Abstract
Influence of pharmacists on treatment selection in male patients with acute urethritis in 2003–2004 (Moscow, Smolensk, Kaluga, Kaliningrad) and 2009 (Moscow, Smolensk, Kaluga, Kaliningrad, Tula) was studied. Using “patient simulation” method and pre-determined scenario, young males aged of 20 to 30 years went to drug stores and asked for advice on treatments for acute urethritis symptoms. A total of 360 and 409 pharmacists were interviewed in 2003–2004 and 2009, respectively. In 2003–2004 and 2009, pharmacists’ recommendations were the following: treatments (57.8 and 41.1%), physician’s consultation (20.6 and 25.2%), both treatments and physician’s consultation (21.1 and 33.7%). Of those pharmacists who recommended treatments, 96.1 and 95.1% of pharmacists advised antimicrobial agents. In 2003-2004, the most frequently recommended antimicrobials were nitroxoline (23.6%), norfloxacin (14.8%), nitrofurantoin (12.4%), ciprofloxacin (8.1%), pipemidic acid (7.4%), co-trimoxazole (4.3%) and fosfomycin (3.8%). In 2009, the most frequently recommended antimicrobials were norfloxacin (24.3%), nitroxoline (13.0%), fosfomycin (12.4%), pipemidic acid (11.0%), ciprofloxacin (8.2%), furazidin (7.8%), nitrofurantoin (5.8%), amoxicillin/clavulanate (4.0%), and azithromycin (2.0%). The mean duration of recommended treatment course was 6.0±1.5 and 5.6±3.0 days in 2003-2004 and 2009, respectively. Pharmacists advised non-antimicrobial medications (most often herbal remedies) to 16.5 and 17.6% of patients in 2003–2004 and 2009, respectively. We concluded that most pharmacists (75.8% in 2003– 2004 and 71.7% in 2009) recommended antimicrobial agents for the treatment of acute urethritis in males. The most recommended antimicrobials were nitroxoline, norfloxacin and nitrofurantoin in 2004 and norfloxacin, nitroxoline and fosfomycin in 2009. Overall, pharmacists’ advises to males with acute urethritis symptoms have not changed over 5 years.
-
1.
Donovan B. Sexually transmissible infections other than HIV. Lancet 2004; 363:545-6.
-
2.
Sow P., Gueye T., Toure L., et al. Drugs in the parallel market for the treatment of urethral discharge in Dakar: epidemiologic investigation and physicochemical tests. Int J Infect Dis 2002; 6:108-12.
-
3.
Riemersma W., Van Der Schee C., Van Der Meijden W., et al. Microbial population diversity in the urethras of healthy males and males suffering from nonchlamydial, nongonococcal urethritis. J Clin Microbiol 2003; 41(5):1977-86.
-
4.
Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections Overview and Estimates, World Health Organization, 2001. Available from: http://www.who.int/docstore/hiv/GRSTI.
-
5.
Beagley K.W., Timms P. Chlamydia trachomatis infection: incidence, health costs and prospects for vaccine development. J Reprod Immunol 2000; 48(1): 47-68.
-
6.
Ness R.B., Markovic N., Carlson C.L., et al. Do men become infertile after having sexually transmitted urethritis? An epidemiologic examination. Fertil Steril 1997; 68(2):205-13.
-
7.
Makulowich G.S. Institute of Medicine report links 15% of infertility to untreated STDS. AIDS Patient Care STDS 1997; 11(3): 201.
-
8.
Idahl A., Boman J., Kumlin U., et al. Demonstration of Chlamydia trachomatis IgG antibodies in the male partner of the infertile couple is correlated with a reduced likelihood of achieving pregnancy. Hum Reprod 2004; 19(5):1121-6.
-
9.
Eley A., Pacey A.A., Galdiero M., et al. Can Chlamydia trachomatis directly damage your sperm? Lancet Infect Dis 2005; 5:53-7.
-
10.
Mena L., Wang X., Mroczkowski T. Mycoplasma genitalium infections in asymptomatic men and men attending a sexually transmitted diseases clinic in New Orleans. Clin Infect Dis 2002; 35:1167-73.
-
11.
Joyner J., Douglas J., Ragsdale S., et al. Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. Sex Transm Dis 2000; 27(4):241-2.
-
12.
Страчунский Л.С., Козлов С.Н. Современная антимикробная химиотерапия. Руководство для врачей. М.: Боргес, 2002; 436 c.
-
13.
Okeke I.N., Klugman K.P., Bhutta Z.A., et al. Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet 2005; 5: 568-80.
-
14.
McKee M., Mills L., Mainous A. Antibiotic use for the treatment of upper respiratory infections in a diverse community. J Fam Pract 1999; 48: 993-6.
-
15.
Carlin E., Barton S. How common is self-treatment in non gonococcal urethritis? Genitourin Med 1995; 71(6):400-1.
-
16.
Adu-Sarkodie Y. Antimicrobial self medication in patients attending a sexually transmitted diseases clinic. Int J STD AIDS 1997; 8(7):456-8.
-
17.
Gordon S., Mosure D., Lewis J., et al. Prevalence of selfmedication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases. Clin Infect Dis 1993; 17(3):462-5.
-
18.
Obaseiki-Ebor E.E., Akerele J.O., Ebea P.O. A survey of antibiotic outpatient prescribing and antibiotic selfmedication. J Antimicrob Chemother 1987; 20:759-63.
-
19.
Multicenter study on self-medication and self-prescription in six Latin American countries. Drug Utilization Research Group, Latin America. Clin Pharmacol Ther 1997; 61(4):488-93.
-
20.
