Department of Pharmacology, V P Chest Institute, University of Delhi, Delhi, India.
J Clin Pharm Ther. 2012 Jun;37(3):308-12. doi: 10.1111/j.1365-2710.2011.01293.x. Epub 2011 Aug 23.
The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. In developing countries like India, pharmacists often dispense 'prescription-only' drugs, like antibiotics, to patients who do not have a prescription. Not much data is available regarding detailed information on behaviour of antibiotic use by community pharmacists which is of particular significance to develop a suitable and sustainable intervention programme to promote rational use of antibiotics. A qualitative study was conducted to understand the dispensing practices and behaviour of community pharmacists to develop policy interventions that would improve the use of antibiotics at the community level.
Focus group discussions (FGDs) were held for five municipal wards of Delhi with retail pharmacists, public sector pharmacists and the office bearers of pharmacists' associations. Data on antibiotic use and resistance were collected earlier from these five wards. FGDs (n = 3 with 40 pharmacists) were analysed through grounded theory.
Four broad themes identified were as follows: prescribing and dispensing behaviour; commercial interests; advisory role; and intervention strategies for rational use of antibiotics. FGDs with pharmacists working in the public sector revealed that, besides the factors listed above, overstock and near-expiry, and under-supply of antibiotics promoted antibiotic misuse. Suggestions for interventions from pharmacists were the following: (i) education to increase awareness of rational use and resistance to antibiotics; (ii) involving pharmacists as partners for creating awareness among communities for rational use and resistance to antibiotics; (iii) developing an easy return policy for near-expiry antibiotics in public sector facilities; and (iv) motivating and showing appreciation for community pharmacists who participate in intervention programmes.
Inappropriate antibiotic dispensing and use owing to commercial interests and lack of knowledge about the rational use of antibiotics and antibiotic resistance were the main findings of this in-depth qualitative study. Community pharmacists were willing to participate in educational programme aimed at improving use of antibiotics. Such programmes should be initiated within a multidisciplinary framework including doctors, pharmacists, social scientists, government agencies and non-profit organizations.
社区抗生素使用总量是导致抗生素耐药性的首要原因之一。在印度等发展中国家，药剂师经常向没有处方的患者分发“仅限处方”的药物，如抗生素。关于社区药剂师使用抗生素的行为的详细信息，没有多少数据，这对于制定合适和可持续的干预计划以促进抗生素的合理使用具有特别重要的意义。进行了一项定性研究，以了解社区药剂师的配药行为和行为，以制定政策干预措施，从而改善社区一级抗生素的使用。
对德里的五个市政区进行了焦点小组讨论（FGD），参与者包括零售药剂师、公共部门药剂师和药剂师协会的官员。此前从这五个区收集了有关抗生素使用和耐药性的数据。通过扎根理论对 FGD（n = 3，共 40 名药剂师）进行了分析。
确定了以下四个广泛的主题：处方和配药行为；商业利益；咨询角色；以及合理使用抗生素的干预策略。与公共部门工作的药剂师进行的 FGD 显示，除了上述因素外，库存过多和接近过期以及抗生素供应不足会促进抗生素的滥用。药剂师提出的干预建议如下：（i）教育以提高对抗生素合理使用和耐药性的认识；（ii）让药剂师参与其中，为社区提供有关抗生素合理使用和耐药性的意识；（iii）在公共部门设施中为接近过期的抗生素制定简便的退货政策；（iv）激励并感谢参与干预计划的社区药剂师。
这项深入的定性研究的主要发现是，由于商业利益以及对合理使用抗生素和抗生素耐药性的知识不足，导致抗生素的不当配药和使用。社区药剂师愿意参与旨在改善抗生素使用的教育计划。此类计划应在包括医生、药剂师、社会科学家、政府机构和非营利组织在内的多学科框架内启动。
