2. ABSTRACT:
Antibiotics are a medications that destroy or slow down the growth of bacteria. It is also known as
antibacterial or anti-microbial agent. They include a range of effective therapeutic drugs which are used to
treat diseases caused by bacteria.The discovery of antibiotics revolutionized medicine in the 20th
century.Antibiotic resistance occurs when bacteria transform and become able to resist the effects of an
antibiotic. This means that the antibiotic are failed to kill or stop the growth of bacteria. There are many
reasons of antibiotic-resistance.Antibiotics are used to treat various bacterial diseases such as Pneumonia,
scarlet fever, sepsis, typhoid fever, bacterial gastroenteritis, respiratory infections, urogenital infections,
skin and mucous membrane infections, fungal or ENT infections etc.Antibiotics are usually contraindicated
in patients with renal or hepatic disorders, pregnancy, lactation, hypersensitivity, blood dyscrasia, CNS
disorders and chronic alcoholism.
The world is facing continuously a problem of antibiotic resistance which is a possible threat to the ongoing
prevention of different type of infections.A community pharmacy is a healthcare facility that offers
community-based prescription services.. In Nepal, a "community pharmacy" is a specialized term that is
also known as a medical shop, store, or retail pharmacyThe offer of anti-microbials without clinical
solution has been perceived as a significant wellspring of medication abuse and meds danger in Jordan.The
practices of antibioticsapportioning in community drug stores may contribute to unreasonable utilize of
antibiotics. The aim of this study was to gauge the antibiotic dispensing patterns in community pharmacies
of the Eastern DR Congo.
Antibiotics are most usually utilized drugs throughout the world with almost all the countries they are
dispense as a prescription based medicines. But the utilization of antibiotics without any prescription is the
great casual factor of development of antimicrobial resistance.
3. ANTIBIOTICS:
Antibiotics are a medications that destroy or slow down the
growth of bacteria. It is also known as antibacterial or anti-
microbial agent. They include a range of effective therapeutic
drugs which are used to treat diseases caused by bacteria. The
word antibiotic derived from a Greek word which means
“against life.” Any drug or chemical substance which can kill or
inhibit the bacterial growth in your body is called an antibiotic.
Antibiotics are among the most prescribed medication
nowadays and over 100 different antibiotics are available to
treat moderate to severe life threatening infections nowadays.
Today, over 100 different antibiotics are available to cure
minor, and life-threatening infections. Antibiotics cannot treat
infections caused by viruses, such as cold, flu, and coughs etc.
Only bacterial infections can be treated with antibiotics, but
sometimes they are prescribed in viral infections to help
prevent a “secondary bacterial infection.” Secondary infections
occur when an individual is immune-compromised due to an
existing illness. Some antibiotics work on many different kinds
of bacteria and known as “broad-spectrum antibiotics” and
some target specific bacteria only and known as “narrow-
spectrum antibiotics.”
4. DISCOVERY OF ANTIBIOTIC:
The discovery of antibiotics revolutionized medicine in the 20th century. In 1900, infectious
disease was a leading cause of death; The first antibiotic was penicillin, discovered accidentally
from a mould culture. Alexander Fleming, a Scottish researcher, discovered penicillin, the first
natural product antibiotic, in 1928. While performing his experiment, he observed that a mould
had developed accidentally on a contaminated staphylococcus culture plate. Upon examination of
the mould, he noticed that the penicillin was active against streptococcal infection and prevented
the growth of staphylococci. Following this discovery, penicillin started to be used systemically as
an antibiotic.
Since then, the discovery of penicillin changed the course of medicine and has enabled physicians
to treat formerly severe and life-threatening illnesses such as bacterial endocarditis, meningitis,
pneumococcal pneumonia, gonorrhoea and syphilis. Penicillin-based antibiotics, such as
ampicillin, amoxicillin, and penicillin G, are still available to treat a variety of infections and have
been around for a long time.
