Background The consequences of the COVID-19 pandemic on physical and mental health in addition to the global economy are huge. Vaccination is a pivotal measure to decrease COVID-19 morbidity and mortality and to help bring the pandemic under control. Yet, success of the vaccination process depends on the population’s willingness to be vaccinated which may be determined by their level of knowledge about and trust in currently available COVID-19 vaccines. Therefore, this study aims to assess the knowledge, attitude, and acceptance of Palestinians towards COVID-19 vaccines. Methods A national cross-sectional study was distributed in different Palestinian regions to assess the knowledge and attitude of Palestinians toward COVID-19 vaccines using an online questionnaire, it included three sections; sociodemographic characteristics, knowledge assessment questions, and attitude assessment questions. Results A total of 6226 participants completed the questionnaire; among them, 41.36% believed that vaccines are safe, 69.02% agreed that vaccines are vital to protect from COVID-19; in addition, 55.1% approve administering the vaccine once available, and 37.86% do not believe their benefits outweigh the risks. The Source of information for 22.07% of participants in social media, while 11.92% rely on health care providers. Participants’ attitudes and knowledge were significantly affected by gender, governorate, age, education level, and marital status (P <0.001). Conclusion The findings suggest that there is good knowledge and attitude toward the vaccination process against COVID-19 in Palestine, although low acceptance was detected. Awareness campaigns are required to spread reliable knowledge about COVID-19 vaccines.

Introduction: Rates of antimicrobial resistance in the Gaza Strip are rising while regulations on antibiotics use are weakly implemented. This study aimed to investigate antibiotic use in hospitals utilizing World Health Organization (WHO) hospital, prescribing, and patient care indicators. Methodology: A retrospective study was conducted at Al Shifa medical complex (SMC), Nasser Medical Complex (NMC), and European Gaza Hospital (EGH). Data for hospital indicators were collected from drug inventory records and by interviewing hospital pharmacy managers, while data for prescribing and patient care indicators were collected from medical records from all departments. WHO standard data collection forms and formulas to calculate quantitative indicators were used. Results: Standard treatment guidelines for infectious diseases were unavailable. The availability of key antibiotics on the day of the investigation was 58.62%, 90.9%, and 44.82%, and antibiotics were out of stock for 120.5, 63.3, and 119.8 days/year in SMC, NMC, and EGH, respectively. A total of 1400 patients’ records were screened; 68.2% of patients were prescribed antibiotics with an average duration of 3 days. The number of antibiotics prescribed was 1.26/hospitalization, 55% were prescribed by generic name, 98% were consistent with the essential medicine list, and 94.7% were given parenterally. Ceftriaxone was the most commonly used antibiotic (47.5%). Adherence rates to STGs for Caesarean section antibiotic prophylaxis and for pneumonia were 43% and 6.3%, respectively. About 97% of doses of prescribed antibiotics were administered and patients on antibiotics stayed in the hospital for 4.1 days. Conclusions: Antibiotic utilization patterns are less than optimal. Strategies to improve antibiotic use in the investigated hospitals are needed.

Evidence-based guidelines for perioperative antimicrobial prophylaxis (PAP) are well established. It is unknown whether PAP practice in Gaza Strip hospitals follows those guidelines. This study aimed to assess the adherence of PAP practice at surgical wards in Gaza Strip hospitals to the American Society of Health-System Pharmacists (ASHP) guidelines for antimicrobial surgical prophylaxis. Data were collected over a 6-month period by direct observation and chart review methods. Aspects of PAP (indication, selection, duration, dosing, and first dose timing) were assessed against ASHP guidelines. The study enrolled 444 surgical patients, of whom 94.8% received PAP. The overall adherence rate was 7.4%. Adherence rates for indication, selection, dosing, timing of first dose, and duration were 70.7%, 56.3%, 17.7%, 59%, and 58%, respectively. Patients who underwent clean surgeries were less likely to be given the recommended antibiotic than those who underwent clean-contaminated surgeries (OR 0.480, 95% CI 0.375-0.615, p-value 0.021). Nurses were less likely to adhere to the right first dose timing than anesthesiologists (OR 0.132, 95% CI 0.051-0.374, p-value 0.011). This study showed poor adherence to guidelines in all aspects of PAP use, particularly dosing. Strategies to improve PAP practice should be adopted and implemented.

Inappropriate antibiotic-related practices are common worldwide but feature more strongly in developing countries. An example of such practices is dispensing antibiotics without prescription [DAwP] in community pharmacies, despite being illegal in most countries around the globe. The aim of this review is to discuss in-depth all aspects related to the practice of DAwP in Arab countries. We searched SCOPUS, PubMed and Google Scholar for articles involving studies addressing the practice of DAwP, conducted in any Arab country, and published from 2000 to 2022. We found that DAwP is very common with extremely high prevalence rates that differ according to methodologies used in those studies. Malpractices associated with DAwP include poor information-gathering before dispensing, poor counseling, inappropriate choice of the antibiotic, recommending antibiotics when they are not indicated, wrong duration and wrong dosing. Common factors shown to contribute to this practice include lax enforcement of regulations, misconceptions about antibiotics by the public, accessibility of community pharmacies, trustability of pharmacists, and the business orientation of pharmacies. Enforcement of regulations, increasing the competency of pharmacists by enhancing undergraduate pharmacy plans and establishing well-planned continuing education programs, reframing regulations to account for the expanding role of competent pharmacists, and increasing the awareness of the public towards antibiotics may limit DAwP and other antibiotic-related inappropriate practices.

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