices regarding antibiotic use in farm animals in Rwanda was carried out countrywide. Interviews were conducted on 229 farmers rearing different types of animals. The study has revealed that almost all respondent farmers could name at least one antibiotic used in farm animals and peni-streptomycin was named by most of them (95.6%). The use of antibiotics in farm animals was observed in the majority of respondents (97.4%). It was found that 44.4 and 26.5% of respondents reported that they used antibiotics for disease prevention and growth promotion, respectively. The use of non-prescribed antibiotics in animals was also reported by more than the half of respondent farmers (55.6%). The majority of farmers had a moderate level of practices regarding antibiotic use in farm animals (73.5%), very few had a high level (26%) and only one respondent had a low level. The high level of practices in regard to antibiotic use in animals was associated with the location of the farm, the type of reared animals, and the rearing system. The results of this study give an insight into antibiotics usage practices in farm animals in Rwanda. The generated information can guide sensitizations and promotions of the prudent use of antibiotics among farmers in order to limit the increase of antibiotic resistance in the country.

Determinants of Antibiotics Misuse by the Parents in Children: A Survey From Northern Region of Saudi Arabia

Objectives: To investigate knowledge, beliefs and practices associated with parental antibiotic misuse.Methods: This cross sectional study was conducted among the parents visited 4 major shopping malls (selling medicines) of Tabuk, Saudi Arabia from June to December 2015. Self-prescription of antibiotics for a child in the past year was defined as antibiotic misuse was noted.Results: From 610 parents (60.5% mothers and 39.5% fathers) 11.6% reported selfprescription. Responded parents differed by age, education, number of children and profession. Parents responded that antibiotics should be used for runny nose, sore throat, cough and fever (50%); to reduce symptom severity and duration (57.7%), should be stopped on clinical improvement (28.7%), are effective in viral infections (68.6%) and if used by the other family members should be given to the children (20.1%). Determinants of misuse in a multivariable model, were income, number of kid, type of infection treated last year, knowledge of diseases requiring antibiotics, or being unsure, using same antibiotics used by the other family person, unsure of such use and adjusting for the type of responding parent. Logistic regression model shows that those who incorrectly had knowledge that any type of infection with fever needs to be treated by antibiotics had twice the odds of misusing antibiotic (AOR: 2.17, 95%CL: 1.19-3.96), Parents who believed that it was acceptable to administer the same antibiotics to their children that were used for a similar illness by any other family member in the past; had thrice the Odds of using non-prescribed antibiotics (AOR=3.01, 95% CI=1.77-5.37). Similarly, those who were not sure about the use of prior antibiotics by any other family member were also three times more likely to misuse antibiotics (AOR:3.00,95%CI/ :1.00-9.01). Parents reporting monthly income of less than SAR 5000 had twice the Odds of misusing anti biotics (OR:2.00,95% CI:1.05-3.83).Conclusion: Parents having low income, more than two kids below 12 years age, low education level, inappropriate beliefs and practices are vulnerable for misusing antibiotics in their children.Bangladesh J Child Health 2016; VOL 40 (2) :64-71

Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia

ABSTRACTBackground: In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern. Consequently, the aim is to ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia.Methods: The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios.Results: Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients’ indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees’ professional qualification in four out of five simulations.Conclusion: Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.

Knowledge, awareness, and attitudes toward antibiotic use and antimicrobial resistance among Saudi population.

Background Inappropriate use of antibiotics is a public health problem of great concern. Objective To evaluate knowledge of antibiotics, race, gender and age as independent risk factors for self-medication. Setting Residents and population from different regions of Saudi Arabia. Methods We conducted a cross sectional survey study among residents. Data were collected between June 2014 to May, 2015 from 1310 participants and data were recorded anonymously. The questionnaire was randomly distributed by interview of participants and included sociodemographic characteristics, antibiotics knowledge, attitudes and behavior with respect to antibiotics usage. Main outcome measure Population aggregate scores on questions and data were analyzed using univariate logistic regression to evaluate the influence of variables on self-prescription of antibiotics. Results The response rate was 87.7%. A cumulative 63.6% of participants reported to have purchased antibiotics without a prescription from pharmacies; 71.1% reported that they did not finish the antibiotic course as they felt better. The availability of antibiotics without prescription was found to be positively associated with self-medication (OR 0.238, 95% CI 0.17-0.33). Of those who used prescribed or non-prescribed antibiotics, 44.7% reported that they kept left-over antibiotics from the incomplete course of treatment for future need. Interestingly, 62% of respondents who used drugs without prescription agreed with the statement that antibiotics should be access-controlled prescribed by a physician. We also found significant association between storage, knowledge/attitudes and education. Conclusions The overall level of awareness on antibiotics use among residents in Saudi Arabia is low. This mandates public health awareness intervention programs to be implemented on the use of antibiotics.