5. MECHANISM OF ACTION OF ANTIBIOTICS:
Following are the general mechanism of action of antibiotics:
• Inhibit DNA/RNA synthesis
• Inhibition of protein synthesis
• Inhibition of biosynthesis of bacterial cell wall
• By change the permeability of cell membrane of bacteria
6. CLASSIFICATION OF ANTIBIOTICS:
DRUG CLASS MECHANISM OF
ACTION
EXAMPLE OF DRUGS
Sulfonamides Folate synthesis Inhibitors Co-trimoxazole (Bactrim) and
trimethoprim (Proloprim)
Macrolides Protein synthesis Inhibitor Erythromycin (E-Mycin),
clarithromycin (Biaxin), and
azithromycin (Zithromax)
Tetracycline Protein synthesis Inhibitors Tetracycline (Sumycin,
Panmycin) and doxycycline
(Vibramycin)
Fluoroquinolones DNA gyrase and Topo isomerase
Inhibitors
Ciprofolxacin (Cipro),
levofloxacin (Levaquin), and
ofloxacin (Floxin)
Beta Lactam Cell wall synthesis Inhibitors Penicillin derivatives,
cephalosporins, monobactams,
carbapenems and carbacephems
Amino glycoside Protein synthesis Inhibitor Gentamicin (Garamycin) and
tobramycin (Tobrex)
7. ANTIBIOTIC RESISTANCE:
Antibiotic resistance occurs when bacteria transform and become able to resist the effects of
an antibiotic. This means that the antibiotic are failed to kill or stop the growth of bacteria.
There are many reasons of antibiotic-resistance. Mostly overuse and misuse of antibiotics has
led to antibacterial resistance. Bacteria modified over time and become “super bacteria”.
Usually this situation is life threatening in most cases, because antibiotic which are used to
treat bacterial disease, are not able to kill bacteria because they change itself and antibiotic are
no longer work on them. Antibiotic-resistant bacterial infections are very dangerous and
increase the risk of death.
ADVERSE EFFECTS:
The side effects of antibiotics range from minor to severe. Some of the common side effects
include
• Nausea and vomiting
• Diarrhea
• Yeast infections
• Loss of appetite
• abdominal cramps
• Severe or life threatening allergic reaction (shortness of breath, hives, swelling of lips,
face, or tongue, fainting)
• White patches on the tongue
8. INDICATIONS:
Antibiotics are used to treat various bacterial diseases such as Pneumonia,
scarlet fever, sepsis, typhoid fever, bacterial gastroenteritis, respiratory
infections, urinogenital infections, skin and mucous membrane infections,
fungal or ENT infections etc.
CONTRAINDICATIONS:
Antibiotics are usually contraindicated in patients with renal or hepatic
disorders, pregnancy, lactation, hypersensitivity, blood dyscrasia, CNS
disorders and chronic alcoholism.
9. EVALUATION OF ANTIBIOTIC DISPENSING
PRACTISE IN PHARMACIES OF PAKISTAN:
The world is facing continuously a problem of antibiotic resistance which is a possible threat to
the ongoing prevention of different type of infections.
There are many reasons behind the antibiotic resistance but the vital among them is the multiple
antibiotic use. WHO (World Health Organization) has also seated the inappropriate use of
antibiotics as the main cause of increased antibacterial resistance. The WHO global strategy has
clearly stated the appropriate use of antibiotics as “The effective-use of anti-microbials in such a
way that maximizes the therapeutic effects and decreasing the drug-related toxicity”. Hence it
explains the unrequired use of antibiotics to treat such conditions including incorrect drug doses
and improper durations/timings.
Antibiotics are primarily dispensed medication from pharmacies which are prescribed mostly for
inappropriate indications. It is highly increasing in developing countries because of the fact that
most of these antibiotics are usually purchased from drug outlets and pharmacies without a
prescription thus breaking the laws and regulations related to limited accession to these drugs.
Most of the studies revealed that pharmacies are the main dispensing source of non-prescribed
antibiotics.
Antibiotics are used after the prescribed medication in Pakistan and cannot be sold as over the
counter medication but lack of awareness in public, expensive health care centres and extensive
markets of medicines.
10. ASSESMENT OF COMMUNITY PHARMACY
REGARDING DISPENSING PRACTICES OF
ANTIBIOTICS IN NEPAL:
A community pharmacy is a healthcare facility that offers community-based
prescription services. In Nepal, a "community pharmacy" is a specialized term that is
also known as a medical shop, store, or retail pharmacy.
