Request Antibiotics Research Articles

Traitement de la cystite simple en pharmacie d’officine : regards croisés de pharmaciens d’officine et d’étudiants en 6e année de pharmacie dans le contexte de la dispensation sous protocole

Introduction: The management of cystitis by community pharmacists based on advanced practices (dispensing antibiotic without a medical prescription) is supposed to meet a public health need. The adoption and successful of these new practices need that those involved in the field take ownership. The aim of this study was to explore the perceptions and attitudes of community pharmacists and pharmacy students towards the management of cystitis in community pharmacies in the current context and perspective of advanced practices.Method: A cross-sectional multicentric study involving community pharmacists and pharmacy students in their sixth-year internship was performed. Three questionnaires (one/month) designed by pharmacists were sent by email. These focused on the attitude of dealing with patients suffering from cystitis, their interest in the advanced practice, the identification of risk factors for complications, and their behavior in real-life situations.Results and discussion: Almost all of the respondents had already dealt with requests for antibiotics for cystitis without medical prescription, and 50% of pharmacists had already agreed to do so. 88.5% of pharmacists wanted to implement the considered advanced practice. 25% of respondents considered that a dialogue with the patient allows to identify risk factors for complications. The time frame in which the request was made had an impact on their choice of dispensing. The differences between pharmacists and students highlighted the impact of experience and recent initial training. This new advanced practice seems to be able to provide solutions for cystitis management without removing all the barriers especially in term of regulation.

Determination of knowledge levels and attitudes of clinician veterinarians working in Thrace region towards antibiotic use

Antimicrobial resistance (AMR) has become a global problem due to widespread antimicrobial use in human and veterinary medicine. AMR affects health systems by leading to prolonged and severe illnesses, high mortality rates, and treatment failures caused by resistant microorganisms. As antibiotics are the most widely used drugs in veterinary medicine, veterinarians' knowledge, attitudes and practices regarding antibiotic use are crucial in combating AMR. In this cross-sectional study, an online questionnaire of 20 questions was administered to clinician veterinarians and members of the Trakya Chamber of Veterinarians and 60 participants answered the questionnaire. In the current survey, 98 % of veterinarians agree that AMR is an important public health problem and emphasize that focusing on rational antibiotic use in veterinary medicine is a critical area to slow the development of AMR. Only 10 % of the respondents stated that they take into account antibiotic requests from patient owners, 68.3 % stated that they rarely use off-label drugs and 16.7 % stated that they often use them. Of those respondents, 16.7 % stated that they routinely perform antibiograms. Regarding education, 41.7 % of veterinarians had received training on rational antibiotic use. When asked about their preferred type of training, 56.7 % favored online training, while 35 % preferred face-to-face sessions. The results indicate that veterinarians play a significant role in combating AMR and that more awareness and education are needed in this field.

Seeing an apocalyptic post-antibiotic future lowers antibiotics expectations and requests

BackgroundAntibiotic resistance is an ongoing pandemic which represents a global public health threat. To encourage the judicious use of antibiotics, public health discourse and campaigns often engage in threat-based messaging depicting an apocalyptic post-antibiotic future. We studied the effectiveness of the strategy because of mixed evidence for its success, and because it is unclear how experiencing the COVID-19 pandemic might have influenced it.MethodsWe conducted a randomised controlled trial with 378 participants in three waves (before and during the pandemic in 2021 and 2022). Participants were randomly allocated to either the baseline arm, featuring a control film, or the intervention arm featuring a short film, Catch, depicting a post-antibiotic future. Participants expressed expectations and intended requests for antibiotics for a hypothetical ear infection and their adherence to a prescribed antibiotic for a hypothetical kidney infection. In waves 2 and 3, they also reported any COVID-19-related changes to their antibiotic desires.ResultsShowing participants a film about a post-antibiotic future substantially lowers clinically inappropriate expectations for antibiotics and their intended requests. Participants report that the experience of the COVID-19 pandemic decreased their desire for antibiotics but only when they watched the intervention film. The intervention slightly decreases participants’ adherence intentions towards a prescribed antibiotic treatment.ConclusionsPresenting a film about an apocalyptic post-antibiotic future lowers expectations and intended requests for antibiotics and therefore has the potential to encourage judicious use of them. However, the adverse effects of such messaging on adherence to a course of antibiotics should be proactively managed.

