Developing Strategies For Combating Antimicrobial Resistance In Community Pharmacies

Authors

  • Jitendra Singh
  • Anju Dinkar
  • Ramanand Yadav
  • Nilesh Kumar
  • Debojit Samajdar
  • Medha Wadhwa

DOI:

https://doi.org/10.63682/jns.v14i4.3159

Keywords:

Antimicrobial resistance, community pharmacies, antibiotic misuse, stewardship programs, patient education

Abstract

Antibiotic resistance represents a major global health threat, the scale of which is often exacerbated by misuse of antibiotics and weak regulatory environments, a key issue in low and middle-income countries. This study looks at how community pharmacies in India can address Antimicrobial Resistance (AMR), through pharmacy staff and patients’ knowledge, attitudes, and practices (KAP). Data were collected using a mixed methodology from 250 pharmacy staff and 300 patients in urban, suburban, and rural areas. Pharmacy staff knowledge levels were found to be moderate, with significant geographic disparities towards urban areas, and positive, but uneven, attitudes toward AMR management. Practice compliance scores (PCS) were variable, with the highest adherence (80%) in urban pharmacies and the lowest (65%) in rural pharmacies. Awareness about AMR was critically low (30%), and a high rate of self medication (55%) was present, driven by past experience with antibiotics and convenience. These findings underscore the need for targeted interventions, but they also need pharmacy staff training programs, public education campaigns and the implementation of antimicrobial stewardship programs (ASPs) targeted to their local context. In response, it underscores the need for regulatory reform that will support the enforcement of prescription requirements, and enhance the dispensing practices. This has implications for LMICs, and provides a framework for leveraging community pharmacies to address AMR. Community pharmacies have the capacity to transform their role in reducing AMR and protecting public health by filling in the identified gaps.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Aggarwal, R., Mahajan, P., Pandiya, S., Bajaj, A., Verma, S. K., Yadav, P., Kharat, A. S., Khan, A. U., Dua, M., & Johri, A. K. (2024). Antibiotic resistance: a global crisis, problems and solutions. Critical reviews in microbiology, 50(5), 896–921. https://doi.org/10.1080/1040841X.2024.2313024

Bhardwaj, S., Mehra, P., Dhanjal, D. S., Sharma, P., Sharma, V., Singh, R., Nepovimova, E., Chopra, C., & Kuča, K. (2022). Antibiotics and Antibiotic Resistance- Flipsides of the Same Coin. Current pharmaceutical design, 28(28), 2312–2329. https://doi.org/10.2174/1381612828666220608120238

Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019). Global Contributors to Antibiotic Resistance. Journal of global infectious diseases, 11(1), 36–42. https://doi.org/10.4103/jgid.jgid_110_18

Darby, E. M., Trampari, E., Siasat, P., Gaya, M. S., Alav, I., Webber, M. A., & Blair, J. M. A. (2023). Molecular mechanisms of antibiotic resistance revisited. Nature reviews. Microbiology, 21(5), 280–295. https://doi.org/10.1038/s41579-022-00820-y

Hasanuzzaman, M., Bang, C. S., & Gong, E. J. (2024). Antibiotic Resistance of Helicobacter pylori: Mechanisms and Clinical Implications. Journal of Korean medical science, 39(4), e44. https://doi.org/10.3346/jkms.2024.39.e44

Karaman, R., Jubeh, B., & Breijyeh, Z. (2020). Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approaches. Molecules (Basel, Switzerland), 25(12), 2888. https://doi.org/10.3390/molecules25122888

Lin, E. Y., Adamson, P. C., & Klausner, J. D. (2021). Epidemiology, Treatments, and Vaccine Development for Antimicrobial-Resistant Neisseria gonorrhoeae: Current Strategies and Future Directions. Drugs, 81(10), 1153–1169. https://doi.org/10.1007/s40265-021-01530-0

Liu, J. H., Liu, Y. Y., Shen, Y. B., Yang, J., Walsh, T. R., Wang, Y., & Shen, J. (2024). Plasmid-mediated colistin-resistance genes: mcr. Trends in microbiology, 32(4), 365–378. https://doi.org/10.1016/j.tim.2023.10.006

Netthong, R., Donsamak, S., John, D. N., Kane, R., & Armani, K. (2024). Empowering Thai community pharmacists in combating antimicrobial resistance: Qualitative insight and sentiment analysis. Exploratory research in clinical and social pharmacy, 16, 100535. https://doi.org/10.1016/j.rcsop.2024.100535

Revie, N. M., Iyer, K. R., Robbins, N., & Cowen, L. E. (2018). Antifungal drug resistance: evolution, mechanisms and impact. Current opinion in microbiology, 45, 70–76. https://doi.org/10.1016/j.mib.2018.02.005

Roy, R., Tiwari, M., Donelli, G., & Tiwari, V. (2018). Strategies for combating bacterial biofilms: A focus on anti-biofilm agents and their mechanisms of action. Virulence, 9(1), 522–554. https://doi.org/10.1080/21505594.2017.1313372

