Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study

It is well known that the emergence of antibiotic resistance is linked to the misuse and overuse of antibiotics. Misuse includes self-medication and the inappropriate use of antibiotics because of improper dosage or improper duration than recommended. This study investigated three patterns of dispensing antibiotics in a sample of community pharmacies in Jordan. This included dispensing antibiotics by prescription or over-the-counter either by direct request or upon a pharmacist’s recommendation. The antibiotics dispensed were evaluated in terms of indication, appropriateness of dose, and duration of treatment based on the empirical treatment suggested by selected references: Lexicomp (2017) and UptoDate (2017) and the manufacturer’s recommendations. Of the 457 antibiotics dispensed, almost one third were without prescription. Of the antibiotics dispensed with prescription or without prescription, 31.5% and 24.6% respectively were appropriate dosage and duration (p = 0.002). In the three patterns of dispensing, beta lactam antibiotics were the most commonly dispensed. In addition, it was noticed that there was a tendency to prescribe or dispense higher generations of antibiotics to cases that could have been treated with lower generation or safer antibiotics. Furthermore, 12.2% of the antibiotics were dispensed to treat infections that are not indicated for them. In conclusion, a significant proportion of antibiotics are dispensed without prescription in Jordan. Moreover, a considerable proportion of prescribed antibiotics were inappropriate for the conditions concerned. This indicates the importance of enforcing the Jordanian regulations prohibiting the dispensing of nonprescription antibiotics and the implementation of continuous education to physicians and pharmacists to increase awareness about the emergence of antibiotic resistance.众所周知，抗生素耐药性的出现与抗生素的误用及过度使用息息相关。抗生素误用涵盖自我用药，以及因剂量不当或疗程未符合推荐标准而引发的不合理用药行为。 本研究针对约旦社区药房样本中的三类抗生素配发模式展开调研，具体包括凭处方配发、以及根据患者直接诉求或药师推荐按非处方方式配发抗生素。 本研究依据Lexicomp（2017）、UptoDate（2017）两部权威参考资料及制造商的推荐方案，从适应症、剂量合理性及疗程合理性三个维度对所配发的抗生素进行评估。 在共计457例配发的抗生素中，近三分之一未凭处方配发。在凭处方配发与非处方配发的抗生素样本中，剂量与疗程均符合要求的比例分别为31.5%与24.6%（p = 0.002）。 在三类配发模式中，β-内酰胺类抗生素（beta lactam antibiotics）为最常配发的品类。此外，研究观察到存在为本可使用低代或更安全抗生素治疗的患者开具或配发更高代次抗生素的倾向。另有12.2%的抗生素被用于并无对应适应症的感染治疗。 综上，约旦境内有相当比例的抗生素未凭处方配发。此外，大量凭处方配发的抗生素与患者病症适配性不佳。这提示需严格落实约旦禁止非处方配发抗生素的相关法规，并对医师与药师开展持续教育培训，以提升其对抗生素耐药性产生机制的认知水平。