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Antibiotics
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Antimicrobial Resistance: Primary Care Perspectives and Practices
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Antimicrobial Resistance: Primary Care Perspectives and Practices

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 30773

Special Issue Editors

Dr. Keivan Ahmadi

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Guest Editor
Pharmacology and Theraputics, Lincoln Medical School, Universities of Nottingham and Lincoln, 1st Floor, Charlotte Scott Building, Brayford Pool LN6 7TS, UK
Interests: public health; clinical research; health education and interprofessional education; scale (survey tools) development techniques
Dr. Ali Qais Blebil

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Guest Editor
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Interests: smoking-related diseases and smoking cessation; outcome-based research; health-related quality of life; pharmacy practice; pharmacy education
Dr. Juman Abdulelah Dujaili

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Guest Editor
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
Interests: outcome-based research; development and validation of patient-reported outcomes (PROs) measure; pharmacoepidemiology and public health; observational studies in the fields of respiratory diseases; infectious diseases; smoking cessation; pharmacy education

Special Issue Information

Dear Colleagues,

With the current pace at which the landscape and scope of primary care are constantly evolving, and with the impact of COVID-19 on different aspects of practices of primary care and public health, antimicrobial resistance remains a top priority challenge that needs to be tackled by healthcare policies and practices. Primary care perspectives and practices are at the heart of any initiatives/action plans aimed at addressing global/local antimicrobial resistance. Thus, this Special Issue is of particular relevance, as it will focus on discovering more about the primary care perspectives and practices pertinent to the smart use of antimicrobials. It is hoped that this Special Issue will be viewed as a suitable platform to share innovative interventions and practices toward streamlining our policies and their implementation regarding the appropriate use of antimicrobial agents globally.

Dr. Keivan Ahmadi
Dr. Ali Qais Blebil
Dr. Juman Abdulelah Dujaili
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial resistance
  • rational antibiotic use
  • antimicrobial stewardship
  • global antimicrobial resistance
  • local antimicrobial resistance
  • primary care
  • primary care practices
  • community care perspectives
  • public health
  • prescribing
  • dispensing

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (7 papers)