Understanding patient demand for and use of antibiotics for upper respiratory tract infection: A qualitative application of the Necessity-Concerns Framework in Saudi Arabia.

Reducing antimicrobial resistance (AMR) is a priority for public health. Inappropriate patient demand is an important driver of unnecessary antibiotic use. To develop an effective intervention to reduce inappropriate demand for antibiotics in upper respiratory tract infections (URTIs), it is important to identify patient perceptions that influence demand for, and appropriate use of antibiotics. To identify and describe the beliefs about antibiotics necessity and concerns that patients with URTIs have, in Riyadh, Saudi Arabia. An exploratory qualitative approach was used. One-to-one, face-to-face or telephone semi-structured interviews were conducted with participants recruited using purposive sampling (based on age and gender) from primary healthcare centre in Riyadh, Saudi Arabia were conducted. Only adult patients who currently experience URTIs symptoms and agreed to participate were recruited. Recruitment for interviews continued until data saturation point was reached. The interview guide explored patients' necessity beliefs and concerns about antibiotics, AMR perceptions, and expectations from URTIs consultation. Interview transcripts were coded using QSR NVivo 12 using framework analysis informed by the Necessity-Concerns Framework to identify key motivations driving antibiotic requests and consultations. the study interviewed 32 participants (44% were male, average age was 36.84). Results identified that the patients often relate their personal need for antibiotics when encountering an URTIs symptoms to the type, severity and duration of symptoms. Patients also linked antibiotics with quicker recovery, generally expressing few concerns about antibiotics mainly because of its short duration of use. However, some conveyed their concern about frequent administration of antibiotics and effect on the body's immune system function, which may make them more prone to infections in the future. Participants varied widely in their awareness of AMR; this was associated with many misconceptions, such as confusing AMR with antibiotics efficacy and tolerance. Interestingly, the interplay between necessity beliefs and concerns was observed to influence the decision to start and stop antibiotic, potentially impacting inappropriate antibiotic demand and unnecessary use. This study highlighted important beliefs and misconceptions about antibiotics and AMR in Saudi population which can be targeted in future interventions to reduce inappropriate demand for antibiotics and optimise appropriate usage.

Antibiotics on Demand: Advances in Asynchronous Telemedicine Call for Increased Antibiotic Surveillance.

The rapid growth of telehealth services has brought about direct-to-consumer telemedicine platforms, enabling patients to request antibiotics online without a virtual or face-to-face consultation. While telemedicine aims to enhance accessibility, this trend raises significant concerns regarding appropriate antimicrobial use and patient safety. In this viewpoint, we share our first-hand experience with 2 direct-to-consumer platforms, where we intentionally sought inappropriate antibiotic prescriptions for nonspecific symptoms strongly indicative of a viral upper respiratory infection. Despite the lack of clear necessity, requested antibiotic prescriptions were readily transmitted to our local pharmacy following a simple monetary transaction. The effortless acquisition of patient-selected antibiotics online, devoid of personal interactions or consultations, underscores the urgent imperative for intensified antimicrobial stewardship initiatives led by state and national public health organizations in telehealth settings. By augmenting oversight and regulation, we can ensure the responsible and judicious use of antibiotics, safeguard patient well-being, and preserve the efficacy of these vital medications.