Parimi N., Pinto Pereira L.M., Prabhakar P. The general public’s perceptions and use of antimicrobials in Trinidad and Tobago. Rev Panam Salud Publica 2002; 12:11-8.
-
21.
Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use. Official Journal L 311; 28/11/2001:67-128.
-
22.
Kennedy J.G. Over the counter drugs. BMJ 1996; 312:593-4.
-
23.
Borg M.A., Scicluna E.A. Over-the-counter acquisition of antibiotics in the Maltese general population. Int J Antimicrob Agents 2002; 20:253-7.
-
24.
Okeke I.N., Lamikanra A., Edelman R. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis 1999; 5(1):18-27.
-
25.
Sturm A.W., van der Pol R., Smits A.J., et. al. Overthe-counter availability of antimicrobial agents, selfmedication and patterns of resistance in Karachi, Pakistan. J Antimicrob Chemother 1997; 39:543-7.
-
26.
Thamlikitkul V. Antibiotic dispensing by drug store personnel in Bangkok, Thailand. J Antimicrob Chemother 1988; 21:125-31.
-
27.
Stratchounski L.S., Andreeva I.V., Ratchina S.A., et al. The inventory of antibiotics in Russian home medicine cabinets. Clin Infect Dis 2003; 37:498-505.
-
28.
Андреева И.В., Рачина С.А., Петроченкова Н.А. с соавт. Самостоятельное применение антимикробных препаратов населением: результаты многоцентрового исследования. Клин фармакол терап 2002; 11:25-9.
-
29.
Abramson J.H., Abramson Z.H. Survey Methods in Community Medicine, 5th edition. Churchill-Livingstone, Edinburg, 1999, 440 p.
-
30.
Caamano F., Ruano A., Figueiras A., et al. Data collection methods for analyzing the quality of the dispensing in pharmacies. Pharm World Sci 2002; 24:217-23.
-
31.
Watson M.C., Skelton J.R., Bond C.M., et al. Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting. Pharm World Sci 2004; 26:32-7.
-
32.
Korman T.M., Grayson M.L. Treatment of urinary tract infections. Aust Fam Physician 1995; 24(12):2205-11.
-
33.
Schaeffer A.J., Stuppy B.A. Efficacy and safety of selfstart therapy in women with recurrent urinary tract infections. J Urol 1999; 161(1):207-11.
-
34.
Gupta K., Hooton T.M., Roberts P.L., et al. Patientinitiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med 2001; 135(1):9-16.
-
35.
Hooton T.M. Recurrent urinary tract infection in women. Int J Antimicrob Agents 2001; 17(4):259-68.
-
36.
Van Duong D., Binns C.W., Van Le T. Availability of antibiotics as over-the-counter drugs in pharmacies: a threat to public health in Vietnam. Trop Med Int Health 1997; 2:1133-9.
-
37.
Wachter D.A., Joshi M.P., Rimal B. Antibiotic dispensing by drug retailers in Kathmandu, Nepal. Trop Med Int Health 1999; 4:782-8.
-
38.
Orero Gonzalez A., Ripoll Lozano M.A., Gonzalez Nunez J. Analysis of automedication with antibiotics in Spain. Enferm Infecc Microbiol Clin 1998; 16:328-33.
-
39.
Turner A.N., Ellertson C., Thomas S., et al. Diagnosis and treatment of presumed STIs at Mexican pharmacies: survey results from a random sample of Mexico City pharmacy attendants. Sex Transm Infect 2003; 79:224-8.
-
40.
Goel P., Ross-Degnan D., Berman P., et al. Retail pharmacies in developing countries: A behavior and intervention framework. Soc Sci Med 1996; 42:1155-61.
-
41.
Paswa B., Barnett L. Care or cash: assessing quality of care provided by drug retailers in Nepal. International Quarterly of Community Health Education 1993; 13(4):317-28.
-
42.
Väänänen M.H., Pietilä K., Airaksinen M. Self-medication with antibiotics--does it really happen in Europe? Health Policy 2006; 77(2):166-71.
-
43.
Sawair F.A., Baqain Z.H., Abu Karaky A., et al. Assessment of self-medication of antibiotics in a Jordanian population. Med Princ Pract 2009; 18(1):21-5.
-
44.
Llor C., Cots J.M. The Sale of Antibiotics without Prescription in Pharmacies in Catalonia, Spain. Clin Infect Dis 2009; 48(10):1345-9.
-
45.
Ramos M.C., da Silva R.D., Gobbato R.O., et al. Pharmacy clerks’ prescribing practices for STD patients in Porto Alegre, Brazil: missed opportunities for improving STD control. Int J STD AIDS 2004; 15(5):333-6.
-
46.
Chuc N.T., Larsson M., Do N.T., et al. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol 2002; 55:1148-55.
-
47.
Lamsam G.D., Kropff M.A. Community pharmacists’ assessments and recommendations for treatment in four case scenarios. Ann Pharmacother 1998; 32:409-16.
-
48.
Ralph S.G., Preston A., Clarke J. Over-the-counter advice for genital problems: the role of the community pharmacist. Int J STD AIDS 2001; 12:513-5.
-
49.
Hellinger W.C. Confronting the problem of increasing antibiotic resistance. South Med J 2000; 93:842-8.
-
50.
Hoiby N. Ecological antibiotic policy. J Antimicrob Chemother 2000; 46 (Suppl. 1):59-62.
-
51.
Liu Y.C., Huang W.K., Huang T.S., et al. Inappropriate use of antibiotics and the risk for delayed admission and masked diagnosis of infectious diseases: a lesson from Taiwan. Arch Intern Med 2001; 161:2366-70.
-
52.
Okeke I.N., Lamikanra A., Edelman R. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis. 1999; 5(1):18-27.