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8 pages, 241 KiB  
Article
An Interventional Call-Back Service to Improve Appropriate Use of Antibiotics in Community Pharmacies
by Bridget Paravattil, Monica Zolezzi, Ziad Nasr, Maria Benkhadra, May Alasmar, Sara Hussein and Aya Maklad
Antibiotics 2021, 10(8), 986; https://doi.org/10.3390/antibiotics10080986 - 16 Aug 2021
Cited by 4 | Viewed by 3437
Abstract
Pharmacists play a key role in tackling antibiotic misuse through counseling and education of patients and healthcare providers. The study aim is to evaluate the appropriateness of antibiotic prescriptions in community pharmacy settings while implementing an interventional call-back service to assess adherence and [...] Read more.
Pharmacists play a key role in tackling antibiotic misuse through counseling and education of patients and healthcare providers. The study aim is to evaluate the appropriateness of antibiotic prescriptions in community pharmacy settings while implementing an interventional call-back service to assess adherence and symptom resolution among patients prescribed an antibiotic. Patients were recruited by community pharmacists who were assigned to either the call-back, structured counseling, or standard care arms. Patients in the call-back group received intensive antibiotic counseling and a phone call from the study pharmacist 3 to 5 days after antibiotic initiation. The counseling arm patients received intensive antibiotic counseling from the study pharmacist while patients in the standard care arm received routine care. Antibiotic adherence rates among the standard care (n = 25), counseling (n = 29), and call-back (n = 26) groups were 64%, 86.2%, and 88.5%, respectively (X2 = 5.862, p = 0.053). Symptom severity scores after completion of antibiotic treatment among all groups were rated as excellent. Twenty-nine percent of the outpatient antibiotic prescriptions were deemed as inappropriate. A pharmacist call-back service is a simple and inexpensive intervention which can effectively identify opportunities for improving appropriate antibiotic use, particularly with respect to adherence. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
20 pages, 760 KiB  
Article
Antimicrobial Resistance and Community Pharmacists’ Perspective in Thailand: A Mixed Methods Survey Using Appreciative Inquiry Theory
by Rojjares Netthong, Ros Kane and Keivan Ahmadi
Antibiotics 2022, 11(2), 161; https://doi.org/10.3390/antibiotics11020161 - 27 Jan 2022
Cited by 7 | Viewed by 4399
Abstract
Global action plans to tackle antimicrobial resistance (AMR) are the subject of ongoing discussion between experts. Community pharmacists have a professional responsibility to tackle AMR. This study aimed to evaluate the knowledge of antibiotic resistance and attitudes to promoting Antibiotic Smart Use (ASU) [...] Read more.
Global action plans to tackle antimicrobial resistance (AMR) are the subject of ongoing discussion between experts. Community pharmacists have a professional responsibility to tackle AMR. This study aimed to evaluate the knowledge of antibiotic resistance and attitudes to promoting Antibiotic Smart Use (ASU) amongst part and full-time practicing community pharmacists across Thailand. An online mixed-method survey applying Appreciative Inquiry theory was validated and conducted in 2020. Non-probability sampling was used, with online survey dissemination via social networks. A total of 387 community pharmacists located in 59 out 77 provinces seemed knowledgeable about antimicrobial resistance (mean score = 82.69%) and had acceptable attitudes towards antibiotic prescribing practices and antimicrobial stewardship (mean score = 73.12%). Less than 13% of pharmacists had postgraduate degrees. Postgraduate education, training clerkship, preceptors, and antibiotic stewardship training positively affected their attitudes. The community pharmacists proposed solutions based on the Appreciative Inquiry theory to promote ASU practices. Among these were educational programmes consisting of professional conduct, social responsibility and business administration knowledge, up-to-date legislation, and substitutional strategies to compensate business income losses. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
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26 pages, 3172 KiB  
Systematic Review
Patients’ and Healthcare Professionals’ Experiences and Views of Recurrent Urinary Tract Infections in Women: Qualitative Evidence Synthesis and Meta-Ethnography
by Leigh N. Sanyaolu, Catherine V. Hayes, Donna M. Lecky, Haroon Ahmed, Rebecca Cannings-John, Alison Weightman, Adrian Edwards and Fiona Wood
Antibiotics 2023, 12(3), 434; https://doi.org/10.3390/antibiotics12030434 - 22 Feb 2023
Cited by 13 | Viewed by 5377
Abstract
Background: Urinary tract infections (UTIs) are a common and significant problem for patients, clinicians, and healthcare services. Recurrent UTIs (rUTIs) are common, with a 3% prevalence in the UK. Although acute UTIs have a significant negative impact on the lives of patients, evidence [...] Read more.
Background: Urinary tract infections (UTIs) are a common and significant problem for patients, clinicians, and healthcare services. Recurrent UTIs (rUTIs) are common, with a 3% prevalence in the UK. Although acute UTIs have a significant negative impact on the lives of patients, evidence of the impact of rUTIs is limited. To enhance shared decision-making around rUTI management, it is important to understand both the patients’ and healthcare professionals’ (HCPs’) perspectives. The objective of this qualitative evidence synthesis is to understand patients’ and HCPs’ experiences and views in the management of rUTIs. Methods: A qualitative evidence synthesis (QES) was performed that included primary qualitative studies involving patients with rUTIs or primary care HCPs who manage patients with rUTIs, up to June 2022. The following databases were searched: MEDLINE, Embase, CINAHL, PsycInfo, ASSIA, Web