Dispensing of Antibiotics for Tuberculosis Patients Using Standardized Patient Approach at Community Pharmacies: Results from a Cross-sectional Study in Pakistan

Overview

Journal Front Public Health

Specialty Public Health

Date 2024 Jan 23

PMID 38259789

Authors

Ali Hassan Gillani

Hafsa Arshad

Hasan Mujtaba

Muhammad Farooq Umer

Sen Xu

Wenjing Ji

Kamran Bashir

Jie Chang

Caijun Yang

Yu Fang

Affiliations

Soon will be listed here.

Abstract

Background: Pakistan is among top countries for antibiotic consumption around the globe and patients often receive antibiotics directly from community pharmacies. Thus, our aim was to assess the drug dispensing practices of pharmacies for presumed and confirmed tuberculosis by using standardized patients' method in Pakistan.

Methods: In this cross-sectional study, we adopted two standardized patient cases in pharmacies of three cities of Punjab. The first case involved a presumed tuberculosis patient presenting with 2-3 weeks of cough and fever (Case-1), and the second case involved a confirmed tuberculosis patient carrying microbiologically confirmed tuberculosis results (Case-2). The ideal management for Cases-1 and Case-2 is referral of standardized patients to a healthcare provider without dispensing antibiotics or steroids, or both. The differences in antibiotic use, steroid use, and the number of medicines dispensed in referred and non-referred patients between Case-1 and Case-2 were analyzed using descriptive statistics.

Results: Between April 1, 2020, and July 31, 2020, standardized patients completed 575 out of 598 interactions among community pharmacies in Lahore, Rawalpindi, and Sialkot. We recorded ideal management in 115 (37.7%) of the 305 Case-1 interactions and 130 (48.1%) of the 270 Case-2 interactions. Antibiotic dispensing was higher in Case-1, with 71 out of 305 instances (23.3%), than in Case-2 interactions, with 27 out of 270 instances (10.0%). Anti-tuberculosis drugs were dispensed to 1 patient in Case-1 (0.3%) and to 19 patients (7.0%) in Case-2.

Conclusion: Slightly more than one-third of pharmacies in Punjab, Pakistan, ideally managed patients with presumed tuberculosis, but almost half of them ideally managed cases of confirmed tuberculosis. The presence of confirmed diagnosis slightly changes the behavior in the correct management of patients.

Citing Articles

Using Unannounced Standardized Patients to Assess the Quality of Tuberculosis Care and Antibiotic Prescribing: A Cross-Sectional Study on a Low/Middle-Income Country, Pakistan.

Zhao M, Gillani A, Hussain H, Arshad H, Arshed M, Fang Y Antibiotics (Basel). 2025; 14(2).

PMID: 40001418 PMC: 11852056. DOI: 10.3390/antibiotics14020175.

References

Chen T, Lu P, Lin C, Lin W, Chen Y . Fluoroquinolones are associated with delayed treatment and resistance in tuberculosis: a systematic review and meta-analysis. Int J Infect Dis. 2011; 15(3):e211-6. DOI: 10.1016/j.ijid.2010.11.008. View

Daftary A, Satyanarayana S, Jha N, Singh M, Mondal S, Vadnais C . Can community pharmacists improve tuberculosis case finding? A mixed methods intervention study in India. BMJ Glob Health. 2019; 4(3):e001417. PMC: 6528751. DOI: 10.1136/bmjgh-2019-001417. View

Dixit K, Biermann O, Rai B, Aryal T, Mishra G, de Siqueira-Filha N . Barriers and facilitators to accessing tuberculosis care in Nepal: a qualitative study to inform the design of a socioeconomic support intervention. BMJ Open. 2021; 11(10):e049900. PMC: 8488704. DOI: 10.1136/bmjopen-2021-049900. View

Ullah W, Almansour H, Fatima R, Saini B, Khan G . Engaging Community Pharmacies in Early Detection of Missing Tuberculosis Patients through Public-Private Mix Intervention in Pakistan. Am J Trop Med Hyg. 2020; 103(1):221-230. PMC: 7356437. DOI: 10.4269/ajtmh.19-0939. View

Christian C, Gerdtham U, Hompashe D, Smith A, Burger R . Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis. Int J Environ Res Public Health. 2018; 15(4). PMC: 5923771. DOI: 10.3390/ijerph15040729. View

Kamat V, Nichter M . Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Soc Sci Med. 1998; 47(6):779-94. DOI: 10.1016/s0277-9536(98)00134-8. View