Nonprescription Antimicrobial Use in a Primary Care Population in the United States.

Community antimicrobial resistance rates are high in communities with frequent use of nonprescription antibiotics. Studies addressing nonprescription antibiotic use in the United States have been restricted to Latin American immigrants. We estimated the prevalence of nonprescription antibiotic use in the previous 12 months as well as intended use (intention to use antibiotics without a prescription) and storage of antibiotics and examined patient characteristics associated with nonprescription use in a random sample of adults. We selected private and public primary care clinics that serve ethnically and socioeconomically diverse patients. Within the clinics, we used race/ethnicity-stratified systematic random sampling to choose a random sample of primary care patients. We used a self-administered standardized questionnaire on antibiotic use. Multivariate regression analysis was used to identify independent predictors of nonprescription use. The response rate was 94%. Of 400 respondents, 20 (5%) reported nonprescription use of systemic antibiotics in the last 12 months, 102 (25.4%) reported intended use, and 57 (14.2%) stored antibiotics at home. These rates were similar across race/ethnicity groups. Sources of antibiotics used without prescriptions or stored for future use were stores or pharmacies in the United States, "leftover" antibiotics from previous prescriptions, antibiotics obtained abroad, or antibiotics obtained from a relative or friend. Respiratory symptoms were common reasons for the use of nonprescription antibiotics. In multivariate analyses, public clinic patients, those with less education, and younger patients were more likely to endorse intended use. The problem of nonprescription use is not confined to Latino communities. Community antimicrobial stewardship must include a focus on nonprescription antibiotics.

'Struggling to be a defender of health' -a qualitative study on the pharmacists' perceptions of their role in antibiotic consumption and antibiotic resistance in Romania.

BackgroundAntibiotic resistance is a serious global public health problem directly correlated to high antibiotic consumption. Romania is one of the European countries with the highest rates of antibiotic consumption, non-prescription antibiotics use and resistance of several pathogens to antibiotics. Pharmacists are an important stakeholder in respect to antibiotic management and context specific research on this topic is needed.The aim of the research is to increase the understanding of how community pharmacists in Romania perceive their roles in respect to antibiotic consumption and antibiotic resistance.Semi-structured interviews with 18 pharmacists were conducted to explore the perceptions and attitudes of pharmacists towards their roles on antibiotics consumption and antibiotic resistance. Manifest and latent qualitative content analysis was used to analyse interview transcripts.ResultsThree sub-themes emerged from the analysis. ‘Maintaining equilibrium between ethics, law and economy’ expresses how pharmacists often feel when trying to fulfil their duties considering all the dimensions of the pharmacist profession.‘ Antibiotic resistance problem rooted in a low social capital environment’ reflects the pharmacists’ perceptions of the deep causes of antibiotic resistance and the underlying problems that perpetuate the status quo and impact their role in relation to this problem. Wanting to fulfil their educational role illustrates how the pharmacists feel they could best contribute to improving the present situation. The overarching theme ‘Undervalued medicines’ professionals struggling with agency related and structural barriers to meet their deontological duties’- meaning the ethical responsibilities that come with the pharmacy practice, reflects that the pharmacists see their roles as being challenged by several barriers.ConclusionsA health system and societal context perspective is helpful in order to understand the pharmacists’ roles in respect to antibiotic consumption and antibiotic resistance. Health promotion interventions and policy revisions should take into account concepts of structure and agency. These could highlight barriers that pharmacists encounter in their activities related to antibiotics management.

Non-prescribed antibiotic use and general practitioner service utilisation among Chinese migrants in Australia

Non-prescribed antibiotic use occurs worldwide and is an important contributor to antibiotic resistance. Social and health system factors were related to the practice of self-medication with antibiotics. This study aims to investigate the practice of non-prescribed antibiotic use, and to assess the impact of primary health service access and use on this practice among Australian Chinese migrants. Four-hundred and twenty-six participants, who self-identified as Chinese and who had been residing in Australia for at least 12 months, were recruited through several Australian Chinese social websites to participate in an online health survey about antibiotic use and health services use from July to October 2013. Logistic regression analyses were conducted to assess the associations between health services utilisation factors and the use of non-prescribed antibiotics. In total, 20.2% (86/426) participants reported having used antibiotics without medical consultation in the last 12 months. Of 170 antibiotic users, 50.6% (86/170) used antibiotics without medical consultation. Chinese migrants who self-evaluated as 'satisfied' with the experiences of GP services were less likely to self-medicate with antibiotics. In addition, Chinese migrants without any perceived barriers to using primary health services in Australia were less likely to use non-prescribed antibiotics. Among Australian Chinese migrants, over half of antibiotic users admitted that they had used antibiotics without medical consultation. Participants with positive experience and perception of primary health services, primarily GP services, had a lower risk of using non-prescribed antibiotics.

