INTRODUCTION:

Antimicrobial stewardship (AMS) is a comprehensive approach designed to ensure the optimal use of antimicrobial agents, aiming to achieve the best possible clinical outcomes while minimizing adverse reactions and preventing antimicrobial resistance. AMS programs seek to guide healthcare providers on the appropriate selection, dose, route, and duration of antimicrobial therapy, thereby maximizing clinical benefit and limiting risks associated with unnecessary antibiotic use. Community AMS programs promote the judicious use of antibiotics in outpatient settings such as primary care clinics and long-term care facilities.

In contrast, hospital AMS programs are dedicated to optimizing the use of antimicrobials within hospital settings, ensuring that hospitalized patients receive the optimal antibiotic with an appropriate dose and duration. The core elements of community AMS are antibiotic prescribing guidelines, education and training for healthcare providers, monitoring and feedback on prescribing practices, and public awareness campaigns on responsible antibiotic use.^1-4

AMS does not just focus on restricting antibiotic usage; it emphasizes a balanced approach. The primary aim is to ensure that patients receive the most suitable antibiotic, administered correctly in terms of dose and duration, and at the appropriate moment. By doing so, AMS programs ensure that antimicrobials are used judiciously, preserving their efficacy for future generations and reducing the adverse impacts on both individual patients and global public health. Antibiotic resistance, as emphasized by the World Health Organization (WHO), poses an alarming threat to global health, safety, and security.^5-6

Being strategically situated in communities, pharmacistscould play an important role in AMS, but they need to be prepared for it. In terms of AMS, pharmacists hold the responsibility of ensuring that antibiotics are dispensed correctly, discouraging over-the-counter sales without prescriptions, and educating patients about the importance of adhering to the recommended treatment regimen.Many findings were also reported from different countries on the awareness and role of community pharmacists in AMS.^7-11Abilities of pharmacists in communicating with patients is important. Conversation of pharmacists to patients will be successful if they are trained for it.^12-17This study's objective was to explore community pharmacists' perceptions and practices towards AMS through a continuing education session.

MATERIALS AND METHODS:

Research Design and Settings:

A pre-posteducational interventional study was conducted in 2023. Initially, a survey was distributed for community pharmacists in the UAE to fill out. This survey aimed to capture insights into their general perception and perception of practices towards AMS. Subsequent to the survey, a training webinar was organized. These discussions served as a platform to delve deeper into the perceived scope of AMS. Specifically, the conversations centered around the influence of these stewardship initiatives on patterns of antibiotic utilization, the resultant patient outcomes, and implications for healthcare costs. The first follow-up survey immediately after the webinar was to assess changes in general perception. This second survey, after one month, was to assess improvements in the perception of the practice of the study participants.

Study Population:

Specific inclusion criteria were established to select eligible community pharmacists. Only those community pharmacists who were practicing in the UAE, whether in urban or rural locations, were asked to fill out the survey. Consent had to be agreed upon to fill out the survey. A study was planning a training workshop with active discussions among the study participants; the study aimed to have a limited number of interested pharmacists enroll. This was naturally the case when a webinar on a specific topic was designed to attract those who were interested in the area of focus. The study was planned for approximately 50 participants as usually attending for such continuing education programs.

Ethical consideration:

The study protocol was approved by the ethical committee of the College of Pharmacy, Gulf Medical University (IRB:COP/STD/03/Jan-2022) dated January 19, 2022. The research methodology adhered to the ethical guidelines enumerated in the World Medical Association Declaration of Helsinki and, thus, the IRB. All participants provided their consent to research. Moreover, it was emphasized that their individual responses would be treated with confidentiality, and evaluations would be conducted by excluding participants' personal identifiers.

Continuing Education (intervention) and Data Collection To study pharmacists’ perceptions regarding AMS, an extensive literature search was conducted across several databases, including Google Scholar, TRIPPro, and PubMed. This literature search facilitated the identification of relevant literature on the topic. Using the insights gathered, a preliminary questionnaire was formulated, aligning with the study's objectives.

