The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.

Objective Antimicrobial resistance (AMR) is an increasing global problem. AMR threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. The misuse and overuse of antibiotics (AB) is the major contributor to the emergence of resistant bacteria in humans. To present and describe characteristics in parents' knowledge about when and how to use AB for an upper respiratory tract infection (URTI), their attitudes towards doctors and AB use in general, and their behaviour when their child suffers from an URTI. Key Findings The database search was conducted in EMBASE and PubMed for articles published in English, French, Spanish and Scandinavian languages from the inception until May 2016. Qualitative and quantitative studies with focus on parent' knowledge, attitude and behaviour concerning treatment with AB for URTIs among children and adolescents were included. Extracted information included date of study, design, focus, location and population, parental knowledge, attitudes and behaviours regarding paediatric AB use and parental socioeconomic and sociodemographic characteristics. Parental knowledge about the causes of URTIs and when to use AB, education and parental and children's age affect attitudes and behaviours. However, good level of knowledge about AB (when and how to use it), often correlated with living in a Western country and belonging to high socioeconomic position, does not always imply judicious use of AB for URTIs among children. Providing parents with a contingency plan and clarifications on why an AB is not needed for common colds improves parental satisfaction with their physicians. Summary Evidence gathered from 20 countries from studies published in the last 20 years shows that parental knowledge still plays a major role in when and how to use AB for URTIs among children. However, parents are not disappointed if the physician does not prescribe AB, provided that proper explanations and a contingency plan are given.

Background:Kosovo is a new state and has a high consumption of antibiotics in relation to other European countries. Existing quantitative studies have shown that practices exist that is not optimal when it comes to antibiotic use in Kosovo, this includes citizens’ use of antibiotics, pharmacy practices of selling antibiotics without prescriptions and physicians’ prescribing behaviours. To address these problems, there is a need for a deeper understanding of why antibiotics are handled in a suboptimal way.Objective:The objective was to explore antibiotic users’, community pharmacists’ and prescribers’ attitudes towards, experiences of, and knowledge about antibiotics in Kosovo.Methods:Semi-structured interviews were conducted with patients who recently received an antibiotic prescription for an upper respiratory tract infection (URTI), patients who recently received antibiotics for a URTI without a prescription, community pharmacists, and physicians. Interviews were recorded, translated into English, and analysed using deductive content analysis.Results:In total, 16 interviews were conducted in the period from 2015-2016. Five themes were identified: Obtaining antibiotics, Choice of antibiotics, Patient information, Patients’ knowledge and views on when to use antibiotics, and Professionals’ knowledge and attitudes towards antimicrobial resistance. Antibiotics were sometimes obtained without a prescription, also by patients who currently had received one. The specific antibiotic could be chosen by a physician, a pharmacist or the patient him/herself. Former experience was one reason given by patients for their choice. Patients’ knowledge on antibiotics was mixed, however health professionals were knowledgeable about e.g. antimicrobial resistance.Conclusions:There is currently a culture of antibiotic use in Kosovo, including attitudes and behaviours, and hence also experiences, which is possibly underlying the high consumption of antibiotics in the country. The culture is reproduced by patients, pharmacists and physicians. There is, however, an awareness of the current problematic situation among practitioners and policy makers; and as Kosovo is a new country, opportunities to effectively tackle antimicrobial resistance exist.

BackgroundThe inappropriate use of antimicrobials is a problem worldwide. To target future interventions, a thorough understanding of the reasons behind this current behaviour is needed. Within the EU, the culture of antimicrobial use has been intensely studied, but this is not the case in non-EU southeastern European countries, despite the frequent use of (broad-spectrum) antibiotics (ABs) in this region. The aim of this study was to explore AB knowledge, attitudes and behaviours of health care professionals (HCPs) and patients in one southeastern European country, Albania.MethodsIn total, 16 semi-structured interviews were carried out with four groups of interviewees: physicians, community pharmacists, and patients with and without AB prescriptions. Interviews were used to investigate participants’ recent practices with four specific antibiotics for upper respiratory tract infections, along with their typical behaviours, knowledge and attitudes towards the use of antimicrobials. A directed content analysis was applied.ResultsThe patients showed little awareness of the differences between viruses and bacteria; however, they often self-diagnosed, which led them to request ABs from pharmacies without a prescription. Pharmacists felt pressured to give in to patients’ demands. All of the participants (including HCP) showed suboptimal beliefs about illness severity as they all believed that ‘flu complications’, i.e. flu/cold symptoms that persisted after 2–3 days, should be treated with ABs. Physicians usually had no rapid tests to guide them in their practice; however, they were not concerned about this fact. HCPs acknowledged AMR, but only a few of them seemed to consider its risk in their daily practice.ConclusionsPatients had high levels of trust in and desire for ABs, and HCPs did not often negotiate with patients’ demands. Suggested initiatives to improve the prudent use of ABs in Albania include higher reimbursement for prescribed antibiotics (to reduce illegal sales), academic detailing as well as implementing public awareness campaigns.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-017-0102-1) contains supplementary material, which is available to authorized users.

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