Life-course inequalities in intrinsic capacity and healthy ageing, China

To measure sales of antibiotics without a prescription in pharmacies in China in 2017 and 2021, before and during the coronavirus disease 2019 (COVID-19) pandemic, and determine the factors associated with such sales. We conducted cross-sectional surveys using the simulated patient method in retail pharmacies in 13 provinces in eastern, central and western China in 2017 and 2021. At the pharmacies, the simulated patients (trained medical students) reported that they had mild respiratory tract symptoms and asked for treatment, using a three-stage process: (i)request some treatment; (ii)request antibiotics; (iii)request specific antibiotics. We used multivariable logistic regression analysis to determine factors associated with sale of antibiotics without a prescription. Of the pharmacies visited in 2017, 83.6% (925/1106) sold antibiotics without a prescription; this figure was 78.3% (853/1090) in 2021 (P-value: 0.002). After excluding pharmacies prohibited from selling antibiotics because of COVID-19, this difference was not significant (83.6% versus 80.9%; 853/1054; P-value: 0.11). Factors significantly associated with selling antibiotics without a prescription in both 2017 and 2019 were: location in central and western China compared with eastern China; being in a township or village compared with in a city; and presence of a counter where antibiotics were dispensed. Although laws became stricter between 2017 and 2021, antibiotic sales without a prescription were still common in pharmacies across China. Existing regulations need to be more strictly enforced, and pharmacy staff and the public should be made more aware of the risks of antibiotic misuse and dangers of antimicrobial resistance.

Evaluating the Efficacy and Safety of EZC Pak, a 5-Day Combination Echinacea-Zinc-Vitamin C Dose Pack with or without Vitamin D, in the Management of Outpatient Upper Respiratory Infections.

Growing antibiotic resistance is among the most serious threats to public health, with antibiotic misuse considered a leading driver of the problem. One of the largest areas of misuse is in outpatient upper respiratory infections (URIs). The purpose of this research is to evaluate the efficacy of EZC Pak, a combination Echinacea-Zinc-Vitamin C dose pack with or without Vitamin D, on the duration of illness and symptom severity of non-specific URIs as an alternative to antibiotics when none are deemed clinically necessary. A secondary analysis was carried out on patient satisfaction. A total of 360 patients across the United States were enrolled and randomized in a double-blind manner across two intervention groups, EZC Pak, EZC Pak+Vitamin D, and one placebo group. The study utilized a smartphone-based app to capture data. Once a participant reported the first URI symptom, they were instructed to take the intervention as directed and complete the daily symptom survey score until their symptoms resolved. The average EZC Pak participant recovered 1.39 days (90% CI 1.05 to 1.73) faster than the average placebo participant (p=0.017). The average EZC Pak participant reported a 17.43% (90% CI 17.1 to 17.8) lower symptom severity score versus placebo (p=0.029). EZC Pak users reported 2.9 times higher patient satisfaction versus placebo users (p=0.012). The addition of Vitamin D neither benefited nor harmed illness duration or symptom severity. The findings support the potential use of EZC Pak as an alternative to patient request for antibiotics when none are deemed clinically necessary at the time of initial clinical presentation. The decision to replete vitamin D in the acute phase of URI is an individualized decision left to the patient and their clinician. EZC Pak may play a critical role in improving outpatient URI management and antibiotic stewardship (ClinicalTrials.gov number, NCT04943575).

Practices, knowledge, and attitude toward dispensing antibiotics without a prescription in Iraqi pharmacies

Dispensing antibiotics without a prescription (DAWRx) is a potential threat to global public health and can lead to antimicrobial abuse and resistance development. Further research is required to examine the characteristics of DAWRx practice in Iraq. This study aimed to investigate the practices of DAWRx in Iraqi community pharmacies. A semi-structured, validated, pilot-tested online questionnaire was used to conduct a descriptive cross-sectional study in March 2020 among the members of the Iraqi Pharmacist Syndicate. The questionnaire contained five sections: demographics, antibiotic dispensing knowledge, and the prevalence, sources, and characteristic features of DAWRx practices. The results are presented using descriptive statistics and significant associations were reported. A total of 403 respondents completed the questionnaire and, of them, 363 were analyzed. Despite having a satisfactory knowledge of dispensing (64.7%), the practice of DAWRx was prevalent (98.3%). DAWRx was reported based on the pharmacies’ recommendation (30.58%) and patients’ request for antibiotics. Adults and pediatric patients received antibiotics from pharmacies for various conditions. Injectable antibiotics were also dispensed without a prescription (mainly ceftriaxone, n = 51/72). Moreover, the prevalence and the daily number of antibiotics dispensed were significantly associated with sex, pharmacy attitude toward DAWRx, and DAWRx upon patients’ request. A significant association was noted between the knowledge of dispensing inquiries and the prevalence of and attitude toward DAWRx (p < 0.05). Impactful intervention strategies based on patterns identified in this study should be developed to improve antibiotic dispensing in community pharmacies and safeguard public health from the adverse effects of antimicrobial resistance.