Dispensing of non-prescribed antibiotics in Jordan.

ObjectiveCurrent regulations in Jordan state that antibiotics cannot be sold without a medical prescription. This study aimed to assess the percentage of pharmacies that dispense antibiotics without a medical prescription in the Kingdom of Jordan and identify and highlight the extent and seriousness of such practices among Jordanian pharmacies.MethodsA prospective study was performed, and five different clinical scenarios were simulated at pharmacies investigated including sore throat, otitis media, acute sinusitis, diarrhea, and urinary tract infection in childbearing-aged women. Three levels of demand were used to convince the pharmacists to sell an antibiotic.ResultsA total of 202 total pharmacies in Jordan were visited in the present study. The majority of pharmacies (74.3%) dispensed antibiotics without prescription with three different levels of demand. The percentage of pharmacies dispensing antibiotics without a prescription for the sore throat scenario was 97.6%, followed by urinary tract infection (83.3%), diarrhea (83%), and otitis media (68.4%). The lowest percentage of antibiotic dispensing was for the acute sinusitis simulation at 48.5%. Among the pharmacies that dispensed antibiotics, the pharmacists provided an explanation as the number of times per day the drug should be taken in 95.3% of the cases, explained the duration of treatment in 25.7%, and inquired about allergies prior to the sale of the antibiotic in only 17.3%. Only 52 pharmacies (25.7%) refused to dispense any kind of antibiotics, the majority (61.5%) of this refusal response came from acute sinusitis cases, while the minority (2.4%) came from the sore throat cases.ConclusionThe results of this study demonstrate that antibiotics continue to be dispensed without prescription in Jordan in violation with national regulations regarding this practice. The findings of this study could provide a layout for governmental health authorities to implement strict enfrorcment of national regulations regarding antibiotic dispensing in order to avoid the serious complications that could arise in the future as a result of such practices.

Beliefs, Practices and Evaluation of Non-prescribed Antibiotics Use among Children in Madinah, Saudi Arabia

Objectives: To assess the current knowledge, beliefs, awareness and practices of the Saudi population attending Maternity and Children Hospital (MCH) in Madinah City, Saudi Arabia using non-prescribed antibiotics for their children. Methods: A cross-sectional study was conducted. Socio-demographic, knowledge, beliefs, awareness and behaviour data related antibiotics and patterns of antibiotics usage (PAPA scale) were collected. The knowledge, beliefs, awareness, and behaviours data were compared between subjects using non-prescribed antibiotics for their children and those did not by using appropriate statistical methods. Results: 170 subjects reported using non-prescribed antibiotics for their children (48.5%). The average score of negative knowledge and beliefs about antibiotics misuse was higher among Original Research Article Abdoh et al.; BJMMR, 10(7): 1-9, 2015; Article no.BJMMR.20210 2 subjects using non-prescribed antibiotics. It was 4.3±3.1 among subjects using non-prescribed antibiotics for their children compared to 1.7±3.2 among those not using non-prescribed antibiotics. Also, the average positive score of behaviour and awareness was lower among subjects using non-prescribed antibiotics. The average score of the studied behaviour and awareness was found to vary by the educational level of the studied subjects with the higher average score was among of highly educated subjects. Conclusion: The study revealed a considerable high proportion of the Saudi population using non-prescribed antibiotics for their children. The average score of negative knowledge and beliefs and positive score of behaviour was found to vary by the usage of non-prescribed antibiotics and by the educational level of the studied cohort. There is a need to conduct more community-based studies and to deliver health education programs about the dangers of antibiotics misuse through mass media.

Antibiotic use and knowledge in the community of Yemen, Saudi Arabia, and Uzbekistan.

