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BMC Health Services Research

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Open Access 01-12-2022 | Antibiotic | Research

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

Author: Hani M. J. Khojah

Published in: BMC Health Services Research | Issue 1/2022

Abstract

Background

Recent studies have reflected increased global concern regarding the possible acceleration of bacterial resistance secondary to the reported overuse and misuse of antibiotics during the COVID-19 pandemic. Therefore, this study aimed to investigate the nonprescribed sale of antibiotics by community pharmacies in Saudi Arabia during the COVID-19 outbreak and the pharmacists’ skills in triaging COVID-19 suspects.

Methods

Herein, 120 pharmacies were randomly selected and surveyed by simulated clients who presented gradual demands to convince the encountered pharmacists to agree to the over-the-counter sale of antibiotics. The pharmacists’ responses and counseling skills were documented in addition to their effectiveness in triaging suspected COVID-19 cases.

Results

Nineteen pharmacists (15.8%) were convinced to sell nonprescribed antibiotics after various levels of demand by clients. Moreover, twenty pharmacists (16.7%), who refused to sell nonprescribed antibiotics, referred the clients to clinics where they could easily obtain prescriptions, or to other pharmacies that violate the system. In addition, 29 pharmacists (24.2%) were not concerned about possible COVID-19 suspects, and 47–66 (39.2–55%) of them demonstrated different responses and recommendations. Moreover, 12 pharmacists of the 19 who violated the law did not offer any counseling regarding the use of the antibiotics.

Conclusions

The nonprescribed sale of antibiotics is still prevalent and may have increased during the COVID-19 outbreak in Saudi Arabia, thereby increasing the risk of accelerated bacterial resistance. The pharmacists’ skills in triaging COVID-19 suspects and patient education and counseling were below expectations. Further follow-up studies are highly recommended.

Hutchings MI, Truman AW, Wilkinson B. Antibiotics: past, present and future. Curr Opin Microbiol. 2019;51:72–80. https://doi.org/10.1016/j.mib.2019.10.008.CrossRefPubMed

Abushaheen MA, Muzaheed Fatani AJ, Alosaimi M, Mansy W, George M, Acharya S, et al. Antimicrobial resistance, mechanisms and its clinical significance. Dis Mon. 2020;66:100971. https://doi.org/10.1016/j.disamonth.2020.100971.CrossRefPubMed

Wesgate R, Evangelista C, Atkinson R, Shepard A, Adegoke O, Maillard J-Y. Understanding the risk of emerging bacterial resistance to over the counter antibiotics in topical sore throat medicines. J Appl Microbiol. 2020;129:916–25. https://doi.org/10.1111/jam.14682.CrossRefPubMed

Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109:309–18. https://doi.org/10.1179/2047773215Y.0000000030.CrossRefPubMedPubMedCentral

Tong S, Pan J, Lu S, Tang J. Patient compliance with antimicrobial drugs: a Chinese survey. Am J Infect Control. 2018;46:e25–9. https://doi.org/10.1016/j.ajic.2018.01.008.CrossRefPubMed

Algammal AM, Hetta,HF, Elkelish A, Alkhalifah D, Hozzein WN, Batiha GE, et al. Methicillin-resistant Staphylococcus aureus (MRSA): one health perspective approach to the bacterium epidemiology, virulence factors, antibiotic-resistance, and zoonotic impact. Infect Drug Resist 2020;13:3255–3265. https://doi.org/10.2147/IDR.S272733.

World Health Organization. Lack of new antibiotics threatens global efforts to contain drug-resistant infections. https://www.who.int/news/item/17-01-2020-lack-of-new-antibiotics-threatens-global-efforts-to-contain-drug-resistant-infections. Accessed 24 January 2021.

Dadgostar P. Antimicrobial resistance: implications and costs. Infect Drug Resist. 2019;12:3903–10. https://doi.org/10.2147/IDR.S234610.CrossRefPubMedPubMedCentral

Silva ML, Cargnello C, Aulois-Griot M, Dumartin C. Antibiotic misuse: how to evaluate the costs? Med Mal Infect. 2019;49:485–94. https://doi.org/10.1016/j.medmal.2019.03.012.CrossRefPubMed

10.

Walger P. Rational use of antibiotics. Internist (Berl). 2016;57:551–68. https://doi.org/10.1007/s00108-016-0071-5.CrossRef

11.

World Health Organization Regional Office for Europe. The role of pharmacist in encouraging prudent use of antibiotic medicines and averting antimicrobial resistance – a review of current policies and experiences in Europe (2014). https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/publications/2014/the-role-of-pharmacist-in-encouraging-prudent-use-of-antibiotic-medicines-and-averting-antimicrobial-resistance-a-review-of-current-policies-and-experiences-in-europe-2014. Accessed 25 Jan 2021.

12.

Auta A, Hadi MA, Oga E, Adewuyi EO, Abdu-Aguye SN, Adeloye D, et al. Global access to antibiotics without prescription in community pharmacies: a systematic review and meta-analysis. J Inf Secur. 2019;78:8–18. https://doi.org/10.1016/j.jinf.2018.07.001.CrossRef

13.

Chang J, Xu S, Zhu S, Li Z, Yu J, Zhang Y, et al. Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. Lancet Infect Dis. 2019;19:1345–54. https://doi.org/10.1016/S1473-3099(19)30324-X.CrossRefPubMed

14.