Weighing patient attributes in antibiotic prescribing for upper respiratory tract infections: A discrete choice experiment on primary care physicians in Hubei Province, China.

This study aimed to determine how primary care physicians weigh intervenable patient attributes in their decisions of antibiotic prescribing for upper respiratory tract infections (URTIs). A discrete choice experiment (DCE) was conducted on 386 primary care physicians selected through a stratified cluster sampling strategy in Hubei province, China. The patient attributes tested in the DCE were identified through semi-structured interviews with 13 primary care physicians, while the choice scenarios were determined by a D-efficient design with a zero prior parameter value. Conditional logit models (CL) and mixed logit models (MXL) were established to determine the preference of the study participants in antibiotic prescribing for URTI patients with various attributes. Relative importance (RI) was calculated to reflect the influence of each attribute. In addition to age and duration of symptoms, the interventionable patient attributes were also considered by the primary care physicians in their antibiotic prescribing decisions. They preferred to prescribe antibiotics for URTI patients with difficulties to schedule a follow-up appointment (p < 0.001) and for those without a clear indication of refusal to antibiotics (p < 0.001). Patient request for antibiotics had an RI ranging from 15.2 to 16.3%, compared with 5.1-5.4% for easiness of follow-up appointment. The influence of these two interventionable patient attributes was most profound in the antibiotic prescribing decisions for patients aged between 60 and 75 years as indicated by their interaction effects with age (β = 0.69 for request for antibiotics, p < 0.01; β = -1.2 for easiness of follow-up, p < 0.001). Reducing patient pressure and improving accessibility and continuity of care may help primary care physicians make rational antibiotic prescribing decisions for URTIs.

Study of the Drivers of Inappropriate Use of Antibiotics in Community Pharmacy: Request for Antibiotics Without a Prescription, Degree of Adherence to Treatment and Correct Recycling of Leftover Treatment.

The WHO considered antibiotic resistance as 1 of the 10 greatest threats to global health in 2019. The inappropriate and indiscriminate use of antibiotics, together with the lack of new therapeutic alternatives, may eradicate their effectiveness in the closest future. The general objective is to analyze the different causes attributable to patients, providers and pharmacists that could be drivers of irrational use of antibiotics, and responsible for the appearance of bacterial resistance, in community pharmacies. To this end, the different processes or indicators were studied: patients' requests of antibiotics at the pharmacy, their degree of adherence, satisfaction with the prescribed treatment and antibiotics' surplus recycling. This study was observational, descriptive, and cross-sectional, carried out in 2 pharmacy offices, including 333 participants. At the time of dispensing, first phase, surveys to collect patients', providers' and pharmacists' data were carried out over the counter. The second phase, with the aim of checking adherence, degree of satisfaction and recycling. There were 333 requests for antibiotic regardless prescription availability, 17% of the patients requested an antibiotic without having one. 38% of patients did not have full adherence to antibiotics. Exploring non-adherence reasons, 24% forgot to take the treatment, 2% experienced adverse effects; 8% improved infection symptoms and 21% had problems to follow schedule. Regarding the recycling habits, 57% of patients had leftover treatments at home, but only 11% recycled it. 10% of medical prescriptions were forced by the patient, and significant gender differences were observed in adherence and knowledge of treatment. The results of this study suggested that there may be a significant level of antibiotic inappropriate use locally, potentially related to patients' sex, finding significant deficiencies in prescription by doctors, in the dispensing act carried out in community pharmacies, and finally in patient compliance with treatment.

