Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.
Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
Front Public Health. 2023 Mar 9;11:983997. doi: 10.3389/fpubh.2023.983997. eCollection 2023.
The emergence of MDR-TB is a global threat and an obstacle to the effective control of TB in Pakistan. A lack of proper TB knowledge among the staff in private pharmacies and the sale of compromised quality anti-TB drugs are the main instigators of multidrug-resistant tuberculosis (MDR-TB). Thus, this study was aimed at investigating the quality and storage conditions of fixed-dose combination (FDC) anti-TB drugs along with the awareness of staff working in private pharmacies regarding the identification of potential patients with TB and dispensing the inappropriate treatment regimens contributing to MDR-TB.
The study is completed in two phases. In phase I a cross-sectional study is performed using two quantitative research designs, i.e., exploratory and descriptive, to evaluate the knowledge of private pharmacy staff. The sample of 218 pharmacies was selected. While in phase II cross sectional survey is conducted in 10 facilities from where FDC anti TB drugs were sampled for analyzing their quality.
Results revealed the presence of pharmacists only at 11.5% of pharmacies. Approximately 81% of staff at pharmacies had no awareness of MDR-TB, while 89% of pharmacies had no TB-related informative materials. The staff identified that most of the patients with TB (70%) were of poor socio-economic class, which restricted their purchase of four FDCs only up to 2-3 months. Only 23% were acquainted with the Pakistan National TB Program (NTP). Except for MDR-TB, the results showed a significant correlation between the experiences of staff with TB awareness. Findings from the quality evaluation of four FDC-TB drugs indicated that the dissolution and content assay of rifampicin were not according to the specifications, and overall, 30% of samples failed to comply with specifications. However, the other quality attributes were within the limits.
In light of the data, it can be concluded that private pharmacies could be crucial to the effective management of NTP through the timely identification of patients with TB, appropriate disease and therapy-related education and counseling, and proper storage and stock maintenance.
耐多药结核病（MDR-TB）的出现是一个全球性威胁，也是巴基斯坦有效控制结核病的障碍。私营药店工作人员缺乏适当的结核病知识，以及销售质量受损的抗结核药物是导致耐多药结核病（MDR-TB）的主要原因。因此，本研究旨在调查固定剂量组合（FDC）抗结核药物的质量和储存条件，以及私营药店工作人员对潜在结核病患者的识别能力和开具不适当治疗方案导致 MDR-TB 的认识。
该研究分为两个阶段完成。在第一阶段，采用两种定量研究设计，即探索性和描述性设计，进行了一项横断面研究，以评估私营药店工作人员的知识。共选择了 218 家药店作为样本。在第二阶段，对 10 家从这些药店购买 FDC 抗结核药物的机构进行了横断面调查，以分析其质量。
结果显示，只有 11.5%的药店有药剂师。大约 81%的药店工作人员不了解耐多药结核病，而 89%的药店没有与结核病相关的信息材料。工作人员发现，大多数结核病患者（70%）来自贫困的社会经济阶层，这限制了他们购买四种 FDC 的数量，只能购买 2-3 个月。只有 23%的人了解巴基斯坦国家结核病规划（NTP）。除了耐多药结核病，工作人员对结核病意识的经验之间还存在显著相关性。对四种 FDC-TB 药物的质量评估结果表明，利福平的溶出度和含量测定不符合规格，总体上有 30%的样品不符合规格。然而，其他质量特性都在允许范围内。
根据这些数据，可以得出结论，私营药店可以通过及时发现结核病患者、提供适当的疾病和治疗相关教育和咨询、以及妥善储存和库存管理，对抗结核规划的有效管理起到至关重要的作用。
