尼泊尔加德满都的药剂师对不合理使用抗菌药物的看法。
Perspectives of pharmacy employees on an inappropriate use of antimicrobials in Kathmandu, Nepal.
机构信息
Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal.
Nuffield Department of Medicine, Medical Sciences Division, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.
出版信息
PLoS One. 2023 May 3;18(5):e0285287. doi: 10.1371/journal.pone.0285287. eCollection 2023.
BACKGROUND
Unregulated antimicrobial use is common in both hospital and community settings of low- and middle-income countries (LMICs). However, discrete data regarding the use/misuse of antimicrobials at pharmacies in LMICs are limited. This study was conducted to understand knowledge, attitude, and practice of pharmacy employees on antimicrobial dispensing in Nepal.
METHODS
We conducted a cross-sectional survey using a structured questionnaire on 801 pharmacy employees working in community and hospital pharmacies located in Lalitpur metropolitan city (LMC) of Kathmandu, Nepal between April 2017 and March 2019.
RESULTS
A majority (92%) of respondents agreed that demand for non-prescription antimicrobials was common. Asking for prescription before dispensing was ranked as the first preference by majority (69%) of participants. Suspected respiratory tract infection was the most common reason demanding for non-prescription antimicrobials with the highest mean rank of 1.5. Azithromycin was the most commonly prescribed and sold antimicrobial, as reported by 46% and 48% of participants respectively. A majority (87%) of respondents agreed on antimicrobial resistance (AMR) to be a global public health threat; and misuse/overuse of antimicrobials was perceived as the most common cause of AMR with a mean rank of 1.93.
CONCLUSION
Our study revealed that unfounded dispensing and use of antimicrobials is prevalent among pharmacies in Kathmandu, Nepal. This over reliance on antimicrobials, notably azithromycin, may escalate burden of AMR. We identified several drivers of inappropriate antimicrobial dispensing practice in pharmacies, which will aid public health authorities in addressing these issues. Further studies considering role of other stakeholders, such as doctors, veterinarians, general public, and policy makers are required to obtain a more holistic perspectives on practices of antimicrobial use so to curb the extant AMR crisis.
背景
在中低收入国家（LMICs）的医院和社区环境中，抗生素的不规范使用都很常见。然而，关于 LMIC 中药房使用/滥用抗生素的具体数据有限。本研究旨在了解尼泊尔药房员工对抗生素配药的知识、态度和实践。
方法
我们于 2017 年 4 月至 2019 年 3 月期间，在尼泊尔加德满都的 Lalitpur 大都市地区，对 801 名在社区和医院药房工作的药房员工进行了一项横断面调查，使用结构化问卷。
结果
大多数（92%）受访者认为非处方抗生素的需求很普遍。大多数（69%）参与者认为在配药前询问处方是首选。疑似呼吸道感染是要求非处方抗生素的最常见原因，需求程度的平均排名为 1.5。阿奇霉素是最常被处方和销售的抗生素，分别有 46%和 48%的参与者报告。大多数（87%）受访者认为抗生素耐药性（AMR）是对全球公共卫生的威胁；并认为抗生素的滥用/过度使用是 AMR 的最常见原因，其平均排名为 1.93。
结论
我们的研究表明，在尼泊尔加德满都的药房中，存在不合理的抗生素配药和使用现象。这种对抗生素的过度依赖，尤其是阿奇霉素，可能会加剧 AMR 的负担。我们确定了药房中导致不适当抗生素配药实践的几个驱动因素，这将有助于公共卫生当局解决这些问题。需要进一步研究考虑其他利益相关者的作用，如医生、兽医、普通公众和政策制定者，以更全面地了解抗生素使用实践，从而遏制现有的 AMR 危机。
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