Pharmacists under pressure to concede: Why pharmacists provide non-prescribed antibiotics in the Arab minority in Israel

BackgroundAntibiotics overuse has become a global health threat because of increased antimicrobial resistance. Consumption of non-prescribed antibiotics contributes to this problem and has been found particularly among minority populations. One source for non-prescribed antibiotics are pharmacists. This study focuses on perspective of Arab pharmacists working in the Arab society in Israel--a minority reported to overconsume antibiotics--in order to learn why Arab pharmacists might accede to customers’ requests for non-prescribed antibiotics. DesignFace-to-face interviews were conducted with 60 Arab pharmacists working in private pharmacies in different regions in Israel. Qualitative data were analyzed thematically by focusing on the characteristics of pharmacist-customer relations, conceptions of social norms, and perceived expectations to provide non-prescribed antibiotics. Key resultsThe findings highlight how perceived normative expectations associated with a collectivist orientation predispose pharmacists to concede to customers' requests. The analysis identified two inter-related factors serving to pressure pharmacists to dispense non-prescribed antibiotics: personal customer-pharmacist relationship and cultural collectivist values. Pharmacists faced dilemmas between obligation to comply with customers' requests and going against professional ethos and described strategies to resist customers’ requests. ConclusionsThis study illuminates the central role of sociocultural contexts and social norms in pharmacist-customer relations in a collectivist-oriented minority, resulting in pressuring pharmacists to go against regulations. The findings have implications to understanding reasons for dispensing prescription-only medications. Interventions to reduce antibiotics use could enlist the centrality of social ties and commitment in pharmacist-customer relationships to resist dispensing prescription-only medications without prescriptions and to strengthen pharmacists’ role in providing pro-health messages.

Antibiotics use in children: Practice predictors among mothers of under–fives

In the developing countries, drug administration in children under the age of five is a task mostly undertaken by mothers. Parental practices in the use of antibiotics in children can determine the extent of the therapeutic benefit and the development of resistance. This study investigated mothers’ practices on use of antibiotics in children and determined the possible socio-demographic predictors of good practice.&#x0D; Mothers of at least a child under the age of five were interviewed to determine their use of antibiotics in children and summary and inferential statistical analysis were conducted.&#x0D; Of the 313 mothers interviewed, 119(38%) had overall poor practice. One hundred and eighty-eight (60.1%) used antibiotics when their children had catarrh and sore throats, 195(62.3%) stopped giving antibiotics when their children felt better before completing the dose, 260(83.1%) saved some antibiotics at home in case of future use, 126(40.3%) gave antibiotics without the doctor’s prescription. Older mothers had a greater likelihood to save some antibiotics at home in case of future use, OR=1.087,95%CI-1.016-1.163, increasing age of first child decreases the odds of requesting antibiotics from the doctor OR=0.989, 95% CI:0.981-0.997 while increasing number of children had almost a two-fold increase on the likelihood to request for antibiotics, OR=1.624,95% CI=1.05-2.386. Attaining a tertiary level of education had over a two-fold (OR=2.337, 95% CI=1.063-5.137) and a three-fold (OR=3.262,95% CI= 1.566-6.802) increase on the odds of giving antibiotics to a child without a doctor’s advice and reading information leaflets respectively. There was a significant difference between self- perceived practice level and actual practice level (P=0.01).&#x0D; A good proportion of mothers had less than adequate antibiotics practice levels and some demographic factors predicted practice. Advocacy should be employed to improve practices associated with antibiotics use in children in the developing countries.

Inappropriate supply of antibiotics for common viral infections by community pharmacies in Vietnam: A standardised patient survey

SummaryBackgroundThis study aimed to evaluate the appropriateness of antibiotic dispensing of private pharmacies in Vietnam.MethodsStandardised patient surveys were conducted in randomly selected community pharmacies across 40 districts in Vietnam. Four clinical scenarios were represented by patient actors: (a) an adult requesting treatment for a sibling with a viral upper respiratory tract infection (URTI), (b) a parent requesting treatment for a child with acute diarrhoea, (c) an adult making a direct antibiotic request, and (d) an adult presenting with an antibiotic prescription. We calculated the proportion of interactions that resulted in inappropriate supply of antibiotics and patient advice. Predictors of inappropriate antibiotic supply were assessed.FindingsPatient actors attended 949 pharmacies, resulting in 1266 clinical interactions. Antibiotics were inappropriately supplied to 92% (291/316) of adults requesting treatment for URTI symptoms, 43% (135/316) for children with acute diarrhoea symptoms and to 84% (267/317) of direct request for antibiotics. Only 49% of pharmacies advised patients regarding their antibiotic use. Female actors were more likely to be given antibiotics than male actors for URTI (aOR 2·71, 1·12–6·60) but not for diarrhoeal disease. Pharmacies in northern Vietnam were more likely than those in southern Vietnam to supply antibiotics without a prescription: for adult URTI (aOR=5·8, 95% CI: 2·2–14·9) and childhood diarrhoea (aOR=3·5, 95% CI: 2·0–6·0) symptoms, but less likely to dispense for direct antibiotics request.InterpretationInappropriate antibiotic supply was common in Vietnamese private pharmacies. Multifaceted measures are urgently needed to achieve WHO's global action plan for the optimal use of antimicrobials.FundingThis study was funded by a grant from the Australian Department of Foreign Affairs and Trade.