The developed questionnaire consisted of three sections with a total of 32 questions. The questionnaires' content was reviewed by two experts in the field, and face validity was checked by a few pharmacists before wide circulation. Section one (Demographics) included nine questions about their gender, residence, and years of experience. In the same section, the participants were asked about the source of the prescription (Hospital, Clinic, Independent Doctor, or All of them). In addition, they were asked if they had studied AMS in their degree program or received training within the continuing education programs. The second section was designed to evaluate the community pharmacist perception and belief towards antimicrobial resistance and the importance of AMS programs. This section consisted of six 5-point Likert scale questions that focused on the importance of the role of community pharmacists in AMS programs, the need for continuing education programs about AMS, and the role of AMS in improving infection cure rate, reducing antimicrobial resistance, decreasing health care cost, and improving the collaboration between healthcare professionals. The responses to these questions were Strongly agree, agree, neither agree nor disagree, Disagree, or Strongly disagree. The third section was divided into two subsections: IIIA, which evaluated the AMS contribution with patients (13 questions), and IIIB, which evaluated AMS contribution in collaboration with prescribers (4 questions). These questions were designed in a scale format from 0 to 10, where 0 indicates the lowest contribution and 10 indicates the highest contribution, helping in statistical analysis as changes in practice were expected to be less prominent than changes in perception.

Feedback from experts in similar research and a few pharmacists were instrumental in refining the tool for relevance. Some pharmacists tested the clarity and readability of the questionnaire. The final questionnaire was distributed among the community pharmacists using Google Forms. The questionnaire was distributed using online platforms such as WhatsApp, LinkedIn, and Telegram groups of community pharmacists in UAE, as well as offline visits to several pharmacies in Abu Dhabi, Dubai, Sharjah, and Al-Ain.

After receiving the initial responses from the participants, they were invited to attend a one-hour webinar entitled "AMS in Community Pharmacies: Creating Microenvironments of Patient Safety." This webinar was held online and was moderated by six experts with pharmacy and medical backgrounds, including academicians and practitioners in the UAE and USA. The objective of this webinar was to give an overview of AMS, the role of community pharmacists in AMS programs, and, finally, a panel discussion about the participants' practice towards AMS. One-month post-discussion, the same survey was distributed among the participants to assess the potential evolution of perceptions and to measure the impact of the focus group discussions.

Data Analysis:

The collected data at the first and second phases were added to a Microsoft Excel spreadsheet in the form of pre- and post-group discussions. All analyses were performed using the Statistical Package for Social Science (SPSS software, IBM Inc., version 26). Pre- and post-test scores were compared using the McNemar test, where applicable. In the case of the inapplicability of McNemar, binomial distribution was used for the comparison of proportions. The paired samples Wilcoxon test (also known as the Wilcoxon signed-rank test) was used instead of the paired T-test to compare paired data. A p-value of less than 0.05 was considered statistically significant.

RESULTS:

Demographic Characteristics:

A total of 28 community pharmacists completed all steps in the study. The majority of the participants were males (n=17, 60.7%). More information about the study participants is shown in Table 1.

Table 1: Demographic Characteristics

Variables		Number	%
Gender	Female	11	39.3
Gender	Male	17	60.7
Years of Experience	2-5 Years	7	25.0
	5-10 Years	13	46.4
	More than 10 Years	8	28.6
I did Study Antimicrobial Stewardship in my Degree Program	No	17	60.7
I did Study Antimicrobial Stewardship in my Degree Program	Yes	11	39.3
Antimicrobial stewardship continuing education or seminar I attended recently within one year	No	18	64.3
	Yes	10	35.7

Perception towards AMS by the study participants before and after the training was summarized in Table 2. Change of perception on “Antimicrobial Stewardship decreases healthcare costs” was statistically significant.

Changes perceived by the participants on their AMS practice with patients and physicians were significant for some items, as shown in Tables 3 and 4.

