SYDNEY – Cold, flu, sore throat, even headaches and body aches were all conditions that pharmacology students in Sri Lanka, questioned in a recent study, said could be treated with antibiotics. These answers were among a series highlighting wide gaps in critical knowledge necessary to protect infection-fighting drugs, discovered among future pharmacists in the South Asian country, Sakina Ameen, who with colleagues conducted the survey, told an audience here today.
On top of insufficient understanding of how misuse and inappropriate use of antibiotics can lead to antimicrobial resistance, student subjects in the study also lacked knowledge on how bacteria develop resistance to antibiotics, Ameen said.
Ameen conducted a systematic review of antibiotic sales in developing countries and found that 28 don’t require prescriptions for purchasing antibiotics, she said. Ameen identified six factors driving antibiotics misuse in these countries: poor medicines regulation, lack of qualified staff at pharmacies, community pressure for access to antibiotics, lack of awareness on appropriate use, inappropriate prescribing practices, and consumer demand.
Sri Lanka, which adopted a new national strategic plan for combating antimicrobial resistance in 2017, requires prescriptions for the purchasing of antibiotics, but those laws are not well enforced outside of the capital city of Colombo, Ameen said. Because patients are easily able to access antibiotics, which contributes to misuse and overuse and subsequently to growing antimicrobial resistance, well-trained and qualified pharmacists at the community level can play an important role in reducing the antimicrobial resistance burden, she said.
Ameen assessed antimicrobial resistance knowledge among pharmacology students at six universities in Sri Lanka and found widespread lack of knowledge on antimicrobial resistance, especially on appropriate use and how resistant bacteria is formed, she said. More than half of junior pharmacy students incorrectly indicated that antibiotic use is appropriate for the management of cold and flu conditions. She also found that pharmacists face challenges in providing antibiotic counseling services, she said.
Ameen subsequently worked with the institutions to develop a new pharmacology curriculum for Sri Lankan universities which follows World Health Organization guidelines on antibiotic use.
“If pharmacy students have better knowledge, they can serve the community wisely as a pharmacist, educate consumers on appropriate use and spread knowledge about the global threat of AMR,” Ameen said.
This would be key in areas with weak health care infrastructure or conflict settings with few trained doctors as populations largely rely on pharmacists to provide health care, Abiodun Egwuenu, a field epidemiologist with the Nigeria Centers for Disease Control said. In a study monitoring antibiotic consumption in Nigeria, Egwuenu found the highest antibiotic consumption in the northwestern section of the country – a region rife with conflict.
“If they don’t have access to health centers or hospitals, they are going to pharmacies for self-treatment,” she said.
Egwuenu and colleagues at the Nigeria CDC are planning to launch an antimicrobial stewardship initiative among pharmacies and private health practitioners soon, she said.
Rabita Aziz is senior global health policy specialist at the Infectious Diseases Society of America, which produces this blog.