of Science, Cochrane Database of Systematic Reviews, Epistemonikos, Cochrane Central Registry of Controlled Trials, OpenGrey, and the Health Management Information Consortium (HMIC). The QES was prospectively registered on PROSPERO (CRD42022295662). Reciprocal translation was conducted and developed into a line of argument synthesis. We appraised the confidence in our review findings by using GRADE-CERQual. Results: Twelve studies were included in the final review; ten of those included patients, and three included HCPs (one study included both). Our review demonstrates that women with rUTIs have a unique experience, but it is generally of a chronic condition with significant impacts on numerous aspects of their lives. Antibiotics can be “transformative”, but patients have serious concerns about their use and feel non-antibiotic options need further research and discussion. HCPs share similar views about the impacts of rUTIs and concerns about antibiotic use and find the management of rUTIs to be complex and challenging. Based on our GRADE-CERQual assessment of the review findings, we have moderate confidence in those related to patients and low confidence in those related to HCPs. New conceptual models for both patients and HCPs are presented. Conclusions: This review has significant clinical implications. Patients require information on antibiotic alternative acute and preventative treatments for rUTIs, and this is not currently being addressed. There are communication gaps around the impact of rUTIs on patients, their perceived expectation for antibiotics, and the reasons for treatment failure. Further development of current clinical guidance and a patient decision aid would help address these issues. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
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13 pages, 754 KiB  
Article
The Use of the TARGET Antibiotic Checklist to Support Antimicrobial Stewardship in England’s Community Pharmacies
by Sejal Parekh, Catherine V. Hayes, Jill Loader, Diane Ashiru-Oredope, Kieran Hand, Gemma Hicks and Donna Lecky
Antibiotics 2023, 12(4), 647; https://doi.org/10.3390/antibiotics12040647 - 24 Mar 2023
Cited by 10 | Viewed by 5617
Abstract
Antimicrobial Stewardship (AMS) requires effective teamwork between healthcare professionals, with patients receiving consistent messages from all healthcare professionals on the appropriate antimicrobial use. Patient education may reduce patients’ expectations to receive antibiotics for self-limiting conditions and reduce the pressure on primary care clinicians [...] Read more.
Antimicrobial Stewardship (AMS) requires effective teamwork between healthcare professionals, with patients receiving consistent messages from all healthcare professionals on the appropriate antimicrobial use. Patient education may reduce patients’ expectations to receive antibiotics for self-limiting conditions and reduce the pressure on primary care clinicians to prescribe antibiotics. The TARGET Antibiotic Checklist is part of the national AMS resources for primary care and aims to support interaction between community pharmacy teams and patients prescribed antibiotics. The Checklist, completed by the pharmacy staff with patients, invites patients to report on their infection, risk factors, allergies, and knowledge of antibiotics. The TARGET antibiotic checklist was part of the AMS criteria of England’s Pharmacy Quality Scheme for patients presenting with an antibiotic prescription from September 2021 to May 2022. A total of 9950 community pharmacies claimed for the AMS criteria and 8374 of these collectively submitted data from 213,105 TARGET Antibiotic Checklists. In total, 69,861 patient information leaflets were provided to patients to aid in the knowledge about their condition and treatment. 62,544 (30%) checklists were completed for patients with an RTI; 43,093 (21%) for UTI; and 30,764 (15%) for tooth/dental infections. An additional 16,625 (8%) influenza vaccinations were delivered by community pharmacies prompted by discussions whilst using the antibiotic checklist. Community pharmacy teams promoted AMS using the TARGET Antibiotic Checklist, providing indication-specific education and positively impacting the uptake of influenza vaccinations. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
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16 pages, 1169 KiB  
Article
The National Implementation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI) through the English Pharmacy Quality Scheme 2020 to 2022
by Catherine V. Hayes, Sejal Parekh, Donna M. Lecky, Jill Loader, Carry Triggs-Hodge and Diane Ashiru-Oredope
Antibiotics 2023, 12(4), 793; https://doi.org/10.3390/antibiotics12040793 - 21 Apr 2023
Cited by 9 | Viewed by 4029
Abstract
Since 2020, England’s Pharmacy Quality Scheme (PQS) has incentivised increased antimicrobial stewardship (AMS) activities in community pharmacy. In 2020/21, this included the requirement for staff to complete an AMS e-Learning module, pledge to be an Antibiotic Guardian and develop an AMS Action plan. [...] Read more.