Table 2: Perceptions of participants towards AMS Pre- and Post-training

Question	Answer	Pre-Training		Post-Training		p-value
Question	Answer	N (%)	Mean score	N (%)	Mean score	p-value
Community Pharmacists have important roles to play in Antimicrobial Stewardship efforts	Strongly agree	16 (57.1%)	4.57±0.504	11 (39.3%)	4.29±0.81	0.108
	Agree	12 (42.9%)		16 (57.1%)
	Neither agree nor disagree	0 (0%)		0 (0%)
	Disagree	0 (0%)		0 (0%)
	Strongly disagree	0 (0%)		1 (3.6%)
Community pharmacists need continuing education on Antimicrobial Stewardship	Strongly agree	16 (57.1%)	4.39±0.956	5 (17.9%)	4.18±0.39	0.124
	Agree	10 (35.7%)		23 (82.1%)
	Neither agree nor disagree	0 (0%)		0 (0%)
	Disagree	1 (3.6%)		0 (0%)
	Strongly disagree	1 (3.6%)		0 (0%)
Antimicrobial stewardship improves infection cure rates	Strongly agree	11 (39.3%)	4.36± 0.559	13 (46.4%)	4.46± 0.508	0.439
	Agree	16 (57.1%)		15 (53.6%)
	Neither agree nor disagree	1 (3.6%)		0 (0%)
	Disagree	0 (0%)		0 (0%)
	Strongly disagree	0 (0%)		0 (0%)
Antimicrobial stewardship reduces antimicrobial resistance	Strongly agree	13 (46.4%)	4.29± 0.93	9 (32.1%)	4.18± 0.819	0.499
	Agree	13 (46.4%)		17 (60.7%)
	Neither agree nor disagree	0 (0%)		1 (3.6%)
	Disagree	1 (3.6%)		0 (0%)
	Strongly disagree	1 (3.6%)		1 (3.6%)
Antimicrobial stewardship decreases healthcare costs	Strongly agree	6 (21.4%)	3.93± 0.716	13 (46.4%)	4.46±0.508	0.006
	Agree	14 (50.0%)		15 (53.6%)
	Neither agree nor disagree	8 (28.6%)		0 (0%)
	Disagree	0 (0%)		0 (0%)
	Strongly disagree	0 (0%)		0 (0%)
Antimicrobial stewardship improves the collaboration between healthcare professionals	Strongly agree	6 (21.4%)	4.07±0.663	6 (21.4%)	4.07±0.766	0.854
	Agree	19 (67.9%)		20 (71.4%)
	Neither agree nor disagree	2 (7.1%)		1 (3.6%)
	Disagree	1 (3.6%)		0 (0%)
	Strongly disagree	0 (0%)		1 (3.6%)

Table 3: Antimicrobial Stewardship Practice Change with Patients

Questions	Pre-training Score	Post-training Score	P-value
I am available to patients with minor infections as their first point of contact	6.7±2.1	7.8±2.5	0.044
I educate patients on the prevention and control of infections on opportunities arise	7.6±1.7	8.2±2.5	0.166
I advise patients on their symptoms, self-care, and OTC products required for infection management	8.4±1.7	7.9±2.4	0.472
I recognize patients who do not need a referral to the doctor and provide necessary advice for minor infections	7.7±1.8	7.7±2.3	0.935
Providing advice and support on self-care and over-the-counter products for patients with ill health, exhibiting no complications or signs of bacterial infection requiring antibiotics	7.7±1.8	8±2.4	0.343
I identify patients with viral infections showing no complications, which need only self-care and OTC products to manage	7.1±2.2	7.9±2.1	0.162
I identify 'alarm' symptoms that require further investigation	6.9±2	8.1±2.2	0.01
I am conducting public health campaigns and opportunistic patient advice and counseling such as hygiene, appropriate use of antimicrobials and self-care	5.9±2.8	6.9±2.7	0.265
I am successfully promoting required immunization to my patients, including flu vaccination	7.3±1.9	7.2±2.7	0.858
I am providing simple diagnostic tests to identify bacterial infection	3.9±3.2	5.5±3	0.047
I am providing preventative advice, particularly for individuals who suffer from recurring infections, e.g., urinary tract infections and upper respiratory infections	7.9±1.6	7.1±2.4	0.153
I am collecting and recording drug allergy history information, including the type of reaction and severity	5.4±3.1	7.5±2.7	0.02
I provide follow-up calls to patients on their antibiotic use	5.4±2.8	6.9±2.9	0.079

Table 4: Antimicrobial Stewardship Practice Change with Prescribers

Questions	Pre-training Score	Post-training Score	P-value
I verify all my patients are prescribed with the right antibiotic choice	7.8±1.9	7.5±2.6	0.931
I am discussing with prescribers if I have a concern on antibiotics prescribed	6.9±2.6	8.0±2.5	0.072
I am advising the doctors prescribing antibiotics on the current antibiotic evidence base and appropriateness of prescribing for different conditions	5.8±2.8	7.6±2.5	0.011
I am contributing to the development of local formularies (list of antibiotics to use) of clinics or doctors for who, I frequently dispense antibiotics	4.5±2.9	6.8±2.9	0.002

The overall score of practice has been improved significantly (p-value 0.025) from 112.9±21.3 at pre-training to 126.6±35.2 at post-training.

