Behind the Pharmacy Counter: An Exploration of Antimicrobial Resistance (AMR) from a Customer-Centric Perspective. A National Study of Saudi Pharmacies.
Main Article Content
Keywords
Antimicrobial, Resistance, Pharmacy, Saudi pharmacies, Customer-Centric Perspective
Abstract
The misuse of antibiotics contributes to the development of antibiotic resistance, posing serious global health risks. Understanding public awareness is crucial in addressing this issue. This research investigates the awareness, attitudes, and behaviours related to antibiotics and their use among pharmacy customers in Saudi Arabia. Methods: A comprehensive questionnaire was developed and refined through expert evaluation and field testing. The study was conducted in pharmacies. Data collection involved a systematic approach using Google Forms and QR codes. The analysis was conducted through descriptive statistics and ANOVA to assess demographic influences by using SPSS. Results: This study involves the 718 customers, 16 withdrew, yielding a 97.8% response rate. A significant portion (46.2%) of participants were aged 25 years or younger, with males comprising 71.1%. More than half (56.4%) held bachelor’s degrees. About 53.1% perceived antibiotics and anti-inflammatory drugs as dissimilar medications. A notable majority (70.7%) understood antibiotics as intended solely for bacterial infections, while 80.3% expressed concern about excessive antibiotic use. Around 43.3% believed expensive antibiotics didn’t guarantee safety or effectiveness. Additionally, 66.3% believed in the efficacy of multiple antibiotics, but 69.5% cautioned against saving and reusing leftover antibiotics. A minority (21.1%) admitted to never reading antibiotic instructions, contrasting with 40.7% who reported consulting doctors before changing antibiotics. Educational level significantly influences the knowledge, attitudes, and practices concerning antibiotic usage. Conclusion: Positive and concerning trends in antibiotic awareness and usage reveal the need for targeted education campaigns to promote responsible antibiotic usage and combat the growing threat of antimicrobial resistance.
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1-12
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9. Davey P, Pagliari C, Hayes A. The patient’s role in the spread and control of bacterial resistance to antibiotics. Clinical
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10. Buke C, Hosgor-Limoncu M, Ermertcan S, Ciceklioglu M, Tuncel M, Köse T. Irrational use of antibiotics among university
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11. Chen C, Chen Y-M, Hwang K-L, Lin S-J, Yang C-C, Tsay R-W. Behavior, attitudes and knowledge about antibiotic usage among
residents of Changhua, Taiwan. J Microbiol Immunol Infect. 2005;38(1):53–9
12. Hutchings MI., Truman AW, Wilkinson B. Antibiotics: Past, present and future. Curr. Opin. Microbiol. 2019; 51:72–80
13. Atif M, Zia R, Malik I, Ahmad N, Sarwar S. Treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis
patients attending Bahawal Victoria Hospital, Pakistan. PLoS One. 2021 13;16(1): 1-13
14. Septimus EJ. Antimicrobial Resistance: An Antimicrobial/Diagnostic Stewardship and Infection Prevention Approach. Med.
Clin. North Am. 2018; 102:819–829
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16. McNulty CA, Boyle P, Nichols T, Clappison P, Davey P. Don’t wear me out—the public’s knowledge of and attitudes to antibiotic
use. Journal of Antimicrobial Chemotherapy. 2007;59(4):727–38
17. Aponte-González J, González-Acuña A, Lopez J, Brown P, Eslava-Schmalbach J. Perceptions in the community about the use of
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6
19. Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: a systematic
review and meta-analysis. PloS one. 2017;12(12): 1-16
20. Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA. Global increase and geographic convergence in antibiotic
consumption between 2000 and 2015. Proceedings of the National Academy of Sciences. 2018;115(15):3463–70
21. Bryce A, Costelloe C, Wootton M, Butler CC, Hay AD. Comparison of risk factors for, and prevalence of, antibiotic resistance
in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. Journal of
Antimicrobial Chemotherapy. 2018;73(5):1359–67
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D.T., Gelband H., Horton S., Jha P., Laxminarayan R., Mock C.N., Nugent R., editors. Disease Control Priorities: Improving Health
and Reducing Poverty. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; Washington, DC,
USA: 2018.