The majority of people in developing countries like Nepal live in rural areas with
minimal access to healthcare. The position of pharmacists as practitioners is not well
known. Furthermore, many people think of community pharmacists as chemists or
druggists.Consumers respond equally when buying medication from drug outlets as
they would when purchasing food or other general goods from a grocery store. As a
result, community pharmacies have been the primary destination for those pursuing
general healthcare. Furthermore, consultation is more convenient and less costly. Non-
professionals, i.e., non-pharmacists, who run community pharmacies, particularly in
rural areas, are the issue.
Antibiotics are commonly prescribed and used in the treatment of infections. It's
important to make correct illness diagnosis and choose antibiotics wisely. The
development of antibiotic-resistant bacterial strains, which complicate treatment even
more, is a major complication of uncontrolled antibiotic use.
11. CONTINUED…
Certain infectious diseases, such as viral rhinitis, are self-limiting and thus do not
require antibiotic treatment. Antibiotics, likewise, are ineffective in treating diarrhoea
caused by viral infections.There are no strict rules or protocols on the rational usage of
antibiotics in developing countries, which also leads to overuse or unnecessary use of
them.
The National Antibiotic Treatment Guidelines 2014 were established by Nepal's
government. However, putting these recommendations into action continues to be
difficult. Thus, the extent of irrational antibiotic usage in Nepal is easily discernible.
In the results it was seen that Twenty-five percent of the 161 community pharmacies
were not licensed, and the majority were in rural areas. Dispensing antibiotics without a
prescription was common (66.5%), and non-pharmacists made up the majority (91.4%)
of the dispensing workers.In addition, the study found that switching one type of
antibiotic with another (66 percent), dispensing insufficient courses of antibiotics (73
percent), and not providing any guidance on antibiotic use (39 percent) or completion
of a full course of therapy (39 percent) are all popular practices (80 percent).
In terms of Good Pharmacy Practice, community hospitals were in a bad spot. While a
number of reasons lead to widespread irrational antibiotic dispensing, a critical cause is
a shortage of properly qualified staff such as pharmacists. As a result, it is critical to
resolve these concerns and encourage the appropriate use of antibiotics in the
environment. The Nepalese government and relevant authorities should implement
rigid strategies to track dispensing activities in pharmacies and take appropriate action.
12. EVALUATION OF ANTIBIOTIC DISPENSING
PRACTICE IN JORDAN:
The offer of anti-microbials without clinical solution has been perceived as a significant wellspring of
medication abuse and meds danger in Jordan. This training Constitutes one of the significant reason
for the continuous issue of anti-microbial opposition. This examination gives a drug specialist point of
view on the issue through introducing the most well-known anti-toxins apportioned, the connected
signs and drug specialist proposed answer for this issue in the city of Amman, Jordan. This was
accomplished by methods for an organized poll arranged by the examiners and finished by the drug
specialist themselves. It was proposed that the issue at the hand can be defeated through the
authorization of law to control such practice. Additionally expanding mindfulness among patients and
drug specialist and engaging drug specialist to assume more dynamic part in patients care are
significant advances that will contribute in limiting this training.
Giving drug care is one of the essential errand a clinical drug specialist ought to give to his patients. It
is characterized as a patient centred results situated drug store practice that require the drug specialist
to chip away at show with the patients and the patients other medical services suppliers to elevate
wellbeing to forestall sickness and to screen and change prescription use to guarantee that drug
treatment regimens applied are protected and powerful.
Self- prescription is characterized as the choice and utilization of drugs by individual to treat self -
perceived ailment or indications. These prescription ought to be utilized to treat self-perceived
conditions either persistent or intermittent after starting conclusion and should be intended for this
reason.
13. CONTINUED…
The act of self drug can bring about self -damage particularly while considering a class of
medicine like anti-infection agents where there use require proficient determination, dosing
change and treatment follow up utilizing such medicine straightforwardly without legitimate
medicine by a doctor opens patients to superfluous danger and conceivable anti-infection
opposition. The abuse and maltreatment of anti-infection has lamentably fundamentally added to
the presence of anti-toxin safe microorganism. This has prompted a more prominent recurrence of
remedial disappointment and pointlessly more muddled treatment regimens.