DISCUSSION:

In addition to previous studies in the region recognizing the role and practice of community pharmacists' antimicrobial stewardship, our study found how pharmacists can be efficiently trained to improve their general perception and practice with patients and physicians. Community pharmacists occupy a pivotal position in the efforts to implement effective AMS practices. As accessible healthcare providers who interact frequently with the public, they have the unique opportunity to guide appropriate antibiotic use, counsel patients, and work in collaboration with other healthcare providers. Such observations align with research conducted in both Australia and Tasmania, where the need for additional, more thorough training was similarly emphasized before implementing AMS programs in their healthcare environments.^18-20 In Saudi Arabia, 91% of the community pharmacists believe that AMS reduces the problem of antimicrobial resistance. In Jordan, 88.5% and 85.5% of the pharmacists agreed that AMS contributes to reducing the proportion of inappropriate use of antibiotics and the risk of resistance, respectively.^21,22

Moreover, AMS advances interdisciplinary collaboration among healthcare professionals, such as physicians, pharmacists, and nurses, encouraging a team-based approach to patient care. This synergistic effort contributes to more holistic and cost-effective healthcare delivery, enhancing both the quality of care and healthcare sustainability. About 92% of our participants agreed with the statement that AMS improves the collaboration between healthcare professionals. Saleh et al., showed that 87.5% of the pharmacists believe that AMS improves the collaboration between healthcare providers in Jordan. This near-unanimous agreement underscores the widely recognized value of AMS in not only optimizing antimicrobial use but also in fostering a unified, team-based approach to healthcare that elevates patient outcomes and system efficiency.^22,23

Pharmacists are to be trained for AMS like any other front-line healthcare professionals. It involves tracking drug utilization, impact of pharmacist roles as well as effectiveness of the training provided to pharmacists. It is almost impossible to tackle the antimicrobial resistance threat globally without pharmacists become responsible custodians of antimicrobial use in the society.^24-27

In our findings, there was no change in pharmacists' practice levels when it came to recognizing which patients do not need a doctor's referral and can be managed with advice for minor infections. The scores remained consistent pre-and post-training. Research has shown that accurate triage by pharmacists for minor infections can be a crucial step in the appropriate use of healthcare resources and can contribute to the overall goals of AMS.²⁸Past studies have underlined the importance of open dialogue between healthcare professionals for successful AMS programs, indicating that pharmacists should be more proactive in discussing prescriptions that they find concerning.²⁹

Our study also noted a significant increase in pharmacists' willingness to advise prescribers on the current evidence for antibiotics and the appropriateness of their use for different conditions. The improvement in this aspect is an encouraging sign, as it directly aligns with one of the primary objectives of AMS: to ensure that antibiotics are prescribed only when truly necessary and in accordance with the most current scientific evidence. Several studies have demonstrated that pharmacist-led interventions, which include advising on current evidence, can contribute substantially to more rational antibiotic use and, consequently, reduce antibiotic resistance.^30,31 Furthermore, the study revealed a statistically significant increase in pharmacists' contributions to the development of local formularies, which are curated lists of recommended antibiotics. This role allows pharmacists to have a direct impact on initial antibiotic choice at the point of prescribing, thereby promoting rational antibiotic use.³²

There should be a focus on outcomes-based research to measure the impact of community pharmacists in AMS efforts, which can inform future policy and guidelines. By engaging community pharmacists more actively in AMS, more public health benefits could be achieved, but for that, pharmacists need to be educated and trained as needed.

Limitations of the study:

The study primarily focused on pharmacists from major cities like Abu Dhabi, Dubai, Sharjah, and Al-Ain. This geographic limitation may not adequately represent community pharmacists from rural areas or smaller towns, whose experiences and challenges may differ significantly. Additionally, the survey relied on self-reported data, which could introduce bias as present in survey-based research.

CONCLUSION:

The study found that the general perception and practice of studied community pharmacists had limitations that can be improved with training. The perceptions of cost saving, managing minor infections, referrals for further investigation, and conducting point-of-care tests especially improved. While the results highlight those pharmacistsperceived as having some AMS abilities, they also reveal gaps in education and training. These educational and practice-related disparities point to the urgent need for substantial improvements in AMS-focused curricula in academic programs, continuous education, and inter-professional collaboration to elevate the practice standards and effectiveness of community pharmacists in combating antimicrobial resistance.In light of these findings, we recommend the following actions: Train and engage more community pharmacists in antimicrobial stewardship.