Inappropriate use of antibiotics has resulted in a dramatic increase of antimicrobial resistance in developing countries. We examined knowledge, attitudes, and practices of antibiotic use in three Asian countries. A nationwide cross-sectional study of teachers in large cities of Yemen, Saudi Arabia, and Uzbekistan was conducted. A random sample of 1,200 teachers was selected in each country. Data were collected through a questionnaire-based survey and then analyzed using descriptive and multivariate statistical methods. The prevalence of non-prescription antibiotic use ranged from 48% in Saudi Arabia to 78% in Yemen and Uzbekistan. Pharmacies were the main source of non-prescribed antibiotics. The most common reasons for antibiotic use were cough (40%) and influenza (34%). Forty-nine percent of respondents discontinued antibiotics when they felt better. Although awareness of the dangers of antibiotic use correlated inversely with self-medication, understanding of the appropriate use of antibiotics was limited. The prevalence of antibiotic self-medication in the educated adult population in the studied countries was found to be alarmingly high. Effective strategies involving regulatory enforcement prohibiting sales of antibiotics without prescription should be implemented along with educational interventions for health professionals and the public.

Public attitude and justification to purchase antibiotics in the Eastern region Al Ahsa of Saudi Arabia

Use of non-prescription antibiotics can portend danger and predispose the populace to changes in bacterial resistance pattern. The aims of this study were to (a) evaluate the knowledge and attitudes of residents of Al-Ahsa community, Saudi Arabia on the use of non-prescribed antibiotics. (b) To identify possible predictors (if any) for self-medication within the community.A cross-sectional survey study, using self-administered questionnaire was conducted in two sections; demographics and self-medication attitude (in form of self-antibiotic use). Questions contained the following outcomes; for demographics; gender, age, education level and common disease within the community. Whereas the second part evaluated sources of information, knowledge of antibiotics, frequency/duration of use, underlined illness in which drug use was employed, names of antibiotics used and awareness of adverse effects of antibiotics. Results revealed that the adult population in the 18–40year age range constituted about 82.5% of the respondents. Also 18–29age group made of 60.5% of the respondents and that 56.8% the respondents are university graduates. Cold (18.8%) and sore throat (13.0%) were the diseases commonly found among the community that drove them to using non-prescribed antibiotics. About 337 (72.8%) of the respondent mention the use of antibiotics to treat the illness, and 21 (4.5%) were aiming to prevent the illness. While, 19.4% of the respondents admitted to taking non-prescribed antibiotics for both prevention and treatment of illness. 43.6% of the respondents disclosed that they are not aware of the dangers of using non-prescribed antibiotics. In conclusion the use of non-prescribed antibiotics in this community is evident, as a significant number use them from previous experience for prevention and treatment of illness. Therefore introduction of rational use of drugs will help in limiting the attendant development of bacterial resistance.

Perceptions, health care seeking behaviour and implementation of a tuberculosis control programme in Lambaréné, Gabon.

Lambaréné, Gabon. To describe patient perceptions of tuberculosis (TB) and to determine factors that influence health care seeking behaviour to gain insight into the management of multidrug-resistant TB. Participant observation, in-depth semi-structured interviews and focus group discussions were conducted with 30 TB patients, 36 relatives, 11 health care providers and 18 traditional/spiritual healers. Recruitment of patients was linked to the PanEpi study and took place at the Albert Schweitzer Hospital, the General Hospital and the TB-HIV (human immunodeficiency virus) clinic. Patients generally described TB as a natural and/or magical disease. The majority of the patients combined treatment at the hospital with (herbal) self-treatment and traditional/spiritual healing. Despite the free availability of anti-tuberculosis treatment in principle, patient adherence was problematic, hindering effective TB control. Most patients delayed or defaulted from treatment due to financial constraints, stigmatisation, ignorance about treatment, change of health care service or use of non-prescribed antibiotics. The situation was occasionally complicated by drug stockouts. There is an urgent need to bridge the gap between patients and the hospital by avoiding drug shortages, intensifying culturally sensitive TB health education, embedding TB care into the cultural context and enhancing cooperation between hospitals, patients, traditional healers and communities.