Salam, M. A., Al-Amin, M. Y., Salam, M. T., Pawar, J. S., Akhter, N., Rabaan, A. A., & Alqumber, M. A. A. (2023). Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare (Basel, Switzerland), 11(13), 1946. https://doi.org/10.3390/healthcare11131946

Tagliaferri, T. L., Jansen, M., & Horz, H. P. (2019). Fighting Pathogenic Bacteria on Two Fronts: Phages and Antibiotics as Combined Strategy. Frontiers in cellular and infection microbiology, 9, 22. https://doi.org/10.3389/fcimb.2019.00022

Uddin, T. M., Chakraborty, A. J., Khusro, A., Zidan, B. R. M., Mitra, S., Emran, T. B., Dhama, K., Ripon, M. K. H., Gajdács, M., Sahibzada, M. U. K., Hossain, M. J., & Koirala, N. (2021). Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects. Journal of infection and public health, 14(12), 1750–1766. https://doi.org/10.1016/j.jiph.2021.10.020

World Health Organization. (2021). Antimicrobial resistance: Global report on surveillance. Geneva: World Health Organization. Retrieved from https://www.who.int/antimicrobial-resistance/en/

Wu, Y., Battalapalli, D., Hakeem, M. J., Selamneni, V., Zhang, P., Draz, M. S., & Ruan, Z. (2021). Engineered CRISPR-Cas systems for the detection and control of antibiotic-resistant infections. Journal of nanobiotechnology, 19(1), 401. https://doi.org/10.1186/s12951-021-01132-8

Yan, J., & Bassler, B. L. (2019). Surviving as a Community: Antibiotic Tolerance and Persistence in Bacterial Biofilms. Cell host & microbe, 26(1), 15–21. https://doi.org/10.1016/j.chom.2019.06.002

Yu, L., Shang, Z., Jin, Q., Chan, S. Y., Hong, W., Li, N., & Li, P. (2023). Antibody-Antimicrobial Conjugates for Combating Antibiotic Resistance. Advanced healthcare materials, 12(1), e2202207. https://doi.org/10.1002/adhm.202202207

Zahari, N. I. N., Engku Abd Rahman, E. N. S., Irekeola, A. A., Ahmed, N., Rabaan, A. A., Alotaibi, J., Alqahtani, S. A., Halawi, M. Y., Alamri, I. A., Almogbel, M. S., Alfaraj, A. H., Ibrahim, F. A., Almaghaslah, M., Alissa, M., & Yean, C. Y. (2023). A Review of the Resistance Mechanisms for β-Lactams, Macrolides and Fluoroquinolones among Streptococcus pneumoniae. Medicina (Kaunas, Lithuania), 59(11), 1927. https://doi.org/10.3390/medicina59111927

Zowawi H. M. (2016). Antimicrobial resistance in Saudi Arabia. An urgent call for an immediate action. Saudi medical journal, 37(9), 935–940. https://doi.org/10.15537/smj.2016.9.16139

Singh J, Kishor K, Dinkar A, Atam V, Patel ML, Agrawal K. Methemoglobinemia due to Nitrobenzene Poisoning; A Rare Case Series. Adv. Biores 2015; 6(6):158-161. DOI: 10.15515/abr.0976-4585.6.6.158161

Singh J, Gupta KK, Dinkar A, Atam V, Mishra R. Steven-Johnson Syndrome following Sodium Valproate Monotherapy. Indian Journal of Pharmacy and Pharmacology 2016;3(4);227-228.

Atam V, Singh J, Agrawal K, Dinkar A, Atam I. A case report of valproate-induced acute pancreatitis. J Med Soc 2017;31:48-9. DOI: 10.4103/0972-4958.198463

Singh J, Atam V, Dinkar A. Acute onset sensory polyneuropathy due to metronidazole therapy. J Assoc Physicians India 2015;63:87-88.PMID: 27608880.

Singh J, Patel ML, Gupta KK, Pandey S, Dinkar A. Acquired Bartter syndrome following gentamicin therapy. Indian J Nephrol 2016;26:461-3.

Sawlani KK, Chaudhary SC, Singh J, Raja, Mishra S, Goel MM. Dapsone-induced pure red cell aplasia and cholestatic jaundice: A new experience for diagnosis and management. J Res Pharm Prac 2016;5:215-8.DOI: 10.4103/2279-042X.185743

Kishor K, Singh J, Dinkar A, Atam. A, Gupta KK. A Case Report of Sildenafil Poisoning and an Approach to Management. Toxicol Int. 2015;22(2):126-28. DOI: 10.22506/ti/2015/v22/i2/137678

Downloads

Published

2025-04-07

How to Cite

1.
Singh J, Dinkar A, Yadav R, Kumar N, Samajdar D, Wadhwa M. Developing Strategies For Combating Antimicrobial Resistance In Community Pharmacies. J Neonatal Surg [Internet]. 2025Apr.7 [cited 2025Jul.10];14(4):408-17. Available from: https://jneonatalsurg.com/index.php/jns/article/view/3159