DATA AVAILABILITY:

Data available on request

CONFLICT OF INTEREST:

The authors disclose no conflicts of interest.

REFERENCES:

1. Dyar OJ, Huttner B, Schouten J, Pulcini C. What is antimicrobial stewardship?. Clin Microbiol Infect 2017; 23(11): 793-8. doi: 10.1016/j.cmi.2017.08.026.

2. Aryee A, Price N. Antimicrobial stewardship–can we afford to do without it?. Br J Clin Pharmacol 2015; 79(2): 173-81. doi: 10.1111/bcp.12417

3. Lee Y, Bradley N. Antimicrobial stewardship practices in a subset of community pharmacies across the United States. Pharm (Basel, Switzerland). 2023; 11(1): 26. doi: 10.3390/pharmacy11010026.

4. Centers for Disease Control and Prevention. Antibiotic prescribing and use: core elements of outpatient antibiotic stewardship. 2021. Available from: https://www.cdc.gov/antibiotic-use/core-elements/outpatient.html

5. Majumder MAA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, et al. Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Infect Drug Resist 2020; 13: 4713–38. doi: 10.2147/IDR.S290835.

6. World Health Organization (WHO). Antimicrobial resistance. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

7. Lim K, Broom A, Olsen A, Seale H. Community pharmacists as antimicrobial guardians and gatekeepers - A qualitative study of the perspectives of pharmacy sector stakeholders. Explor Res Clin Soc Pharm 2023; 9: 100212. doi: 10.1016/j.rcsop.2022.100212.

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

9. Saha SK, Kong DCM, Thursky K, Mazza D. Antimicrobial stewardship by Australian community pharmacists: Uptake, collaboration, challenges, and needs. J Am Pharm Assoc (2003). 2021; 61(2): 158-168.e7. doi: 10.1016/j.japh.2020.10.014.

10. Al-Shami HA, Abubakar U, Hussein MSE, Hussin HFA, Al-Shami SA. Awareness, practices and perceptions of community pharmacists towards antimicrobial resistance and antimicrobial stewardship in Libya: a cross-sectional study. J Pharm policy Pract 2023; 16(1): 46. doi: 10.1186/s40545-023-00555-y.

11. AlAhmad MM, Rabbani SA, Al-Salman R, Alameri H, Al Namer Y, Jaber AA. Antimicrobial Stewardship Practices of Community Pharmacists in United Arab Emirates. Vol. 12, Antibiot 2023; 12(8): 1238. doi: 10.3390/antibiotics12081238.

12. Thanmayi G, Shanmugasundaram P, Geeth P. Role of clinical pharmacist in improving patients compliance including risk factors among tuberculosis patients. Research Journal of Pharmacy and Technology. 2017; 10(9): 2945-8. doi: 10.5958/0974-360X.2017.00521.2

13. Azeez S, Panakkal LM, Meenpidiyil SS, Sulaiman N. Impact of clinical pharmacist intervention in promoting rational antibiotic use in pediatric patients. Research Journal of Pharmacy and Technology. 2020; Nov 1; 13(11): 5077-82. doi: 10.5958/0974-360X.2020.00889.6

14. Sharma P, Kumar M, Sharma D, Verma KK. A Review on Pharmacist Impact on patient safety. Asian Journal of Pharmacy and Technology. 2024; Mar 4; 14(1): 87-94. doi: 10.52711/2231-5713.2024.00016

15. Layqah LA, Alakeel YS, Shamou JZ. The practice of counseling in pharmacy: patients’ perspectives. Asian Journal of Research in Pharmaceutical Science. 2018; 8(3): 170-6. doi: 10.5958/2231-5659.2018.00030.9

16. Kengar MD, Patil AA, Ankush HS, Pawar SP, Bhagat VV. Importance of Communication and relation between Pharmacist and patient. Asian Journal of Pharmaceutical Research. 2022; 12(2): 176-8. doi: 10.52711/2231-5691.2022.00028

17. Kumar SR, Sunil KR, Pathak R, George SG. Assessment of knowledge and interest of community pharmacists for TB suspect referral programme and DOTS provisions in Bengaluru. Research Journal of Pharmacy and Technology. 2021; 14(2): 903-7. doi: 10.5958/0974-360X.2021.00160.8

