Community Pharmacists' Responses Toward Antimicrobial Prescriptions in Jordan: A Cross-Sectional Survey

Abstract

Background: Globally, community pharmacists worldwide have prescribed more over-the-counter systemic antibiotics, posing significant issues for international organizations tackling antibiotic-resistant bacteria, a major global threat, due to the accessibility in pharmacies. Objectives: This study aimed to examine the Jordanian pharmacists' antibiotic selection and over-the-counter antibiotic prescriptions. Methods: A total of 244 community pharmacists participated in an online standardized survey, which examined five essential domains including sources and trust of pharmacy antibiotic prescription information, category and frequency of permitted antimicrobials, prescription-free antimicrobials, interactions, antimicrobial prescription issues for pharmacists, and pharmacy staff's knowledge of non-prescription antimicrobial questions and answers. Results: This study found that 1-pharmacists are confident in prescribing antibiotics and they use various tools to improve their skills. 2-Antibiotics were the most sought antimicrobials without a prescription, followed by antifungals and antivirals. 3-Throat, urinary tract, chest, and otitis media are the most common infections that require antibiotics. Pharmacists prescribe penicillin for 75% of throat infections, Fluoroquinolones for 48.2% of urinary tract infections, and cephalosporins for 35.9%. Macrolides are the most prevalent otitis media treatment (43.2%). 4-Some people obtain antimicrobial prescriptions without a valid reason or diagnosis. 5-Many pharmacists (171/244, 70%) agree or strongly believe that antibiotic prescription information is difficult to obtain. 6-Many pharmacists (183/200, 91.5%) aimed to educate patients on the risks and correct use of antimicrobials without prescriptions. Conclusions: These results show that Jordanian community pharmacists follow clinical antibiotic prescribing guidelines and conduct antimicrobial stewardship, yet they demand antimicrobials without prescriptions and lack decision support tools. Antibiotic classes address most diseases, and pharmacists emphasize antimicrobial misuse.

Keywords: antibiotics; antimicrobial use; antimicrobials; cross-sectional survey; pharmacist.

Figure 1

Confidence of prescribing antimicrobials. Figure illustrates level of confidence among pharmacists regarding prescription of antimicrobials. Total number of responses was 244, with 53 expressing “highly agree”, 106 “agree”, 72 “neutral”, 11 “disagree”, and 2 “highly disagreeing”. Question posed was, “I feel confident to assess the appropriateness of antimicrobial prescriptions”.

Figure 2

Resources assist in prescription of antimicrobials. Various resources were employed to aid pharmacists in making decisions regarding prescription of antimicrobials. Figure illustrates prevalence of use of these resources among pharmacists in Jordan. Question posed was, “What resources or tools do you find helpful in supporting your decision-making process for antimicrobial prescriptions? (Select all that apply)”.

Figure 3

Types of antimicrobials requested without prescription. Pharmacists’ responses to patients’ requests for antimicrobials without prescription. Query was, “What types of antimicrobials are most frequently requested without a prescription? (Select all that apply)”.

Figure 4

Pharmacists’ responses regarding prescribing antimicrobials without formal prescriptions. Figure presents responses provided by pharmacists regarding their interactions with patients who request antimicrobials without prescriptions in Jordan. Questions encompassed: Q2: “I frequently receive prescriptions for antimicrobials without proper justification or diagnosis.” Q6: “I frequently encounter patients seeking to purchase antimicrobials without a prescription.” Q7: “I frequently encounter patients who self-diagnose and request specific antimicrobials without a prescription”.

Figure 5

Challenges encountered by scientists in prescribing antimicrobials. Enquiries are delineated as follows: Q9: “I frequently encounter challenges in obtaining relevant patient information necessary for assessing the appropriateness of antimicrobial prescriptions.” Q11: “I frequently encounter regulatory or legal challenges when I refuse to provide antimicrobials to patients seeking to purchase them without a prescription”.

Figure 6

Actions undertaken by pharmacists in response to patient requests for antimicrobials in absence of prescriptions. Responses of pharmacists to patients requesting antimicrobials without prescriptions were examined. This study examines prevalent practices as reported by experienced pharmacists in Jordan. Question posed was, “What actions do you typically take when a patient requests to purchase antimicrobials without a prescription? (Select all that apply)”.