Malik Usman Rashid, Chang Jie, Hashmi Furqan, Atif Naveel, Basir Hareem, Hayat Khezar, Khan Faiz Ullah, Kabba John Alimamy, Lambojon Krizzia, Fang Yu
Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
Infect Drug Resist. 2021 Mar 22;14:1129-1140. doi: 10.2147/IDR.S301812. eCollection 2021.
The excessive consumption of antibiotics is a significant contributor to antimicrobial resistance, especially in children. Children are often advised antibiotics for viral infections. In developing countries, drugstores are a prime source of easy access to nonprescription antibiotics. Moreover, in Pakistan, their irrational use is an "everyday routine". The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics to children.
Using pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan, to explore the antibiotics' ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square ( ) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing.
Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. A qualified pharmacist was available in only 164 (21.2%) cases. Of the 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits, respectively. There were considerable differences (p-value <0.05) in the practices and antibiotics dispensing between each disease scenario presented. Moreover, antibiotics were less commonly dispensed at pharmacist-supervised drugstores compared to unsupervised ones.
Overall, inappropriate dispensing practices were prevalent to a large extent at the drugstores, and antibiotics were effortlessly obtainable without prescription. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delay, especially in major cities to help curb the felonious use of antibiotics.
抗生素的过度使用是导致抗菌药物耐药性的一个重要因素，尤其是在儿童中。儿童经常因病毒感染而被建议使用抗生素。在发展中国家，药店是人们轻松获取非处方抗生素的主要来源。此外，在巴基斯坦，抗生素的不合理使用已是“家常便饭”。因此，本研究旨在评估非处方抗生素向儿童的配药情况。
以小儿急性腹泻和急性上呼吸道感染为疾病场景，于2019年11月1日至2020年1月31日在巴基斯坦拉合尔开展了一项模拟客户横断面研究，以探究两类药店（药房和药店）抗生素的易获取性。采用卡方（）检验比较不同分类变量做法的差异。应用多变量逻辑回归分析各种因素与抗生素配药的关联。
在773次模拟就诊中，有456次（59%）未凭处方就配到了抗生素，其中425次（93.2%）是在药店工作人员的建议下配到的。只有164例（21.2%）有合格的药剂师在场。在386次急性腹泻就诊和387次急性上呼吸道感染就诊中，非处方抗生素配药分别发生在259次（67.1%）和197次（50.9%）就诊中。所呈现的每种疾病场景之间在做法和抗生素配药方面存在显著差异（p值<0.05）。此外，与无监督的药店相比，在有药剂师监督的药店配到抗生素的情况较少见。
总体而言，药店在很大程度上普遍存在不恰当的配药做法，无需处方就能轻松获得抗生素。所提供服务的质量，尤其是非药剂师工作人员提供的服务质量也不尽人意。因此，巴基斯坦药品监管局必须立即在药店严格执行药品法律，尤其是在大城市，以帮助遏制抗生素的不当使用。
