Non-compliance with antibiotic therapy for acute community infections: a global survey
A global patient survey of non-compliance with antibiotic therapy for acute community infections included 4514 adult respondents (aged 18-99 years) in 11 countries. Admitted non-compliance (ANC) was reported in 912/4088 (22.3%) of cases but varied widely between countries. Multivariate analysis identified five independent variables associated with ANC: country, daily dosage regimen, age, attitudes to doctors and attitudes to antibiotics. ANC ranged from 44.0% in China to 9.9% in The Netherlands, and from 14.9% in those prescribed once-daily regimens to 27.0% for three or more daily doses. There was a negative correlation between ANC and age. Analysis of the attitudes to doctors confirmed previous findings that involving the patient in the management of their infection can improve overall compliance. The study identified seven key attitudes to antibiotic use with the potential to improve compliance. However, there was a poor understanding in 10 of the 11 countries of how non-compliance can increase the potential for resistance development. Segmentation and cluster analysis identified four psychographic profiles influencing compliant behaviour, which varied across countries. The global picture of antibiotic non-compliance and psychographic profiling should help identify areas for targeted, country-specific patient educational programmes as well as those areas where physicians can improve their interaction with their patients.
Available from: François Angoulvant
- "Finally, options for the difficulty scale were 1, very difficult; 2, rather difficult; 3, rather easy; and 4, very easy. The second assessment was performed 5 to 7 months after the PED visit and served only to evaluate attitudes concerning antibiotic use . Questionnaire reliability was checked in 10 individuals before study initiation. "
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ABSTRACT: To evaluate therapeutic education delivered in a pediatric emergency department to improve parents' satisfaction and attitudes about judicious antibiotic use.
In an emergency department of a tertiary pediatric hospital, children aged 1 month to 6 years and discharged with an oral antibiotic prescription for an acute respiratory or urinary tract infection were randomized to a patient therapeutic education on antibiotic use (intervention group) or fever control (control group) delivered to the parents (in the presence of the children) by a pharmacist trained in therapeutic education. Education consisted in a 30-minute face-to-face session with four components: educational diagnosis, educational contract, education, and evaluation. The main outcome measure was parent satisfaction about information on antibiotics received at the hospital, as assessed by a telephone interview on day 14. The secondary outcome was attitudes about antibiotic use evaluated on day 14 and at month 6.
Of the 300 randomized children, 150 per arm, 259 were evaluated on day 14. Parent satisfaction with information on antibiotics was higher in the intervention group (125/129, 96.9%, versus 108/130, 83.0%; P=0.002, exact Fisher test).
Group parents had higher proportions of correct answers on day 14 to questions on attitudes about judicious antibiotic use than did control-group parents (P=0.017, Mann-Whitney U test).
Therapeutic education delivered by a clinical pharmacist in the pediatric emergency department holds promise for improving the use of antibiotics prescribed to pediatric outpatients.
ClinicalTrials.gov NCT00948779 http://clinicaltrials.gov/show/NCT00948779.
Available from: Proscovia Mukonzo Namuwenge
- "According to Avison, one of the ways to combat antibiotic resistance is simply to develop new drugs.6 Despite the rising need for newer antimicrobial drugs, there has been a several-decades-long gap in new-antibiotic development.7–9 This might be attributed to the likely rapid development of antibiotic resistance, sometimes resulting in loss of resources by pharmaceutical companies, the limited market for antibiotics since bacterial infections diseases are commonest among the poor, and the global restrictions on antibiotic use. "
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ABSTRACT: Overuse and misuse of antibiotics is a serious global problem. While resistance to older antibiotics is increasing, development of newer molecules has stalled. Resistance to the existing antibiotics that is largely driven by their high-volume use is a global public health problem. Uganda is one of the countries where prescription-only drugs, including antibiotics, can be obtained over the counter. We determined the rate of antibiotic dispensing and use in Uganda.
The study utilized a descriptive cross-sectional study design to determine the number of antibiotic "prescribed" daily doses per 1,000 clients. Data were collected from one health center II, eight general/district hospitals, one national referral hospital, and 62 registered community pharmacies. From each study site, data were collected for five consecutive days over the months of November 2011 to January 2012.
The overall antibiotic issue rate was 43.2%. Amoxicillin, metronidazole, ciprofloxacin, sulfamethoxazole-trimethoprim, cloxacillin, and ampicillin, belonging to the WHO anatomical therapeutic chemical classifications of penicillin with extended spectra, imidazole derivatives, fluoroquinolones, and sulfonamide-trimethoprim combinations, constituted 70% of the issued antibiotics. About 41% of antibiotics were issued over the counter. At community pharmacies, where 30% of antibiotic dispensing occurred, the number of prescribed daily doses/1,000 antibiotic clients was 4,169 compared to 6,220, 7,350 and 7,500 at general/district hospitals, the national referral hospital, and the health center, respectively.
In Uganda, at least four in every ten individuals that visit a health-care facility are treated with an antibiotic. Antibiotics are largely given as over-the-counter drugs at community pharmacies. The number of antibiotic prescribed daily doses/1,000 antibiotic clients does not significantly differ between categories of health-care facilities except at community pharmacies, where lower doses are dispensed compared to other health-care facilities.
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