23. Singh R, Singh A, Kumar S, Giri B, Kim KH. Antibiotic Resistance in Major Rivers in the World: A Systematic Review on Occurrence,
Emergence, and Management Strategies. J Clean Prod. 2019; 234:1484–1505
24. Gottlieb T, Nimmo GR. Antibiotic resistance is an emerging threat to public health: An urgent call to action at the Antimicrobial
Resistance Summit 2011. Med J Aust. 2011;194: 281–283
25. Halls A, Van’t Hoff C, Little P, Verheij T, Leydon GM. Qualitative interview study of parents’ perspectives, concerns and
experiences of the management of lower respiratory tract infections in children in primary care. BMJ Open. 2017; 7:1-12
26. Huttner B, Saam M, Moja L, Mah K, Sprenger M, Harbarth S., Magrini N. How to improve antibiotic awareness campaigns:
Findings of a WHO global survey. BMJ Glob Health. 2019; 4:1-16 27. McCullough AR., Parekh S, Rathbone J, Del Mar CB, Hoffmann TC. A systematic review of the public’s knowledge and beliefs
about antibiotic resistance. J. Antimicrob Chemother. 2016; 71:27–33
28. Almohammed RA, Bird EL. Public knowledge and behaviours relating to antibiotic use in Gulf Cooperation Council countries: A
systematic review. J Infect Public Health. 2019;12(2):159-166.
29. Chang J, Ye D., Lv B, Jiang M, Zhu S, Yan K, Fang Y. Sale of antibiotics without a prescription at community pharmacies in urban
China: A multicentre cross-sectional survey. J Antimicrob Chemother. 2017; 72:1235–1242
30. World Health Organization The Pursuit of Responsible Use of Medicines. [accessed on 23 December 2023]; 2012 Available:
https://www.who.int/medicines/publications/responsible_use/en/
31. Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS, Monnet DL, SAR Consortium Attitudes, beliefs and
knowledge concerning antibiotic use and self-medication: A comparative European study. Pharmacoepidemiol. Drug Saf.
2007; 16:1234–1243
32. Andre M, Vernby A, Berg J, Lundborg CS. A survey of public knowledge and awareness related to antibiotic use and resistance
in Sweden. J Antimicrob Chemother. 2010; 65:1292–1296
33. Vallin M, Polyzoi M, Marrone G, Rosales-Klintz S, Wisell KT, Lundborg CS. Knowledge and attitudes towards antibiotic use and
resistance—a latent class analysis of a Swedish population-based sample. PLoS ONE. 2016; 11:1-15
34. Jose J, Jimmy B, Alsabahi AG, Al Sabei GA. A study assessing public knowledge, belief and behavior of antibiotic use in an omani
population. Oman Med J. 2013;28(5):324-30.
35. Waaseth M, Adan A, Røen IL, Eriksen K, Stanojevic T, Halvorsen KH, Ariansen H. Knowledge of antibiotics and antibiotic
resistance among Norwegian pharmacy customers—A cross-sectional study. BMC Public Health. 2019; 19:66–70
36. Al Omari S, Al Mir H, Wrayde S, Merhabi S, Dhaybi I, Jamal S, Al Atrouni A. First Lebanese Antibiotic Awareness Week campaign:
Knowledge, attitudes and practices towards antibiotics. J Hosp Infect. 2019; 101:475–479.