Grigoryan L, Germanos G, Zoorob R, Juneja S, Raphael JL, Paasche-Orlow MK, et al. Use of antibiotics without a prescription in the U.S. population: a scoping review. Ann Intern Med. 2019;171:257–63. https://doi.org/10.7326/M19-0505.CrossRefPubMed

15.

Zapata-Cachafeiro M, Piñeiro-Lamas M, Guinovart MC, López-Vázquez P, Vázquez-Lago JM, Figueiras A. Magnitude and determinants of antibiotic dispensing without prescription in Spain: a simulated patient study. J Antimicrob Chemother. 2019;74:511–4. https://doi.org/10.1093/jac/dky440.CrossRefPubMed

16.

Li X, Wang L, Yan S, Yang F, Xiang L, Zhu J, et al. Clinical characteristics of 25 death cases with COVID-19: a retrospective review of medical records in a single medical center, Wuhan. China Int J Infect Dis. 2020;94:128–32. https://doi.org/10.1016/j.ijid.2020.03.053.CrossRefPubMed

17.

Saudi Ministry of Health. MOH reports first case of coronavirus infection. https://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2020-03-02-002.aspx. Accessed 15 Jan 2021.

18.

Saudi Ministry of Health. COVID 19 Dashboard: Saudi Arabia. https://covid19.moh.gov.sa/. Accessed 25 Jan 2021.

19.

World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/. Accessed 25 Jan 2021.

20.

Clancy CJ, Nguyen MH. COVID-19, superinfections and antimicrobial development: what can we expect? Clin Infect Dis. 2020;71:2736–43. https://doi.org/10.1093/cid/ciaa524.CrossRefPubMed

21.

Rawson TM, Moore L, Castro-Sanchez E, Charani E, Davies F, Satta G, et al. COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother. 2020;75:1681–4. https://doi.org/10.1093/jac/dkaa194.CrossRefPubMed

22.

Ukuhor HO. The interrelationships between antimicrobial resistance, COVID-19, past, and future pandemics. J Infect Public Health. 2021;14:53–60. https://doi.org/10.1016/j.jiph.2020.10.018.CrossRefPubMed

23.

Saudi Ministry of Health. The operational regulations of the system of pharmaceutical establishments and preparations. https://www.moh.gov.sa/eServices/Licences/Documents/2019-09-25-001.pdf. Accessed 25 Jan 2021.

24.

Bin Abdulhak AA, Altannir MA, Almansor MA, Almohaya MS, Onazi AS, Marei MA, et al. Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: a cross sectional study. BMC Public Health. 2011;11:538. https://doi.org/10.1186/1471-2458-11-538.CrossRefPubMedPubMedCentral

25.

Khojah HMJ, Pallos H, Yoshida N, Akazawa M, Tsuboi H, Kimura K. The quality of medicines in community pharmacies in Riyadh, Saudi Arabia: a lot quality assurance sampling (LQAS)-based survey. Pharmacol Pharm. 2013;4:511–9. https://doi.org/10.4236/pp.2013.47074.CrossRef

26.

Al-Tannir M, Altannir Y, Altannir M, AlFayyad I. Community pharmacy sales of non-prescribed antibiotics in Riyadh, Saudi Arabia: a simulated patient study. Int J Clin Pharm. 2020;42:341–6. https://doi.org/10.1007/s11096-020-01033-0.CrossRefPubMed

27.

Khojah HMJ, Abdelhady HG, Alqurashi AA, Kasem EM, Osailan NS, Alnuman MO, et al. Parental awareness regarding pediatric antibiotic use in Madinah, Saudi Arabia. Trop J Pharm Res. 2020;19:411–9. https://doi.org/10.4314/tjpr.v19i2.25.CrossRef

28.

Khojah HMJ. Community pharmacy services and preparedness during COVID-19 outbreak in Madinah. Saudi Arabia Saudi Pharm J. 2020;28:1402–7. https://doi.org/10.1016/j.jsps.2020.09.004.CrossRefPubMed

29.

Rodríguez Del Águila M, González-Ramírez A. Sample size calculation. Allergol Immunopathol (Madr). 2014;42:485–92. https://doi.org/10.1016/j.aller.2013.03.008.CrossRef

30.

Liu S, Luo P, Tang M, Hu Q, Polidoro JP, Sun S, et al. Providing pharmacy services during the coronavirus pandemic. Int J Clin Pharm. 2020;42:299–304. https://doi.org/10.1007/s11096-020-01017-0.CrossRefPubMed

31.

Khojah HMJ, Abdalla AME. Do community pharmacies in Saudi Arabia provide medication-related information to nonbuyers? A mysterious shopper survey. Pharmacol Pharm. 2019;10:169–76. https://doi.org/10.4236/pp.2019.104015.CrossRef

32.

Al-Talal F. 3261 Saudi pharmacists in the private sector ... 13% localization rate .... Aleqtesadiah Newsp. 2020:3. https://www.aleqt.com/2020/02/17/article_1764521.html Accessed 15 Jan 2021.

Title: Over-the-counter sale of antibiotics during COVID-19 outbreak by community pharmacies in Saudi Arabia: a simulated client study
Author: Hani M. J. Khojah
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Antibiotic
COVID-19
Published in: BMC Health Services Research / Issue 1/2022
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-022-07553-x

2024 ASCO Annual Meeting

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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