Vo L, Codlin A, Huynh H, Mai T, Forse R, Van Truong V . Enhanced Private Sector Engagement for Tuberculosis Diagnosis and Reporting through an Intermediary Agency in Ho Chi Minh City, Viet Nam. Trop Med Infect Dis. 2020; 5(3). PMC: 7558378. DOI: 10.3390/tropicalmed5030143. View

Kantele A, Laaveri T, Mero S, Vilkman K, Pakkanen S, Ollgren J . Antimicrobials increase travelers' risk of colonization by extended-spectrum betalactamase-producing Enterobacteriaceae. Clin Infect Dis. 2015; 60(6):837-46. PMC: 4345818. DOI: 10.1093/cid/ciu957. View

Dadu A, Hovhannesyan A, Ahmedov S, van der Werf M, Dara M . Drug-resistant tuberculosis in eastern Europe and central Asia: a time-series analysis of routine surveillance data. Lancet Infect Dis. 2019; 20(2):250-258. DOI: 10.1016/S1473-3099(19)30568-7. View

10.

Kuang L, Liu Y, Wei W, Song X, Li X, Liu Q . Non-prescription sale of antibiotics and service quality in community pharmacies in Guangzhou, China: A simulated client method. PLoS One. 2020; 15(12):e0243555. PMC: 7728288. DOI: 10.1371/journal.pone.0243555. View

11.

Hashmi A, Ul Haq M, Malik M, Hussain A, Gajdacs M, Jamshed S . Perceptions of community pharmacists regarding their role in antimicrobial stewardship in Pakistan: A way forward. Heliyon. 2023; 9(4):e14843. PMC: 10070906. DOI: 10.1016/j.heliyon.2023.e14843. View

12.

Satyanarayana S, Kwan A, Daniels B, Subbaraman R, McDowell A, Bergkvist S . Use of standardised patients to assess antibiotic dispensing for tuberculosis by pharmacies in urban India: a cross-sectional study. Lancet Infect Dis. 2016; 16(11):1261-1268. PMC: 5067371. DOI: 10.1016/S1473-3099(16)30215-8. View

13.

Saleem Z, Hassali M, Godman B, Fatima M, Ahmad Z, Sajid A . Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study. J Pharm Policy Pract. 2020; 13:26. PMC: 7397594. DOI: 10.1186/s40545-020-00233-3. View

14.

Atif M, Ihsan B, Malik I, Ahmad N, Saleem Z, Sehar A . Antibiotic stewardship program in Pakistan: a multicenter qualitative study exploring medical doctors' knowledge, perception and practices. BMC Infect Dis. 2021; 21(1):374. PMC: 8059254. DOI: 10.1186/s12879-021-06043-5. View

15.

Aziz M, Haider F, Rasool M, Hashmi F, Bahsir S, Li P . Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff's Opinion. Antibiotics (Basel). 2021; 10(5). PMC: 8143445. DOI: 10.3390/antibiotics10050482. View

16.

Gillani A, Ji W, Hussain W, Imran A, Chang J, Yang C . Antibiotic Self-Medication among Non-Medical University Students in Punjab, Pakistan: A Cross-Sectional Survey. Int J Environ Res Public Health. 2017; 14(10). PMC: 5664653. DOI: 10.3390/ijerph14101152. View

17.

Ahmad T, Khan F, Ali S, Rahman A, Khan S . Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study. PLoS One. 2022; 17(2):e0263756. PMC: 8853528. DOI: 10.1371/journal.pone.0263756. View

18.

Gillani A, Chang J, Aslam F, Saeed A, Shukar S, Khanum F . Public knowledge, attitude, and practice regarding antibiotics use in Punjab, Pakistan: a cross-sectional study. Expert Rev Anti Infect Ther. 2020; 19(3):399-411. DOI: 10.1080/14787210.2021.1823216. View

19.

Khan M, Bilal W, Asim H, Rahmat Z, Essar M, Ahmad S . MDR-TB in Pakistan: Challenges, efforts, and recommendations. Ann Med Surg (Lond). 2022; 79:104009. PMC: 9289334. DOI: 10.1016/j.amsu.2022.104009. View

20.

Chang J, Xu S, Zhu S, Li Z, Yu J, Zhang Y . Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. Lancet Infect Dis. 2019; 19(12):1345-1354. DOI: 10.1016/S1473-3099(19)30324-X. View