Community consumption of antibacterial drugs within the Jordanian population: sources, patterns and appropriateness
Introduction
A high percentage of the world's antibiotics are used in the community [1]. Uncontrolled use of these important medications can lead to substantial and serious problems with the emergence and prevalence of resistant microbial strains [2], which is a worldwide problem [3], [4]. Resistance to antimicrobial drugs has been linked to levels of consumption [5], [6], with evidence of a cause–effect relationship [7]. Intervention measures resulting in reduction of antibiotic consumption were found to halt and reverse the rate of emergence of resistant microorganisms [8]. Accordingly, each country must define and implement an antibiotic use policy that aims to reduce inappropriate antibiotic use, reduce antibiotic resistance and improve patient health. Detailed knowledge of antibacterial use and the prevalence of resistant strains is necessary for the definition, development and implementation of such policies [9]. Published data on the volume of community antibacterial consumption, patterns and appropriateness in Jordan are not available. Published studies that address antimicrobial use are limited. Otoom et al. [10] reported the overprescription trend of antibiotics, and another study showed that there is misuse of prescribed antibiotics [11]. No study within the literature has addressed the community use of non-prescribed antimicrobial drugs in Jordan.
Parallel to the lack of data in this area, published studies have shown that many community-acquired infections in Jordan are caused by resistant microorganisms [12], [13], [14]. This study sought to collect data to describe the community use of antibacterial drugs within the Jordanian population.
Section snippets
Settings
The study was carried out in Amman, the capital of Jordan, where ca. 900 community pharmacy stores cater for the city's estimated population of 2 085 100 people. Legally, antimicrobial drugs are designated as prescription only medicines, acquired from community pharmacies. Whilst it is not illegal for individuals to request antibiotics over-the-counter (OTC), the Jordanian Drug and Pharmacy Law establishes that the act of dispensing antimicrobial drugs of any formulation without a prescription is
Dispensed antibacterial drugs: sources and rationale of use
Four hundred and eighty customers were interviewed. Between them, they were dispensed 510 antibacterial drugs that included the eight main classes used for systemic infections as classified by the ATC (J01) classification system (Table 2).
The drugs were dispensed according to prescriptions from general practitioners (GPs) or specialists (53.7%), through self-medication (23.2%) and following pharmacist recommendation (23.1%) (Fig. 2). Of the prescriptions, 55.5% were written by a specialist and
Discussion
The aim of this study was to collect data reflecting the state of antibacterial drug consumption within the Jordanian community. OTC acquisition of antibacterial drugs, prescriptions for antibacterial drugs and guidelines for antibacterial use have an impact on community antibacterial use.
Conclusion
This study reflects on the fact that antibacterial consumption in Jordan is uncontrolled and that there is a great extent of antibacterial drug misuse and abuse. This is in part due to the availability of antimicrobial drugs as OTC drugs despite the regulations that classify them as prescription-only medicines. Antibacterial misuse and abuse were not entirely due to self-medication but also due to prescribing and dispensing mistakes of health professionals.
We recommend the development of a
Acknowledgments
This work was supported by the Deanship of Academic Research, University of Jordan grant number 167/2002–2003. We would like to thank the referee for insightful comments and enlightening suggestions, Dr H. MacLehose (UK) for proofreading and constructive comments, and the pharmacy students who helped in data collection.
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