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      Knowledge, Attitude and Practice of Community Pharmacists Regarding Antibiotic Use and Infectious Diseases: A Cross-Sectional Survey in Hungary (KAPPhA-HU)

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          Abstract

          One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic (AB) use, which results in selection pressure towards relevant bacteria. Community pharmacists have pivotal roles in facilitating the prudent use of ABs that have been demonstrated by several studies worldwide. The aim of our present study was to evaluate the knowledge, attitude and practice of community pharmacists related to AB use and infectious diseases in Hungary. A descriptive cross-sectional survey was performed among community pharmacists in Hungary with the use of an anonymous, structured and pilot-tested questionnaire. Data collection ran between January 2016 and January 2018; n = 339 community pharmacists nationwide were approached with our questionnaire, out of which 192 filled out our survey. Hungarian pharmacists have appropriate knowledge regarding ABs and antimicrobial therapy, and they realize the public health impact of the growing AMR. Twenty-five percent of participants admitted to giving out non-prescription ABs at least once in the last year. The age and presence of board-certified specializations were shown to be significant factors of self-perceived knowledge and professional attitudes. Educational strategies and interventions specifically aimed at focusing on identified shortcomings and changing certain attitudes could substantially improve AB dispensing and AB use, in addition to minimizing resistance.

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          Most cited references48

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          Antibiotic resistance-the need for global solutions.

          The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study.

            Assessing the efficacy of an educational intervention that aimed to reduce unnecessary antibiotic prescriptions in primary care by motivating GPs to change their attitudes to communication and by empowering patients. One hundred and four GPs in North-Rhine/Westphalia-Lippe, Germany were cluster-randomized into intervention and control. GPs randomized to receive the intervention were visited by peers. The intervention strategy was focused on the communication within the encounter, not on sharing knowledge about antibiotic prescribing. Leaflets and posters were provided that aimed at patient empowerment, thus enabling patients to raise the topic of antibiotic prescriptions themselves. Eighty-six GPs (83%) remained in the study at 6 weeks and 61 GPs (59%) at 12 months. Antibiotic prescription rates within the control group were 54.7% at baseline and 36.4% within the intervention group at baseline. Generalized estimating equation models were applied. Baseline imbalances and confounding variables were controlled by adjustment. After the intervention, the ORs for the prescription of an antibiotic dropped to 0.58 [95% CI: (0.43;0.78), P < 0.001] after 6 weeks and were 0.72 [95% CI: (0.54;0.97), P = 0.028] after 12 months in the intervention group. In the control group, the ORs rose to 1.52 [95% CI: (1.19;1.95), P = 0.001] after 6 weeks and were 1.31 [95% CI: (1.01;1.71), P = 0.044] after 12 months; these ORs correspond to an approximately 60% relative reduction in antibiotic prescription rates at 6 weeks and a persistent 40% relative reduction at 12 months. An interventional strategy that focused on doctor-patient communication and patient empowerment is an effective concept to reduce antibiotic prescriptions in primary care.
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              Tackling the threat of antimicrobial resistance: from policy to sustainable action.

              Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of antimicrobial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors. Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.
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                Author and article information

                Journal
                Antibiotics (Basel)
                Antibiotics (Basel)
                antibiotics
                Antibiotics
                MDPI
                2079-6382
                21 January 2020
                February 2020
                : 9
                : 2
                Affiliations
                [1 ]Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6, 6720 Szeged, Hungary
                [2 ]Department of Public Health, Faculty of Medicine, University of Szeged, Dóm tér 10, 6720 Szeged, Hungary; paulik.edit@ 123456med.u-szeged.hu (E.P.); szabo.andrea@ 123456med.u-szeged.hu (A.S.)
                Author notes
                [* ]Correspondence: gajdacs.mario@ 123456pharm.u-szeged.hu ; Tel.: +36-62-341-330
                Article
                antibiotics-09-00041
                10.3390/antibiotics9020041
                7168197
                31973119
                a6331a5e-91b7-419e-9ba1-6af28c1d5944
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                community pharmacists,antibiotics,non-prescription,dispensing,knowledge,attitudes,practice,responsibility

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