Evaluation of accordance of antibiotics package size with recommended treatment duration of guidelines for sore throat and urinary tract infections

Abstract

BackgroundThe aim of this study was to investigate whether marketed antibiotics package sizes are in accordance with treatment durations recommended in guidelines for prescribing antibiotics in sore throat and urinary tract infections.MethodsNational drug database was searched with limitation to Antibacterials for systemic use. Formulations which did not have pre-specified dosage unit by the manufacturer were excluded (e.g. powders for oral solutions). The final list contained 94 drugs with 23 different active substances. This list was then cross-referenced with selected antimicrobial prescribing guidelines provided by Intersectoral Society for Antibiotic Resistance Control (ISKRA), National Institute for Health and Care Excellence (NICE) and The Infectious Diseases Society of America (IDSA).ResultsSeven packages matched ISKRA guidelines on sore throat while 16 were mismatched. Considering drug packages under reimbursement, 3 matched ISKRA guidelines and 8 were mismatched. Only 3 packages matched IDSA guidelines for comparable indications, and 18 were mismatched. When considering NICE guidelines there were 5 mismatched and only one package that was in accordance with the guidelines. ISKRA guidelines for urinary tract infections matched 23 packages and mismatched 58 packages. IDSA guidelines for urinary tract infections matched one package and were mismatched in 15 cases.ConclusionsOne of the causes of leftover antibiotics is poor accordance of antibiotic package size with treatment recommendation duration. This should be identified as a potential target for reduction of excess antibiotics in the community. Measures that promote patient adherence to therapy and patient education should be considered essential to manage proper handling of leftover antibiotics.

Correlation of registered drug packs with Maastricht V/Florence Consensus Report and national treatment guidelines for management of Helicobacter pylori infection

“…Poor correlation of the size of drug packs has been previously discussed, for most frequent indications in primary care or antimicrobials that are greatly consumed. [2][3][4] These considerations should further be expanded to indications with great prevalence that are expected to have rising incidence or require combination antibiotic treatments.…”

“…Antibiotic resistance has been emerging worldwide . Patient behaviour, treatment adherence, leftover antibiotics and drug waste should be identified as potential targets for restraining antibiotic resistance, and these may be of greatest interest in primary care, outpatient setting or for infections with great prevalence . Considering the latter, it is estimated that 50% of the world's population will be infected with Helicobacter pylori .…”

Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

“…Some authors are problematizing the accordance of registered and available drug-pack sizes with treatment guidelines, further stressing the importance of patient adherence to the treatment. Even with perfect patient adherence to the treatment, there still might be leftover units of antibiotics that raise the risk of improper treatment in the future if these are left stocked at home [ 39 , 40 , 41 ]. Furthermore, community pharmacists play a key role in addressing patient concerns regarding possible adverse drug reactions, optimizing patient outcomes and referring patients to general practitioners when appropriate [ 42 , 43 ].…”

Antimicrobial Resistance: Physicians' and Pharmacists' Perspective

“…6 Recent studies have raised question about the ability of physicians to follow guidelines due to the limited availability of appropriate drug packs. 7,8 This stresses the importance of different skills needed among physicians and an ever-growing need for new and up-to-date information and education. Furthermore, with most of the antibiotic consumption being in primary care, 9 pharmacists have a unique opportunity to contribute to the management of AMR as well to affect patients' adherence to treatment and management of leftover antimicrobials.…”