The public's perspectives on antibiotic resistance and abuse among Chinese in Hong Kong

Antibiotic abuse and resistance impose a continuing threat to the world. The awareness of antibiotic resistance is said to be inversely associated with the prevalence of abuse. We examined the public's perspectives on antibiotic resistance in our study of the public's knowledge, attitude and practice with antibiotics. The study adopted a combined qualitative and quantitative approach. Eight focus groups were conducted with 56 participants purposively selected from community centres and of different socio-economic strata. The qualitative data collected were used to construct a questionnaire for the telephone survey which surveyed 2471 adults from randomly selected residential numbers. The focus-group participants were unclear about the nature and causes of antibiotic resistance; they also attributed antibiotic abuse to the doctors' responsibility. Of the questionnaire respondents, 9.0% had not heard of the term, 7.8% had ever acquired non-prescribed antibiotics, 6.6% had ever kept the leftover and only 69.8% had always finished the full course of antibiotics. Furthermore, 77.3 % and 75.1%, respectively, agreed that the purchase of antibiotics without prescription and incomplete courses of antibiotics would lead to undesirable consequences. Of the respondents who had heard about antibiotic resistance, 38.7% agreed that they could help the prevention of resistance. They were more likely to complete the full course of antibiotics and less likely to keep the leftovers. The public in general was not aware of the causes of, nor their role and capability in preventing, antibiotic resistance. Future campaigns and health education should empower everyone to restrain antibiotic resistance.

Beliefs About the Use of Nonprescribed Antibiotics Among People in Yogyakarta City, Indonesia

Although antibiotics are prescription-only medicine in Indonesia, they can be purchased without prescription. This qualitative study elicited beliefs about nonprescribed antibiotics use informed by the theory of planned behavior to develop a questionnaire for an expanded theory of planned behavior survey. Twenty-five (N = 25) adults with experience of using nonprescribed antibiotics were interviewed. Content analysis was applied. Participants reported that the use of nonprescribed antibiotics was advantageous in term of saving time and money and of reducing the number of medicines that need to be purchased, in contrast to a perception of what occurs with medical prescriptions. Potential adverse effects, poor health outcomes, and antimicrobial resistance were the perceived disadvantages. Facilitators of such use were the availability of over-the-counter antibiotics and successful experience in using antibiotics. Medication for children was the perceived barrier to such use. Family members and friends, especially those with health education background, approved of such use.

Self‐medication with antibiotics in the Republic of Srpska community pharmacies: pharmacy staff behavior

Self-medication with antibiotics adds to the global risk of increased spread of bacterial resistance. Attitudes and behavior of health professionals also may reinforce self-medication with antibiotics. The aim of this study was to determine whether self-medication with antibiotics is possible in our community pharmacies and to what extent, and to evaluate the behavior and service of pharmacy health professionals regarding non-prescription antibiotic dispensation. An observational, cross-section study was conducted, and pseudo-patient methodology was used to establish the kind of professional service provided in case of patient's explicit demand to buy an antibiotic for treatment of self-diagnosed upper respiratory tract infection. Of the total 318 community pharmacies, 131 (41%) were visited and included in the study. Non-prescription antibiotics were dispensed in 76 (58%) pharmacies. Counseling and symptomatic therapy was offered in 88 (67%) pharmacies. In 25% of pharmacies, no symptomatic therapy was offered; instead, only an antibiotic was sold. Amoxicillin was sold in 85% of cases and, mostly, the one of 1.30 Euro per pack. Both oral and written use instructions were given in 78% cases, whereas none was given in 3% of cases. Self-medication with antibiotics occurs in our community pharmacies, despite being illegal. Pharmacy staff behavior can be a factor that puts patients at risk for self-medication with antibiotics. Community pharmacies are failing their tasks in enhancing rational use of antibiotics. Such a practice may be a consequence of weak enforcement and control over the legislation and professional standards.

Antibiotic Abuse in Developing Countries

The root causes of the spread of antibiotic resistance are multifactorials and interconnected. It basically caused by inappropriate, irrational, high consumption, and profligate use of antibiotics, combined by a low level of compliance of the patients. The unavailability of a health insurance system that covered most of the citizens in those countries has played a part to the irrational use of antibiotics. For example in Indonesia, almost 86% of the populations are not covered by any insurance scheme [13], thus, they have to pay in cash everytime they have medical problem. This condition has forced medical doctors to sometimes skip the supporting diagnosis to confirm the bacterial infections, and directly prescribe antibiotics whenever they suspect infections. With the high number of antibiotic prescription, patients believed that antibiotic is a magical medicine that will cure them. From the patients point of view, those with lower income will skip medical consultation and choose for self medication for common diseases, including with non-prescribed antibiotic. They tend to duplicate their previous prescriptions for self medication by making notes of prescribed medicines for future reference if similar medical problems reoccur [14]. Indonesian government has legally included antibiotics to prescription-only medicines whose sale are restricted to hospitals, public health centers, and community pharmacies. However without a strict supervision, antibiotics are easily purchased at a low