Wide range Antibacterial specialists including ciprofloxacin, levofloxacin, amoxicillin and
piperacillin, tazobactum were among the restorative classifications with the most elevated
medication consumptions as per the National Institute of Health Care Management, USA.
A few investigations have been led to assess the recurrence of self- drug and anti-microbial
apportioning without solution among various populaces. Where a few investigations for the most
part centred around the patients viewpoint others evaluated the act of medical care suppliers in the
clinic settings or locally drug store setting.
Likewise an examination directed I'm Jordan and Syria investigated the impression of medical
services suppliers in regards to the issues and reasons for the irritational utilization of medications
in this district overall showed unnecessary utilization of anti-microbial and outlandish utilization
of anti-infection agents to treat minor upper respiratory plot contamination.
14. CONTINUED…
In Jordan two investigations showed a nearby assessment for apportioning Antibiotics without solution
among the Jordanian populace. The point of this examination was to explore the normal acts of
administering. Anti-toxin without remedy in local area drug stores in Amman Jordan. All the more
explicitly this examination was directed in eastern Amman where these practices have for quite some
time been noticed. The investigation zeroed in on the drug specialist point of view of this practices and
their ideas to control the apportioning of non- recommended Antibiotic in the Jordanian drug market.
A survey was readied and arbitrarily appropriated to very notable drug stores in eastern Amman. These
inquiries replied by drug specialist rehearsing locally drug stores. The eastern Amman zone was picked
on account of the financial status of the populace living.
The inquiries partially two of the survey meant to assess drug specialist clinical practice while
administering Antibiotics without remedy and whether they gathered the main data in regards to
patients conditions prior to apportioning Antibiotic.
The survey was tried by the specialists and five distinctive rehearsing local area drug specialist, no
progressions were needed to be finished.
The poll uncovered that of the talked with drug specialist administer. Anti-infection without solution at
a recurrence of them administer. Just two drug specialist out of the 54 drug specialist meet announced
not administering Antibiotics without a solution. While considering the kinds of anti-infection
apportioned for paediatric patients of anti-microbial administered by drug specialist contained
amoxicillin. Azithromycin came next.
15. ASSESMENT OF ANTIBIOTICS DISPENSING
PRACTICES IN CONGO:
The practices of antibiotics apportioning in community drug stores may contribute to unreasonable
utilize of antibiotics. The aim of this study was to gauge the antibiotic dispensing patterns in
community pharmacies of the Eastern DRCongo.
For many years, antibiotics have played an important role in reducing death rate thanks to bacterial
infections within the world. The invention of penicillin within the early 20th century was followed
by the event of latest antibiotics belonging principally to cephalosporin, aminoglycoside, phenicol,
polymyxine, macrolide, cycline, sulfonamide, glycopeptide, quinolone and lipo-peptide groups.
Unfortunately, the planet is facing with a life-threatening multi-drug resistance, particularly in low
and middle income countries (LMIC). It's estimated at about 700, 000 deaths annually thanks to an
antimicrobial resistance and if no action is taken, the amount is predicted to extend quite tenfold by
2050. Although resistance to current drug therapies is emerging rapidly, there are few new antibiotics
in development against resistant bacteria. In 2015, the planet Health Organization (WHO) launched a
worldwide action plan for antimicrobial resistance. Democratic Republic of Congo (DRC), with the
support of WHO, has adopted a strategic action plan 2018-2022 to combat an emergence of
antimicrobial resistance.
16. CONTINUED…
Over-prescription and self-medication are common sorts of antibiotic misuses resulting in
antimicrobial resistance. Self-medication is extremely common in Sub Saharan Africa countries and
antibiotic dispensing practices may contribute to self-medication. Consistent with the US 2016 Centres
for Disease Control and Prevention report, a minimum of 30% of antibiotics prescribed in outpatient
settings are unnecessary. The diagnosis resulting in the foremost frequent inappropriate prescribing or
dispensing of antibiotics is globally acute tract infections. African specialists were as of late cautioned
around the unseemly co-administration of anti-microbials (Azithromycin) to treat viral tract diseases
like flu sort respiratory diseases.