18. Sarwar MR, Saqib A, Iftikhar S, Sadiq T. Knowledge of community pharmacists about antibiotics, and their perceptions and practices regarding antimicrobial stewardship: a cross-sectional study in Punjab, Pakistan. Infect Drug Resist 2018; 11: 133–45. doi: 10.2147/IDR.S148102

19. Essilini A, Pierre A, Bocquier A, Pulcini C, Wilcke C, Gravoulet J, et al. Community pharmacists’ views on their current role and future opportunities for antibiotic stewardship: a French qualitative study. JAC-antimicrobial Resist 2021; 3(3): dlab129. doi: 10.1093/jacamr/dlab129

20. Rizvi T, Thompson A, Williams M, Zaidi STR. Perceptions and current practices of community pharmacists regarding antimicrobial stewardship in Tasmania. Int J Clin Pharm 2018; 40(5): 1380–7. doi: 10.1007/s11096-018-0701-1.

21. Haseeb A, Essam Elrggal M, Saeed Bawazir M, Omar Bawazir M, Ur Rehman I, Saleh Faidah H, et al. Knowledge, attitude, and perception of community pharmacists towards antimicrobial stewardship in Saudi Arabia: A descriptive cross-sectional study. Saudi Pharm J SPJ Off Publ Saudi Pharm Soc 2022;30(11):1659–64. doi: 10.1016/j.jsps.2022.09.010.

22. Saleh D, Farha RA, El-Hajji FD. Antimicrobial stewardship in community pharmacies in Jordan: assessing current status. J Pharm Heal Serv Res 2021; 12(2): 181–7. doi: 10.3390/antibiotics10040384.

23. Garau J, Bassetti M. Role of pharmacists in antimicrobial stewardship programmes. Int J Clin Pharm. 2018; Oct; 40(5): 948-952. doi: 10.1007/s11096-018-0675-z.

24. Joshi Y, Gurung P, Jain S. Evaluation and Assessment of Drug Utilization in Patients of Urinary Tract Infections. Asian Journal of Pharmaceutical Research. 2018; 8(3): 167-9. doi: 10.5958/2231-5691.2018.00029.1

25. Basak SC, Sathyanarayana D. Evaluation of the impact of an educational workshop for community pharmacists. Research Journal of Pharmacy and Technology. 2009; 2(1): 144-6.

26. Bai HJ. Knowledge and Practice of Health Care Workers on Infection Control Measures. Asian Journal of Nursing Education and Research. 2015; 5(4): 518-22. DOI: 10.5958/2349-2996.2015.00106.8

27. Marnoor SA. A Review on Antimicrobial Resistance and Role of Pharmacist in tackling this Global Threat. Research Journal of Pharmaceutical Dosage Forms and Technology. 2017; 9(4): 143-6.

28. Rehman IU, Asad MM, Bukhsh A, Ali Z, Ata H, Dujaili JA, et al. Knowledge and Practice of Pharmacists toward Antimicrobial Stewardship in Pakistan. Pharm (Basel, Switzerland). 2018; 6(4). doi: 10.3390/pharmacy6040116.

29. Kumar KS, Saranya S, Rani NV. Community Pharmacists’ Knowledge, Attitude, and Nonprescription Dispensing Practices of Antibiotics: An Explorative Study in a Selected City of South India. J Res Pharm Pract 2022; 11(2): 51–8. doi: 10.4103/jrpp.jrpp_48_21.

30. Lambert M, Smit CCH, De Vos S, Benko R, Llor C, Paget WJ, et al. A systematic literature review and meta-analysis of community pharmacist-led interventions to optimise the use of antibiotics. Br J Clin Pharmacol 2022; 88(6): 2617–41. doi: 10.1111/bcp.15254.

31. Wilkinson A, Ebata A, MacGregor H. Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems. Vol. 8, Antibiot 2019; 8(1): 2. doi: 10.3390/antibiotics8010002.

32. Al-Taani GM, Al-Azzam S, Karasneh RA, Sadeq AS, Mazrouei N Al, Bond SE, et al. Pharmacists’ Knowledge, Attitudes, Behaviors and Information Sources on Antibiotic Use and Resistance in Jordan. Antibiot (Basel, Switzerland). 2022; 11(2). doi: 10.3390/antibiotics11020175.

Received on 24.03.2024 Revised on 12.07.2024

Accepted on 02.09.2024 Published on 20.01.2025

Available online from January 27, 2025

Research J. Pharmacy and Technology. 2025;18(1):251-256.

DOI: 10.52711/0974-360X.2025.00039

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.