Assessment of Community Pharmacists’ Knowledge, Attitude and Practice on Antibiotics and Antibiotic Resistance

Antimicrobial resistance is a major public health problem all over the globe. A cross sectional study in different zones of Hyderabad city was conducted with the aim of evaluating community pharmacists’ knowledge, attitude and practice (KAP) on antibiotics and antibiotic resistance. A self-administered questionnaire was developed as data collection tool. Responses were recorded and scored using 5-Point Likert Scale. Descriptive statistics, frequencies, percentages and statistical tests were used to analyse the data. Data was collected from 40 community pharmacists. Results showed that the community pharmacist had poor knowledge on antibiotics and poor antibiotic dispensing practice. About 31(78%) pharmacists never heard about the term antimicrobial resistance. Our study highlighted that there were only 15 pharmacists who considered antimicrobial resistance as a serious issue. Most of the pharmacists (n=20) agreed that antibiotics can be dispensed without prescription. Around 26 pharmacists dispense antibiotics to treat minor ailments without a prescription. The most common reason given by community pharmacists for dispensing antibiotics without prescription was, request for antibiotics by the patients. The study highlights that there is a need for the community pharmacists to update their knowledge and improve their awareness on antibiotic resistance. Short term, intensive training programs are needed to improve their knowledge and practice regarding antibiotic use and resistance.

Antibiotic expectations of patients attending an emergency department with upper respiratory tract infections: clinical and behavioural determinants of antibiotic use

Antibiotics are often prescribed for upper respiratory tract infections (URTIs) in emergency departments (EDs) due to patient requests and expectations perceived by physicians. This study aimed to identify clinical and behavioural factors associated with patient antibiotic expectations. A cross-sectional study was undertaken of 717 patients attending the ED at Tan Tock Seng Hospital for URTIs between June 2016 and November 2018. A questionnaire was administered and electronic medical records were accessed. Principal component analysis was used to derive latent behavioural factors associated with antibiotic use, and these were applied in multi-variable multi-nomial logistic regression analyses. Independent factors associated with patient antibiotic expectations and requests were identified. Patients were predominantly young [mean age 40.5 (standard deviation 14.7) years], had no comorbidities (66.5%, 477/717), presented within <7 days of symptom onset (62.9%, 451/717), and did not fulfil the US Centers for Disease Control and Prevention's influenza-like illness (ILI) criteria (79.1%, 567/717). Behavioural factors identified were: (1) non-compliance with prescribed antibiotic regimen; (2) self-administration of antibiotics that were not prescribed for the illness episode; and (3) self-discontinuation of antibiotics upon experiencing adverse effects or allergies. After adjusting for age, gender, ethnicity, comorbidities, influenza vaccination history, and illness duration, patients with ILI [adjusted odds ratio (OR) 1.73, 95% confidence interval (CI) 1.15-2.59; P=0.008] or who self-administered antibiotics that were not prescribed for an illness episode (adjusted OR 1.28, 95% CI 1.04-1.57; P=0.021) were more likely to expect antibiotics at the ED visit. Patients with ILI or who previously self-administered antibiotics were more likely to expect antibiotics at ED visits. Public education on appropriate antibiotic use is imperative to ensure optimal antibiotic use.

Public Health and Epidemiology Informatics: Recent Research Trends.

