Over-the-counter sale of antibiotics during COVID-19 outbreak by community pharmacies in Saudi Arabia: a simulated client study

Khojah, Hani M J

doi:10.1186/s12913-022-07553-x

Cited by 13 publications

(12 citation statements)

References 25 publications

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“…This high rate of antibiotic use is unsurprising given the inappropriate and empiric prescribing of antibiotics without proper diagnosis or prescription, which is prevalent in both community and hospital settings in Kenya even outside of the pandemic period [ 17 , 21 ]. This finding is consistent with previous studies describing high rates of inappropriate antibiotic prescription in community pharmacies in Indonesia [ 22 ], Tanzania and Uganda [ 23 ], Saudi Arabia [ 24 ] and Russia [ 25 ], as well as among the general public to prevent or manage COVID-19 [ 14 , 26 , 27 ]. A recent metanalysis of global studies reported a pooled prevalence of 74.6% antibiotic usage amongst hospitalised COVID-19 patients [ 28 ].…”

Section: Discussionsupporting

confidence: 92%

Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya

Gacheri,

Hamilton,

Munywoki

et al. 2024

PLOS Glob Public Health

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The COVID-19 pandemic has significantly impacted healthcare systems, including antibiotic use practices. We present data on patterns of antibiotic dispensing and use in community and hospital settings respectively in Nairobi, Kenya during the pandemic. We conducted interviews with 243 pharmacies in Nairobi using a standardised questionnaire from November to December 2021. The data collected included demographic characteristics, antibiotic customers, types of antibiotics sold, and antibiotic prescribing practices. Additionally, we retrospectively reviewed health records for 992 and 738 patients admitted in COVID-19 and general wards at two large inpatient hospitals between April 2020 and May 2021, and January 2019 to October 2021, respectively. Demographic, utilisation of laboratory services, treatment, clinical, and outcome data were collected using a modified Global WHO Point Prevalence Surveys (Global-PPS) tool. Almost all pharmacies (91.4%) served customers suspected of having COVID-19 with a mean weekly number of 15.6 customers. All pharmacies dispensed antibiotics, mainly azithromycin and beta lactams to suspected COVID-19 infected customers. 83.4% of hospitalised COVID-19 patients received at least one antibiotic at some point during their hospitalisation, which was significantly higher than the 53.8% in general ward patients (p<0.001). Similarly, the average number of antibiotics administered to COVID-19 patients was higher than that of patients in the general ward (1.74 vs 0.9). Azithromycin and ceftriaxone were the most commonly used antibiotics in COVID-19 patients compared to ceftriaxone and metronidazole in the general wards. Only 2% of antibiotic prescriptions for COVID-19 patients were supported by microbiological investigations, which was consistent with the proportion of 6.8% among the general ward population. Antibiotics were commonly prescribed to customers and patients suspected of having COVID-19 either in community pharmacies or in hospital, without a prescription or laboratory diagnosis. These findings emphasize the crucial role of antibiotic stewardship, particularly in community pharmacies, in the context of COVID-19.

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Section: Discussionsupporting

confidence: 92%

Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya

Gacheri,

Hamilton,

Munywoki

et al. 2024

PLOS Glob Public Health

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“…We have seen in the study of Khojah that during the recent COVID-19 pandemic, 15.8% of pharmacies in Saudi Arabia dispensed an antibiotic without a prescription, higher than seen in the study of Alshreedy et al (2020) at 12.1% of patients with pharyngitis, with a similar proportion in the study of Al-Tannir et al ( 20 , 24 , 38 ). However, in the current study, the percentage was slightly higher at 18%, indicating a possible lax in the current monitoring of community pharmacies.…”

Section: Discussionmentioning

confidence: 50%

“…However, we are aware that inappropriate practices can return if over time there is less monitoring of community pharmacy activities coupled with continued pressure from patients to dispense antibiotics without a prescription ( 21 – 23 ). Such pressures were heightened during the recent COVID-19 pandemic in Saudi Arabia ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR

Alnezary,

Alamri,

Alrehaili

et al. 2024

Front. Pediatr.

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IntroductionDiarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care.MethodSimulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists’ practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists’ practice was categorized into adequate, less adequate, and poor.Results182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription.ConclusionA high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists’ practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.

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“…In addition, all prescriptions were issued from private clinics and antibiotic combinations were given to 74% of home-isolated patients for a maximum of two weeks [ 30 ]. The second study conducted in Saudi Arabia and stated that 15.8% of pharmacists were convinced to sell non-prescribed antibiotics to the demands of the customers; however, there are restrictions on dispensing antibiotics without prescriptions that have been developed in the recent years [ 31 ]. In the third study, in Jordan, the dispensing of azithromycin without prescriptions was significantly higher during COVID-19, 127% higher than before the pandemic [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

Self-Medication with Antibiotics during COVID-19 in the Eastern Mediterranean Region Countries: A Review

et al. 2022

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Self-treatment with medicines including treatment with antibiotics is a growing global concern, as it can cause public health problems, such as antibiotic resistance and drug toxicity. Therefore, the significance of the self-medication impact of COVID-19 in any region can have an influence on the prevalence of such problems. The review aimed to investigate the self-treatment with antibiotics among the general population in Eastern Mediterranean region countries during COVID-19 pandemic. A comprehensive review of literature in four databases was conducted for the pandemic period from January 2020 to the end of March 2022. Nine studies related to self-treatment with antibiotics were found. The studies were homogeneous in terms of assessing the antibiotic self-treatment usage during the COVID-19 pandemic among the general population and among community pharmacies. The prevalence of self-treatment with antibiotics ranged from 20.8% to 45.8% between the studies. The main reasons for that were cost-saving, fear of COVID-19 infection, quarantine, and ease of accessibility without time limits. Antibiotic self-treatment has been high during the COVID-19 pandemic; however, it was less reported during the study period than before the time of the pandemic. There is a need for more restrictions on dispensing antibiotics from community pharmacies. In addition, there is a need to raise awareness among the population regarding self-treatment with antibiotics.

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Over-the-counter sale of antibiotics during COVID-19 outbreak by community pharmacies in Saudi Arabia: a simulated client study

Cited by 13 publications

References 25 publications

Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya

Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR

Self-Medication with Antibiotics during COVID-19 in the Eastern Mediterranean Region Countries: A Review

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