In western countries, antibiotic dispensing without prescription is extremely scarce whereas in low and
middle income countries, this is often of particular concern. It's estimated that quite 50% of antibiotics
worldwide are purchased without prescription from pharmacies or street vendors within the informal
sector. In LMIC, dispensing drugs without prescription are often facilitated by inadequate pharmacy
regulation and economic problems. In fact, many pharmacies are operating with none license or legal
authorization. Consequently, there's a simple affordability of broad-spectrum antibiotics in retail
pharmacies. It's recognized to pharmacist because the only trained dispenser in selecting appropriate
drug therapy, solving and preventing problems associated with patient medications. In developing
countries, the ratios pharmacists and pharmacies to population are low in order that he is often helped
by a pharmacy technician. Unfortunately, access to a far better pharmaceutical care is impeded by the
large presence of no trained healthcare workers. This study aimed to gauge the extent of antibiotic
dispensing in community pharmacy settings of Bukavu city. To the simplest of our knowledge, data
about the antibiotic dispensing practices are either poorly documented or very scarce within the Eastern
a part of Democratic Republic of the Congo.
17. CONTINUED…
Infectious diseases are main causes of deaths in low and middle income countries and antibiotics
are very useful in fighting against bacterial infections. The efficacy of antibiotics depends partly
on its rational use in clinical also as pharmacy settings. This study shows the poor quality of
antibiotic dispensing in community pharmacies of the Eastern DRCongo. Community pharmacies
are the principal point of antibiotic access in Bukavu city. As shown during this study, most of the
pharmacy workers consisted of pharmacy technicians and non-trained dispensers. Pharmacists
represented only 10% of all dispensers. A study administered in Eritrea reported that dispensers
were essentially made from 35.9% community pharmacists, 41.8% pharmacy technicians and
22.3% others. In Sub Saharan Africa, the ratios pharmacist and community pharmacies to
population are found very low. It had been reported a mean of 6 pharmacists per 10,000
population during a total of 89 WHO countries .In Nigeria, pharmacists ‘density was estimated at
about 0.39 per 10,000 population . Due to the occurrence of antibiotic resistance, antibiotics are
medications which are dispensed on prescription only. Unfortunately, in dispensing practices
observed in community pharmacies of Bukavu, 67.8% of subjects purchased antibiotics without
prescription. The degree of apportioning anti-microbials without medicine was evaluated at
around 87.6% in Eritrea.
In contrast, it had been reported low levels of antibiotic dispensing without prescription in Kenya,
with over 90% of antibiotics dispensed with a legitimate prescription. This was explained by the
presence of well-trained personnel in community pharmacies. Antibiotic dispensing without
prescription may be a matter of concern since it's going to cause self-medication within the
population. In Sub Saharan Africa, the prevalence of self-medication is different between
countries, starting from 30% to 95%. Factors like age, income, education level, occupation and
straightforward access to pharmacies were related to self-medication.
18. CONTINUED…
A study in north Kivu, eastern of DRCongo, reported that 90.7% of scholars self-medicated to
antibiotics, with community pharmacies because the commonest source of antibiotic self-medication.
Our findings show that antibiotics dispensed without prescription were principally on patients’ request
or on the suggestion of dispensers. Besides, the antibiotic substitutions are quite common in pharmacy
settings. Consequently, dispensers aren't valued as healthcare providers since they can't adequately
solve or prevent problems associated with patient medications.