SummaryObjectives: To introduce and analyse current trends in Public Health and Epidemiology Informatics. Methods: PubMed search of 2020 literature on public health and epidemiology informatics was conducted and all retrieved references were reviewed by the two section editors. Then, 15 candidate best papers were selected among the 920 references. These papers were then peer-reviewed by the two section editors, two chief editors, and external reviewers, including at least two senior faculty, to allow the Editorial Committee of the 2021 International Medical Informatics Association (IMIA) Yearbook to make an informed decision regarding the selection of the best papers. Results: Among the 920 references retrieved from PubMed, four were suggested as best papers and the first three were finally selected. The fourth paper was excluded because of reproducibility issues. The first best paper is a very public health focused paper with health informatics and biostatistics methods applied to stratify patients within a cohort in order to identify those at risk of suicide; the second paper describes the use of a randomized design to test the likely impact of fear-based messages, with and without empowering self-management elements, on patient consultations or antibiotic requests for influenza-like illnesses. The third selected paper evaluates the perception among communities of routine use of Whole Genome Sequencing and Big Data technologies to capture more detailed and specific personal information. Conclusions: The findings from the three studies suggest that using Public Health and Epidemiology Informatics methods could leverage, when combined with Deep Learning, early interventions and appropriate treatments to mitigate suicide risk. Further, they also demonstrate that well informing and empowering patients could help them to be involved more in their care process.

Public Perception Toward Ministry of Health Regulations for Antibiotic Dispensing and Its Impact on Pharmacy and Family Physician Visits.

IntroductionAntibiotic dispensing regulations have been implemented in most countries worldwide. Saudi Arabia’s Ministry of Health (MOH) recently implemented a policy for dispensing antibiotics, in which pharmacies in Saudi Arabia are strictly prohibited from dispensing antibiotics without a medical prescription. Failure to adhere to the regulations will result in a fine and may lead to the revoking of the pharmacy's license. The aim of this study was to investigate public perception among the Saudi population toward the recently implemented policy, to examine the effect of antibiotic dispensing regulations on consumers’ request for non-prescribed antibiotics at retail pharmacies, and to elucidate the implications of the recent policies on patient visitation to family physicians.MethodA cross-sectional study was conducted using three questionnaires targeting the general public in Saudi Arabia in addition to pharmacists and family physicians working in Saudi Arabia. ResultsA total of 380 participants completed the questionnaire for the general public, 299 for the pharmacist questionnaire, and 94 for the family physician questionnaire. Most participants in the general public questionnaire obtained their antibiotics using a prescription after consulting with a family physician (72.4%). Most of these individuals also agreed with the strict regulations for antibiotic dispensing (82.1%). Most pharmacist participants either always or frequently received requests to dispense antibiotics without a prescription from customers (71.5%). In addition, most physicians (59.6%) acknowledged that patient demand increased after the implementation of the new policies.ConclusionOur assessment of public perception towards the recent regulation for dispensing antibiotics indicates that most participants who participated in the General Public questionnaire supported the MOH’s strict regulations for antibiotic dispensing. However, customer requests for antibiotics without a prescription from pharmacists were a bit high, which could be attributed to customers' lack of awareness of the regulations. The results also indicate an increase in the number of family physician visits after the regulations were implemented.

503 Clinical Frailty Score (CFS) Vs Antibiotics, Time to Surgery and Time to Computerised Tomography (CT) Scan in An Emergency Surgical Population

Abstract Introduction Frail patients have increased mortality after surgery. However, it is not known if pre-operative process measures such as antibiotic administration, time to CT and time to surgery are influenced by patient frailty. Method The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) assessed outcome after emergency surgery across Scottish hospitals (November 2017 – October 2018). Frailty was measured using the 7-point Clinical Frailty Score (CFS). Outcome measures were antibiotic provision for sepsis, admission to CT time, admission to surgery time, CT request to performance time and CT request to surgery time. Results 1302 patients (median age 63 years [IQR 49-74]; 49% male) with complete data were included. Median time from admission to CT and surgery increased between those with CFS 1 to 6/7 from 597 to 1724 minutes (p &amp;lt; 0.0001) and 1556 to 4120 minutes (p &amp;lt; 0.0001) respectively. Time from CT request to surgery also significantly increased with CFS (p &amp;lt; 0.042). There was no significant association between CFS and antibiotic administration or CT request to performance. Conclusions Frail patients have to wait longer for CT scan requests and surgery, but frailty was not associated with antibiotic administration or delays in CT request to performance time. Possible explanations include frailty-related challenges making correct diagnoses and optimal management plans.

