controlled questionnaires based study

2. o Antibiotics : a natural substance produced by a
micro-organism to kill another
o Anti infectives/Anti-microbrial : any agent (natural
or synthetic) that kills pathogens (microbes)
Bacteriostatic vs Bactericidal:
*Bacteriostati allows for natural immunity to deal with microbe .
Antibodies, Phagocytosis etc .
*Bactericidial may lead to release of toxins and
microbial contents leading to subsequent illness
and inflammatory responses .

3. Mechanism of Action

4. Contraindications associated with antibiotics
Pregnancy: Penicillins are usually the antibiotics of first
choice. Tetracyclines, trimethoprin, cotrimazole,
glycopeptides and aminoglycosides are avoided if possible.
Breastfeeding allows small amounts of antibiotic to
pass from mother to infant. Hypersensitivity responses
and adverse effects may occur in the infant.
Breastfeeding is not advised in some severe infections.
 Impaired liver function causes some drugs to
accumulate e.g. metronidazole, rifampicin.
 Glandular fever (Epstein-Barr virus infection),
cytomegalovirus infection greatly increase the risk of
developing a penicillin-induced rash.

5.  No antibiotics in case of resent viral infections .
 No prophylactic antibiotics in case of immuno
compromised patient
 Tetracycline is panned in patient below 8 years
due to perminant discoloration Of teeth .
 Quinolones are contraindicated in patients lower
than 16 years due to premature
Closure of epiphysis
 chloramphenicol is contraindicated in patient below 6
years due to bon marrow
Depression (aplastic anemia ) & grey baby syndrome
 oral co amoxiclav shouldn’t be used below 9
months to avoid diarrhea .

6. Drug interactions with antibiotics
 Rifampicin and rifabutin
render all oral contraceptives ineffective.
All broad spectrum antibiotics increase the risk of 'pill failure' for
combined oral contraceptives
 Macrolides cause accumulation of other drugs e.g.
digoxin, corticosteroids, anti-coagulants.
 Aminoglycosides intensify the action of muscle relaxants such as
suxamethonium. Their use must be highlighted when the patient is
transferred to the anaesthetic
 Many antibiotics are incompatible with other drugs when co-
administered in intravenous infusions. For example, if
gentamicin is combined with heparin or a penicillin, its
antibiotic activity will be lost.

7. Antibiotic Dispensing in Egyptian
Community Pharmacies
Study
Objective
Methods
Result
Conclusion

8. • In developing countries like Egypt specially in benisuef (the
study area), antibiotics are among the most commonly
sold medications and they are frequently misused. This
represents a considerable public health problem.
Background
• Antibiotics are often perceived by some as strong‟,almost
magical, medicines capable of curing nearly any illness .
• There are high levels of antibiotic use, and resistance may
have observed in Egypt.
• Antibiotic use is highly influenced by cultures and beliefs
This study aims to describe the pattern of
antibiotics dispensing in the Egyptian community
.

9. Methods
 A cross-sectional, observational survey of antibiotic dispensing
from community pharmacies was conducted in 30 randomly-
selected pharmacies in benisuef . Data were collected during one
shift at each pharmacy .
The community pharmacists were instructed on how to fill the
questionnaires and were asked to report every single antibiotic
dispensed in their shifts.
The number of prescriptions which included antibiotics, the
quantity and price of antibiotics dispensed per prescription and
the reason for prescribing the antibiotic were recorded. And the
same with antibiotics dispensed upon patient‟s request or
pharmacist‟ recommendation .

10. Results
Antibiotics Dispensed on Prescription ;
 In different vallages and in the city :
Overall, 400 patients received 736 antibiotics divided between 17 classes of antibiotics.
Patients receiving the prescribed antibiotics ranged in age between 6 months and 66 years .
Approximately , 27% were aged < 18 years and 43.3% were females. Most of the prescriptions
were handed in by the patients themselves who were mostly educated to middle school level
or above (88%).
 The highest proportion of prescriptions was issued by paediatricians and respiratory .
 Penicillins and quinolones were the two major class of antibiotics dispensed on prescription
. 55% were dispensed by pharmacists and the remainder by technicians without being
checked by any pharmacist .
 The pharmacist gave further advice on use for only 9% of the dispensed antibiotics.

11. Antibiotics Dispensed on Pharmacist Recommendation ;
 Urinary tract infections (UTI) (18%) , sore throat ( 18%), cold and flu symptoms (24%)
,infected wound (11%) , Asthma (8%), Acne (6%) ,Tooth ache (11% ) and Burning (4%)
were the most common conditions .
Penicillins
29%
Cephalosporins
46%
Macrolides
11%
Quinolones
14%
Ratio of antibiotics sales

12. Antibiotics Dispensed on Patient’s Request ;
 A total of 192 antibiotics were sold in response to a patient/customer request without
any official prescription .
 25% were aged < 18 years, 38% were females and 75% were educated to middle school
level or above.
 The most commonly dispensed class was penicillins followed by cephalosporine antibiotics .
Penicillins
Tetracycline
Cephalosporins
Macrolides
Sulphonamide
Quinolones
Fusidic acid
 Common cases requesting antibiotics are Fever , Sore throat , Tonsillitis , UTI , Toothache
and Acne .

13. Conclusion
misused

14. Questionnaire Results

16. 1- People think they need antibiotic for cold and flu 75 %
2-Generally I give antibiotic in case of common cold 40 %
3-I give antibiotic in common cold only in secondary bacterial
infection 100%
4-Is there specific class of antibiotic you always use ?
yes (80% ) No 20%
cephalosporins 70% *** penicillins 20% **** macrolides 10%
5-Patient order antibiotics for any disease 60 %
Results

17. 6-Patient always complete the course of antibiotics 55 %
7-Patient think that antibiotic is the magic drug for all diseases 80%
8-When I give antibiotic I use broad spectrum antibiotic 75 %
9-I calculate antibiotic dose mainly according to
age 80% ****** weight 20%
10-the price of antibiotic affects my chosing of antibiotic 90%
11-The main responsible for resistance in Egypt is
the patient 65% **** pharmacist 15% ***** doctor 20%

18. 11-I need culture test for selecting antibiotic befor dispensing
70% No *** 30% Yes
12-Patient follow instructions for using antibiotic 50% yes
13-Prescriptons always contain antibiotics 75 %
14-The Most antibiotic you generally dispense
cephalosporines 40% … penicillines 30%....others 30%
15-The most case you dispense antibiotic
Respiratory infections 35% - UTI 20% - Skin infections 10% -
35% others