坦桑尼亚社区药店和认证药品配药点非处方配药治疗尿路感染症状的做法：以模拟患者为方法。
Non-prescribed antibiotic dispensing practices for symptoms of urinary tract infection in community pharmacies and accredited drug dispensing outlets in Tanzania: a simulated clients approach.
机构信息
Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
出版信息
BMC Prim Care. 2022 Nov 19;23(1):287. doi: 10.1186/s12875-022-01905-6.
BACKGROUND
Antibiotic dispensing without prescription is a major determinant of the emergence of Antimicrobial Resistance (AMR) which has impact on population health and cost of healthcare delivery. This study used simulated clients describing UTI like symptoms to explore compliance with regulation, variations in dispensing practices and drug recommendation, and quality of seller-client interaction on the basis of the gender of the client and the type of drug outlets in three regions in Tanzania.
METHOD
A total of 672 Accredited Drug Dispensing Outlets (ADDOs) and community pharmacies were visited by mystery clients (MCs). The study was conducted in three regions of Tanzania namely Kilimanjaro (180, 26.79%), Mbeya (169, 25.15%) and Mwanza (323, 48.07%) in March-May 2020. During data collection, information was captured using epicollect5 software before being analyzed using Stata version 13.
RESULTS
Overall, 89.43% (CI: 86.87-91.55%) of drug sellers recommended antibiotics to clients who described UTI like symptoms but held no prescription and 58.93% were willing to sell less than the minimum recommended course. Female clients were more likely than male to be asked if they were taking other medications (27.2% vs 9.8%), or had seen a doctor (27.8% vs 14.7%), and more likely to be advised to consult a doctor (21.6% vs 9.0%); pharmacies addressed these issues more often than ADDOs (17.7% vs 13.2, 23.9% vs 16.6%, 17.7 vs 10.9% respectively). Sellers recommended 32 different drugs to treat the same set of symptoms, only 7 appear in the Tanzanian Standard Treatment Guidelines as recommended for UTI and 30% were 2nd and 3rd line drugs. ADDO sellers recommended 31 drug types (including 2nd and 3rd line) but had permission to stock only 3 (1st line) drugs. The most commonly suggested antibiotics were Azithromycin (35.4%) and ciprofloxacin (20.5%). Azithromycin was suggested more often in pharmacies (40.8%) than in ADDOs (34.4%) and more often to male clients (36.0%) than female (33.1%).
CONCLUSION
These findings support the need for urgent action to ensure existing regulations are adhered to and to promote the continuing professional development of drug sellers at all outlet levels to ensure compliance with regulation, high quality service and better antibiotic stewardship.
背景
抗生素无需处方即可配给是出现抗微生物药物耐药性（AMR）的主要决定因素，这对人口健康和医疗保健提供的成本有影响。本研究使用模拟客户描述尿路感染样症状，以根据客户的性别和药物销售点类型，探索在坦桑尼亚三个地区的监管合规性、配药做法和药物推荐的差异以及销售者与客户之间的互动质量。
方法
共对 672 家认可的药物配给销售点（ADDO）和社区药店进行了神秘客户（MC）访问。该研究于 2020 年 3 月至 5 月在坦桑尼亚的三个地区进行，即乞力马扎罗（180 个，26.79%）、姆贝亚（169 个，25.15%）和姆万扎（323 个，48.07%）。在数据收集期间，使用 epicollect5 软件捕获信息，然后使用 Stata 版本 13 进行分析。
结果
总体而言，89.43%（置信区间：86.87-91.55%）的药物销售者向描述尿路感染样症状但未持有处方的客户推荐了抗生素，58.93%的销售者愿意销售少于推荐的最短疗程。女性客户比男性客户更有可能被问及是否正在服用其他药物（27.2%比 9.8%）或是否看过医生（27.8%比 14.7%），并且更有可能被建议咨询医生（21.6%比 9.0%）；与 ADDO 相比，药店更经常处理这些问题（17.7%比 13.2%、23.9%比 16.6%、17.7%比 10.9%）。销售者推荐了 32 种不同的药物来治疗同一组症状，只有 7 种药物出现在坦桑尼亚标准治疗指南中，被推荐用于尿路感染，而 30%的药物是二线和三线药物。ADDO 销售者推荐了 31 种药物类型（包括二线和三线药物），但仅被允许储存 3 种（一线药物）。最常建议的抗生素是阿奇霉素（35.4%）和环丙沙星（20.5%）。阿奇霉素在药店（40.8%）比在 ADDO （34.4%）更常被建议使用，并且更常被推荐给男性客户（36.0%）而不是女性（33.1%）。
结论
这些发现支持急需采取行动，确保遵守现行法规，并促进所有销售点各级药物销售者的持续专业发展，以确保法规遵守、高质量服务和更好的抗生素管理。
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