Non-prescription antibiotic dispensing common in Ethiopian pharmacies
A simulated client study in Ethiopia found a high rate of non-prescription antibiotic dispensing at community pharmacies, researchers reported today in the Journal of Antimicrobial Chemotherapy.
For the study, postgraduate and graduate pharmacy students from the University of Gondar were selected to visit community drug retail outlets (CDROs) in the Amhara region of Ethiopia, with a focus on small towns. They visited each CDRO in pairs, with one presenting a pre-prepared clinical case scenario and the other recording the interaction, and they visited each CDRO twice, presenting the case scenario in the first visit and directly requesting antibiotics in the second. The simulated case scenarios were acute childhood diarrhea, acute childhood upper respiratory tract infection, and adult urinary tract infection.
The study had 450 interactions across the two visits. Non-prescribed antibiotics were obtained in 198 of the 225 (88%) clinical case scenario-based visits and in 205 of the 225 (91%) direct antibiotic request visits. Of those CDROs that dispensed antibiotics, 84% provided them at the first level of demand in the clinical case scenario-based visit, and 95% provided them on the first direct antibiotic request. CDRO staff members requested additional information about the patient or the case in 40% of the clinical case scenario-based visits and 30% of the direct antibiotic request visits.
The study authors note that, despite Ethiopia's prescription-only antibiotic dispensing legislation, the rate of non-prescription dispensing found in the study is higher than pooled estimates in sub-Saharan Africa (69%) and a previous simulated patient study conducted in community pharmacies in Addis Adaba, Ethiopia's capital.
"Our findings suggest the need for immediate and sustained measures to address this issue," they wrote. "These could include stricter enforcement of regulations that restrict antibiotics to prescription-only use, imposing heavier penalties for those who contravene the rules, and enhancing regular CDRO supervision."
Oct 10 J Antimicrob Chemother study
Phage therapy clinical trial launches for cystic fibrosis patients
The National Institutes of Health (NIH) announced last week that enrollment has begun on an early-stage clinical trial to evaluate bacteriophage therapy in cystic fibrosis (CF) patients who carry Pseudomonas aeruginosa in their lungs.
The trial will evaluate the safety and microbiologic activity of WRAIR-PAM-CF1, an experimental phage cocktail manufactured by Adaptive Phage Therapeutics of Gaithersburg, Maryland. The cocktail contains four species of bacteriophage—bacteria-killing viruses—that specifically target P aeruginosa, a frequently multidrug-resistant bacterium that colonizes the lungs of CF patients and is the most common cause of CF exacerbations. The hope is that the cocktail will reduce the amount of P aeruginosa in the lungs.
The trial, which will begin as a phase 1b trial and expand to a phase 2 trial, aims to enroll up to 72 adult CF patients, who will receive a single intravenous infusion of the cocktail at three dosage levels. Investigators with the Antibacterial Resistance Leadership Group will assess the safety and microbiologic activity of the cocktail after eight participants have completed each dosage, and that assessment will determine which dosage level will be given in the next stage of the trial. They'll also be looking at how the phages function in the body and how they affect patients' lung activity.
"The prevalence of antibiotic resistance is concerning, and the need for more effective therapeutics for vulnerable populations, such as people with cystic fibrosis, is especially urgent," National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said in an NIH press release. "Although research on bacteriophage therapy may still be in its infancy in the United States, we hope that this study, and others like it, could open the doors to a new type of therapy for difficult-to-treat bacterial infections."
Oct 4 NIH press release
Surveys indicate many French GPs feel pressure to prescribe antibiotics
Telephone surveys of the general public and general practitioners (GPs) revealed that, despite an overall decline in antibiotic use in France over the past decade, more than a third of clinicians report pressure to prescribe antibiotics, researchers reported last week in Antimicrobial Resistance & Infection Control.
To help inform future national awareness campaigns on antimicrobial resistance, researchers with Public Health France conducted two telephone surveys in 2019 and 2020. The first explored antibiotic consumption and knowledge and beliefs about antibiotic resistance among a representative sample of the general public ages 15 years and older. The second explored the evolution of prescribing practices and attitudes toward patient demands for antibiotics among a representative sample of 388 GPs.
In the general public survey, 27% of respondents said they had received antibiotics during the previous 12 months, and 54% of those with a child aged 6 years and under said their child had received an antibiotic during the same period.
In the GP survey, 65% declared they had reduced their antibiotic prescribing over the previous 5 years, and 64% said they did not automatically prescribe antibiotics but advised patients to contact them in 2 or 3 days if symptoms persisted. Among GPs, 33% said they often have patients who insist on having antibiotics, and that elderly patients with comorbidities were among the most demanding. Only 3% of the general public said they put pressure on their GP to prescribe an antibiotic.
The vast majority of respondents in the general public survey expressed trust in their GP regardless of whether they had prescribed them antibiotics (89%) or not (91%). Only half of respondents said they knew antibiotics only act on bacteria, and 38% said they understood exactly what antibiotic resistance is.
A 2020 study by Public Health France found that, from 2009 to 2019, the number of antibiotic prescriptions fell by 18% among all age-groups except the elderly.
The authors say a forthcoming public awareness campaign will take the survey results into account.
Oct 6 Antimicrob Resist Infect Control study