Since 2020, England’s Pharmacy Quality Scheme (PQS) has incentivised increased antimicrobial stewardship (AMS) activities in community pharmacy. In 2020/21, this included the requirement for staff to complete an AMS e-Learning module, pledge to be an Antibiotic Guardian and develop an AMS Action plan. To build and embed these initiatives, in 2021/22, the PQS required the use of the TARGET Antibiotic Checklist (an AMS tool for use when patients present with a prescription for antibiotics to support conducting and recording of a series of safety and appropriateness checks against each prescribed antibiotic). This paper describes the implementation of the national PQS criteria from 2020 to 2022, and details community pharmacies’ AMS activities and barriers to implementation of the 2021/22 criteria. A total of 8374 community pharmacies submitted data collected using the TARGET Antibiotic Checklist for 213,105 prescriptions; 44% surpassed the required number for the PQS. Pharmacy teams reported checking the following: duration, dose, and appropriateness of antibiotics; patient allergies and medicine interactions (94–95%); antibiotic prescribing guideline adherence (89%); and the patient’s previous use of antibiotics (81%). The prescriber was contacted for 1.3% of TARGET Antibiotic Checklists (2741), and the most common reasons for such contacts were related to dose, duration, and possible patient allergy. A total of 105 pharmacy staff responded to a follow-up questionnaire, which suggested that some AMS principles had been embedded into daily practice; however, the necessary time commitment was a barrier. The PQS was able to incentivise mass AMS activities at pace over consecutive years for England’s community pharmacies simultaneously. Future research should monitor the continuation of activities and the wider impacts on primary care. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
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16 pages, 806 KiB  
Article
GPs’ Perspective on a Multimodal Intervention to Enhance Guideline-Adherence in Uncomplicated Urinary Tract Infections: A Qualitative Process Evaluation of the Multicentric RedAres Cluster-Randomised Controlled Trial
by Angela Schuster, Paula Tigges, Julianna Grune, Judith Kraft, Alexandra Greser, Ildikó Gágyor, Mandy Boehme, Tim Eckmanns, Anja Klingeberg, Andy Maun, Anja Menzel, Guido Schmiemann, Christoph Heintze and Jutta Bleidorn
Antibiotics 2023, 12(12), 1657; https://doi.org/10.3390/antibiotics12121657 - 24 Nov 2023
Cited by 1 | Viewed by 1822
Abstract
Urinary tract infections (UTIs) are among the most common reasons patients seeking health care and antibiotics to be prescribed in primary care. However, general practitioners’ (GPs) guideline adherence is low. The RedAres randomised controlled trial aims to increase guideline adherence by implementing a [...] Read more.
Urinary tract infections (UTIs) are among the most common reasons patients seeking health care and antibiotics to be prescribed in primary care. However, general practitioners’ (GPs) guideline adherence is low. The RedAres randomised controlled trial aims to increase guideline adherence by implementing a multimodal intervention consisting of four elements: information on current UTI guidelines (1) and regional resistance data (2); feedback regarding prescribing behaviour (3); and benchmarking compared to peers (4). The RedAres process evaluation assesses GPs’ perception of the multimodal intervention and the potential for implementation into routine care. We carried out 19 semi-structured interviews with GPs (intervention arm). All interviews were carried out online and audio recorded. For transcription and analysis, Mayring’s qualitative content analysis was used. Overall, GPs considered the interventions helpful for knowledge gain and confirmation when prescribing. Information material and resistance were used for patient communication and teaching purposes. Feedback was considered to enhance reflection by breaking routines of clinical workup. Implementation into routine practice could be enhanced by integrating feedback loops into patient management systems and conveying targeted information via trusted channels or institutions. The process evaluation of RedAres intervention was considered beneficial by GPs. It confirms the convenience of multimodal interventions to enhance guideline adherence. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
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16 pages, 1146 KiB  
Review
The Fragmented Picture of Antimicrobial Resistance in Kenya: A Situational Analysis of Antimicrobial Consumption and the Imperative for Antimicrobial Stewardship
by Aarman Sohaili, Judith Asin and Pierre P. M. Thomas
Antibiotics 2024, 13(3), 197; https://doi.org/10.3390/antibiotics13030197 - 20 Feb 2024
Cited by 7 | Viewed by 4093
Abstract
Antimicrobial resistance (AMR) jeopardizes the effectiveness of essential antimicrobial agents in treating infectious diseases. Accelerated by human activities, AMR is prevalent in Sub-Saharan Africa, including Kenya, due to indiscriminate antibiotic use and limited diagnostics. This study aimed to assess Kenya’s AMR efforts through [...] Read more.
Antimicrobial resistance (AMR) jeopardizes the effectiveness of essential antimicrobial agents in treating infectious diseases. Accelerated by human activities, AMR is prevalent in Sub-Saharan Africa, including Kenya, due to indiscriminate antibiotic use and limited diagnostics. This study aimed to assess Kenya’s AMR efforts through a situational analysis of policy efficacy, interventions, and implementation, culminating in recommendations for strengthening mitigation. Employing two methodologies, this study evaluated Kenya’s AMR endeavors. A systematic scoping review summarized AMR dynamic, and an expert validated the findings, providing an on-the-ground perspective. Antibiotic resistance is driven by factors including widespread misuse in human medicine due to irrational practices, consumer demand, and substandard antibiotics. Heavy antibiotic use in the agricultural sector leads to contamination of the food chain. The National Action Plan (NAP) reflects a One Health approach, yet decentralized healthcare and funding gaps hinder its execution. Although AMR surveillance includes multiple facets, diagnostic deficiencies persist. Expert insights recognize proactive NAP but underscore implementation obstacles. Kenya grapples with escalating resistance, but commendable policy efforts exist. However, fragmented implementations and complexities persist. Addressing this global threat demands investment in healthcare infrastructure, diagnostics, international partnerships, and sustainable strategies. Full article
(This article belongs to the Special Issue Antimicrobial Resistance: Primary Care Perspectives and Practices)
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