Antibiotics in Egyptian pharmacies

Antibiotics in pharmacy

o Antibiotics : a natural substance produced by a micro-organism to kill another

o Anti infectives/Anti-microbrial : any agent (natural or synthetic) that kills pathogens (microbes)

Quick introduction

Bacteriostatic vs Bactericidal:*Bacteriostati allows for natural immunity to deal with microbe .Antibodies, Phagocytosis etc .

*Bactericidial may lead to release of toxins and microbial contents leading to subsequent illness and inflammatory responses .

Mechanism of Action

Contraindications associated with antibiotics Pregnancy: Penicillins are usually the antibiotics of first

choice. Tetracyclines, trimethoprin, cotrimazole, glycopeptides and aminoglycosides are avoided if possible.

Breastfeeding allows small amounts of antibiotic to pass from mother to infant. Hypersensitivity responses and adverse effects may occur in the infant. Breastfeeding is not advised in some severe infections.

Impaired liver function causes some drugs to accumulate e.g. metronidazole, rifampicin.

Glandular fever (Epstein-Barr virus infection), cytomegalovirus infection greatly increase the risk of developing a penicillin-induced rash.

No antibiotics in case of resent viral infections . No prophylactic antibiotics in case of immuno

compromised patient Tetracycline is panned in patient below 8 years

due to perminant discoloration Of teeth . Quinolones are contraindicated in patients lower

than 16 years due to premature Closure of epiphysis

chloramphenicol is contraindicated in patient below 6 years due to bon marrow

Depression (aplastic anemia ) & grey baby syndrome oral co amoxiclav shouldn’t be used below 9

months to avoid diarrhea .

Drug interactions with antibiotics

Rifampicin and rifabutin render all oral contraceptives ineffective. All broad spectrum antibiotics increase the risk of 'pill failure' for combined oral contraceptives

Macrolides cause accumulation of other drugs e.g. digoxin, corticosteroids, anti-coagulants.

Aminoglycosides intensify the action of muscle relaxants such as suxamethonium. Their use must be highlighted when the patient is transferred to the anaesthetic

Many antibiotics are incompatible with other drugs when co-administered in intravenous infusions. For example, if gentamicin is combined with heparin or a penicillin, its antibiotic activity will be lost.

Antibiotic Dispensing in Egyptian Community Pharmacies

Study

Objective

Methods

Result

Conclusion

• In developing countries like Egypt specially in benisuef (the study area), antibiotics are among the most commonly sold medications and they are frequently misused. This represents a considerable public health problem.

Background

• Antibiotics are often perceived by some as strong‟,almost magical, medicines capable of curing nearly any illness .

• There are high levels of antibiotic use, and resistance may have observed in Egypt.• Antibiotic use is highly influenced by cultures and beliefs

This study aims to describe the pattern of antibiotics dispensing in the Egyptian community .

Methods

A cross-sectional, observational survey of antibiotic dispensing from community pharmacies was conducted in 30 randomly-selected pharmacies in benisuef . Data were collected during one shift at each pharmacy .

The community pharmacists were instructed on how to fill the questionnaires and were asked to report every single antibiotic dispensed in their shifts.

The number of prescriptions which included antibiotics, the quantity and price of antibiotics dispensed per prescription and the reason for prescribing the antibiotic were recorded. And the same with antibiotics dispensed upon patient‟s request or pharmacist‟ recommendation .

Results

Antibiotics Dispensed on Prescription ; In different vallages and in the city : Overall, 400 patients received 736 antibiotics divided between 17 classes of antibiotics. Patients receiving the prescribed antibiotics ranged in age between 6 months and 66 years .Approximately , 27% were aged < 18 years and 43.3% were females. Most of the prescriptions were handed in by the patients themselves who were mostly educated to middle school level or above (88%). The highest proportion of prescriptions was issued by paediatricians and respiratory . Penicillins and quinolones were the two major class of antibiotics dispensed on

prescription . 55% were dispensed by pharmacists and the remainder by technicians without being checked by any pharmacist .

The pharmacist gave further advice on use for only 9% of the dispensed antibiotics.

Antibiotics Dispensed on Pharmacist Recommendation ;

Urinary tract infections (UTI) (18%) , sore throat ( 18%), cold and flu symptoms (24%) ,infected wound (11%) , Asthma (8%), Acne (6%) ,Tooth ache (11% ) and Burning (4%) were the most common conditions .

Penicillins29%

Cephalosporins46%

Macrolides11%

Quinolones14%

Ratio of antibiotics sales

Antibiotics Dispensed on Patient’s Request ;

A total of 192 antibiotics were sold in response to a patient/customer request without any official prescription .

25% were aged < 18 years, 38% were females and 75% were educated to middle school level or above.

The most commonly dispensed class was penicillins followed by cephalosporine antibiotics .

PenicillinsTetracyclineCephalosporinsMacrolidesSulphonamideQuinolonesFusidic acid

Common cases requesting antibiotics are Fever , Sore throat , Tonsillitis , UTI , Toothache and Acne .

Conclusion Examining antibiotic dispensing from Egyptian community pharmacies shows that, antibiotics are frequently misused. To understand the reasons behind such practices, it is important to understand the determinants of self-medication, health-seeking behaviour and physician prescribing practices. The results of this study highlight the urgent need for stronger enforcement of the law and for effective educational programs to improve prescribers' decisions and pharmacists‟ dispensing practices. Raising public awareness of the dangers of antibiotic misuse can help change beliefs and behaviours.

Study on resistance of anti-biotics

Questionnaire Results

1- People think they need antibiotic for cold and flu 75 %

2-Generally I give antibiotic in case of common cold 40 %

3-I give antibiotic in common cold only in secondary bacterial infection 100%

4-Is there specific class of antibiotic you always use ? yes (80% ) No 20% cephalosporins 70% *** penicillins 20% **** macrolides 10%

5-Patient order antibiotics for any disease 60 %

Results

6-Patient always complete the course of antibiotics 55%

7-Patient think that antibiotic is the magic drug for all diseases 80%

8-When I give antibiotic I use broad spectrum antibiotic 75 %

9-I calculate antibiotic dose mainly according to age 80% ****** weight 20%

10-the price of antibiotic affects my chosing of antibiotic 90%

11-The main responsible for resistance in Egypt is the patient 65% **** pharmacist 15% ***** doctor 20%

11-I need culture test for selecting antibiotic befor dispensing 70% No *** 30% Yes

12-Patient follow instructions for using antibiotic 50% yes

13-Prescriptons always contain antibiotics 75 %

14-The Most antibiotic you generally dispense cephalosporines 40% … penicillines 30%....others 30%

15-The most case you dispense antibiotic Respiratory infections 35% - UTI 20% - Skin infections 10% - 35% others