Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach.
Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach.
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DOI：
10.1371/journal.pone.0207465
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Chilongola JO
中科院分区：
文献类型：
--
作者：
Horumpende PG;Sonda TB;van Zwetselaar M;Antony ML;Tenu FF;Mwanziva CE;Shao ER;Mshana SE;Mmbaga BT;Chilongola JO
在没有处方的情况下配发抗生素对公众健康构成威胁，因为这会导致过度使用抗生素。不适当地向社区提供抗生素已被证明是出现抗菌素耐药性的驱动因素之一。在低收入和中等收入国家，社区药房是抗生素的来源。我们的目标是评估坦桑尼亚乞力马扎罗莫希市社区药房零售商的抗生素配药做法，并建议改善做法的干预措施。使用模拟客户(SC)方法，于2017年6月10日至7月10日对抗生素配药做法进行了一次观察性横断面调查。使用STATA 13(StataCorp，College Station，TX，USA)进行数据分析。共走访了82家药店。第一部分为26家(31.71%)，第二部分为56家(68.29%)。总体来看，92.3%(95%可信区间77.8~97.6)的零售商在没有处方的情况下发放抗生素。在没有处方的情况下，最常见的抗生素是用于咳嗽(3次)和阿奇霉素(3次)用于止咳的抗生素。口服第三代头孢菌素(头孢克新)在没有处方的情况下，由第一部分药房零售商开了一次，用于排尿疼痛。在21张处方中，有15张(71.43%)的处方被接受并使用了抗菌药物。在68家零售商中，有4家(5.9%)的零售商自愿提供用药说明。没有一家零售商自愿解释药物副作用。在墨氏药店，很高比例的抗生素是在没有处方的情况下销售和分发的。很少给出用药说明，也没有零售商解释副作用。这些发现支持立法执行仅限处方药的抗生素处方规则和条例的必要性。监管机构迫切需要启动临床医生和社区抗生素管理以及药剂师和公众正确使用抗生素的教育计划。
Antibiotic dispensing without a prescription poses a threat to public health as it leads to excessive antibiotic consumption. Inappropriate antibiotic availability to the community has been documented to be amongst drivers of antimicrobial resistance emergence. Community pharmacies are a source of antibiotics in low and middle-income countries (LMICs). We aimed at assessing antibiotic dispensing practices by community pharmacy retailers in Moshi urban, Kilimanjaro, Tanzania and recommend interventions to improve practice. Using a Simulated Client (SC) Method, an observational cross-sectional survey of antibiotic dispensing practices was conducted from 10th June to 10th July 2017. Data analysis was done using Stata 13 (StataCorp, College Station, TX, USA). A total of 82 pharmacies were visited. Part I pharmacies were 26 (31.71%) and 56 (68.29%) were part II. Overall 92.3% (95% CI 77.8–97.6) of retailers dispensed antibiotics without prescriptions. The antibiotics most commonly dispensed without a prescription were ampiclox for cough (3 encounters) and azithromycin for painful urination (3 encounters). An oral third generation cephalosporin (cefixime) was dispensed once for painful urination without prescription by a part I pharmacy retailer. Out of 21, 15(71.43%) prescriptions with incomplete doses were accepted and had antibiotics dispensed. Out of 68, 4(5.9%) retailers gave instructions for medicine use voluntarily. None of the retailers voluntarily explained drug side-effects. In Moshi pharmacies, a high proportion of antibiotics are sold and dispensed without prescriptions. Instructions for medicine use are rarely given and none of the retailers explain side effects. These findings support the need for a legislative enforcement of prescription-only antibiotic dispensing rules and regulations. Initiation of clinician and community antibiotic stewardship and educational programs on proper antibiotic use to both pharmacists and public by the regulatory bodies are highly needed.
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