Changes in public knowledge and perceptions about antibiotic use and resistance in Jordan: a cross-sectional eight-year comparative study

BackgroundResistance to antibiotics is a growing problem, worldwide and particularly in developing countries like Jordan. Raising public awareness on appropriate antibiotic use is crucial to combat this problem. The current study describes the change in public Knowledge and attitudes towards the use of antibiotics over a period of 8 years.MethodsTwo cross-sectional studies were performed 8 years apart on Jordanians of different age groups, and social settings, residing in Amman, Jordan. Convenience non-probability sampling techniques were used. In 2010, a questionnaire was distributed in paper form, whereas in 2018 snowball sampling was used to disseminate an identical electronic questionnaire. Chi-square test and post hoc analysis were done using the z-test to compare column proportions, adjustment for multiple testing using the Bonferroni method. Multiple logistic regression was used to adjust for case mix for each survey. Comparisons were made across the two studies and within each study.ResultsA total of 711 participants in 2010 and 436 participants in 2018 were surveyed. Over the 8-year period, there was a significant improvement in the beliefs regarding the use of antibiotics such as disagreeing to keeping left over antibiotics for later use from 57 to 70% (p < 0.05) and disagreeing to buying antibiotics without physicians’ consent increased from 80 to 89% (P value < 0.001). There was no significant change in the beliefs that support self-medication such as: using antibiotics from a friend (72 to 77%) buying antibiotics without a prescription (42 to 45%), and getting information about medication use from leaflet without referring to a health care professional (60 to 63%). There were some areas of confusion regarding antibiotic range of effectiveness, and origin of resistance. Agreement about antibiotic resistance being a problem in Jordan increased significantly from 44 to 60% (p < 0.001). In addition, there was a significant increase in the percentage of participants who said that they don’t request antibiotics from physicians (56 to 75% (P ≤ 0.001) and who said they would trust physicians’ decisions about the necessity of antibiotics (70 to 83% P < 0.05).ConclusionFindings indicate the need for better suited, and more inclusive, public educational campaigns.

Availability of Medicines in Community Pharmacy to Manage Patients with COVID-19 in Kenya; Pilot Study and Implications

Multiple measures have been instigated across countries to prevent the spread and treat patients COVID-19 with personal protective equipment (PPE), sanitation measures and medicines. However, there has been considerable controversy surrounding initially endorsed treatments such as hydroxychloroquine with misinformation increasing prices and suicides. Prices of PPE and medicines have increased in countries following shortages, potentially catastrophic among lower- and middle-income countries (LMICs) with high co-payment levels. Consequently, there is a need to investigate changes in availability, utilisation, prices and shortages of relevant medicines during the pandemic in Kenya. To address this, a questionnaire was emailed to ten randomly selected community pharmacists from 21 purposely selected pharmacists attached to the University of Nairobi, with the survey covering the period from the start of the pandemic to the end of May 2020. This included suggestions from community pharmacists on potential ways forward with future pandemics. Six pharmacists eventually took in this pilot study. Two thirds noted increased requests for antimalarials and antibiotics; however, these were not dispensed with pharmacists recommending alternatives for symptomatic relief. There was increased use of analgesics as well as vitamins. Price rises were seen for hydroxychloroquine as well as vitamins and zinc (50-100% increase in price); however, no shortages were seen. The pharmacists believed their future role in pandemics include education, improved stock control and patient counselling. Overall, it was encouraging to see increases in the utilisation of vitamins/ immune boosters alongside no antimalarials or antibiotics dispensed without a prescription despite the hype and requests. Community pharmacists have a key role in any pandemic with prevention and guidance, and we will be monitoring this. Countries such as Kenya can also act as exemplar countries where there continues to be high rates of self-purchasing of antibiotics.