A study administered in Tanzania reported that in subjects purchasing antibiotic without prescriptions,
instructions for medicine use was rarely given and none of the dispensers explained side effects. We
found that a lot of antibiotic classes dispensed without prescriptions belonged to the broad spectrum
pharmacological classes, with betalactamines (penicillins, cephalosporins), quinolones and macrolides
the foremost important classes utilized in different pathological conditions. The observed misuse or
overuse of antibiotics in single or combinations may contribute to antibiotic resistance. it had been
reported a better prevalence of multidrug-resistance among self-medicated healthy adults.The profile
of anti-microbial resistance detailed in Bukavu city is reliable with the anti-microbial abuse found
within the show ponder. In truth, uropathogens such as E. coli, Klebsiella were found safe to
antimicrobial drugs (Ciprofloxacin, third era cephalosporin) utilized for urinary tract diseases in
Bukavu. Moreover, tall rates of resistance to Cotrimoxazole, erythromycin and direct to tall resistance
to Ciprofloxacin, Cefuroxime were watched among Gram-negative microbes separated from patients
with blood stream diseases in SouthKivu.
Anti-microbial apportioning practice may be a major wellbeing concern in community drug stores of
Bukavu. Considering the need of qualified dispensers, there's an urgent require for reinforcing the drug
store enactment and direction within the Eastern Majority rule Republic of Congo. As the practice of
dispensing may contribute to self-medication and antibiotic resistance, components related with self-
medication as well as the observing of antibiotic resistance need to be assed in Bukavu city.
19. ANTIBIOTICS DESPENSING PRACTICE IN
MOZAMBIQUE:
Antibiotics are most usually utilized drugs throughout the world with almost all the countries they are
dispense as a prescription based medicines. But the utilization of antibiotics without any prescription is
the great casual factor of development of antimicrobial resistance.
So these studies aimed to antibiotics dispensing in Maputo city of Mozambique where qualitative
analysis was conducted in 2019 between 9 pharmacists which were selected randomly across the city
Maputo Mozambique. Where pharmacists admitted to sale non prescribes antibiotics drugs .as usual
common practice of dispensing antibiotics is without the prescription of physician , without asking from
the patient to brief history of his medical condition ,without advising the patient for the proper guidance
of administering drugs routes ,without telling him about the side effects of antibiotics .
The reason which are associated to dispense non prescribed antibiotics are connected to patient’s
behavioural demanding as patients have believe to take antibiotics are good to heal them and they don’t
need any prescription.
Some other reasons as the owners of pharmacies demand profit, absence of accountability consequences,
and fragile law enforcement.
So here the dispensing of non -prescribed antibiotics in daily life characterize the role of pharmacists as
pharmacists are aware of the legal status of antibiotics and the public health consequences that he has the
right and ethical responsibility to upholding the law to not dispense un appropriate antibiotics to the
patients who are not aware from the side effects and resistance development of antibiotics.
In highlighting this article in Mozambique pharmacist dispense the non- prescribed antibiotics to the
patients carefully with ethical guidelines because pharmacist has the responsibility to play a responsible
role in health care society and aware the patients about their side effects and resistant development.
20. CONCLUSION:
As we know that antibiotic resistance is a process which naturally occurs at low rate. However,
inappropriate usage of antibiotics results in the surfacing and spread of the process. To treat viral
infections, negligent usage of the wrong drug, duration or improper dosage the inappropriate
usage covers the usage of antibiotics. The resistance happens due to specific pressure applied on
microbial communities driving to the determination of resistant strains.
Community pharmacies in Jordan constitute to a significant proportion of dispensing antibiotics
without prescription. Furthermore, many antibiotics are inappropriately administered in terms of
choice, dose, or duration. This results in the evolution of different drug resistant microbes. The
lack of implemented laws in Jordan is promoting pharmacists to transgress the regulations that
govern the acceptable and cautious dispensing of antibiotics. In addition, it is vital to implement
continuous education programs to medical practitioners to keep them updated about the latest
condition of antibiotic resistance and the most appropriate use of antibiotics.
In eastern Nepal, a significant amount of improvement is needed in educating community
pharmacists about the distribution of antibiotics. Degree of understanding of some aspects of
antibiotic dispensing is seemed to be influenced by age, work experience and qualifications.
A survey was conducted on a cross-section of 312 pharmacists operating in community
pharmacies in three eastern districts of Nepal using self-administered questionnaires. Descriptive
Statistical Analysis was used to analyse participants ’ attributes and their knowledge of how
antibiotics are to be dispensed. For the determination of relationships between their knowledge
of antibiotic dispensing and their characteristic attributes Chi-square was used.