37. Asghar S, Atif M, Mushtaq I, Malik I, Hayat K, Babar ZU. Factors associated with inappropriate dispensing of antibiotics among
non-pharmacist pharmacy workers. Res Social Adm Pharm. 2020;16(6):805-811
38. Huang Y, Gu J, Zhang M, Ren Z, Yang W, Chen Y. Knowledge, attitude and practice of antibiotics: a questionnaire study among
2500 Chinese students. BMC medical education. 2013;13(1):1–9
39. Jairoun A, Hassan N, Ali A, Jairoun O, Shahwan M. Knowledge, attitude and practice of antibiotic use among university students:
a cross sectional study in UAE. BMC public health. 2019;19(1):1–8
40. Raosoft Sample Size Calculator. Available o: http://www.raosoft.com/samplesize.html (accessed on 8 Nov 2023).
41. Alenezi S, Alanazi M, Aljazaeri R, Almuzaini M, Alrasheidi S, Shamlan WB, Aljohani R, Alhawiti G, Alqarni M, Aljabri E, Qmmash
M, Kanan M. Community Pharmacies in the Asian Countries of Developing Health System: Formation, Regulation, and
Implication. Pharmacy (Basel). 2023; 11(4):1-18
42. Vallin M. Knowledge and attitudes towards antibiotic use and resistance - a latent class analysis of a Swedish population-based
sample. PLoS One. 2016;11(4): e0152160.
43. Kotwani A, Joshi J, Lamkang AS, Sharma A, Kaloni D. Knowledge and behavior of consumers towards the non-prescription
purchase of antibiotics: An insight from a qualitative study from New Delhi, India. Pharm Pract (Granada). 2021;19(1): 1-12
44. Alhomoud F, Aljamea Z, Basalelah L. “Antibiotics kill things very quickly” - consumers’ perspectives on non-prescribed antibiotic
use in Saudi Arabia. BMC Public Health. 2018,16;18(1):1-17
45. Belkina T, Alwarafi A, Hussein Eltom E, Tadjieva N, Kubena A, Vlcek J. Antibiotic use and knowledge in the community of Yemen,
Saudi Arabia, and Uzbekistan. J Infect Dev Ctries. 2014;8(4):424–429.
46. Emeka PM, Al-Omar M, Khan TM. Public attitude and justification to purchase antibiotics in the eastern region Al Ahsa of Saudi
Arabia. Saudi Pharm J. 2014;22(6):550–554
47. Anghel IB, Craciun C. Self-medication with over-the-counter drugs and antibiotics in Romanian consumers: a qualitative study.
Cogn Brain Behav. 2013;17(3):215–235
48. Gualano M.R., Gili R., Scaioli G., Bert F., Siliquini R. General population’s knowledge and attitudes about antibiotics: A systematic
review and meta-analysis. Pharmacoepidemiol.Drug Saf.2015;24:2–10.
49. Sitotaw B, Philipos W. Knowledge, Attitude, and Practices (KAP) on Antibiotic Use and Disposal Ways in Sidama Region, Ethiopia:
A Community-Based Cross-Sectional Survey. ScientificWorldJournal. 2023, 26;1-20
50. Awad A.I., Aboud E.A. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS ONE. 2015;10:
1-15
51. Cuzzolin L, Benoni G. Safety of non-prescription medicines: knowledge and attitudes of Italian pharmacy customers. Pharm
World Sci. 2010;32(1):97–102.
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May 23, 2025
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Behind the Pharmacy Counter: An Exploration of Antimicrobial Resistance (AMR) from a Customer-Centric Perspective. A National Study of Saudi Pharmacies. Pharm Pract (Granada) [Internet]. 2025 May 23 [cited 2025 Jul. 16];23(2):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3165
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How to Cite
1.
Behind the Pharmacy Counter: An Exploration of Antimicrobial Resistance (AMR) from a Customer-Centric Perspective. A National Study of Saudi Pharmacies. Pharm Pract (Granada) [Internet]. 2025 May 23 [cited 2025 Jul. 16];23(2):1-9. Available from: https://pharmacypractice.org/index.php/pp/article/view/3165