Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries.

Introduction: Studies from developed and developing countries showed that the knowledge levels of stroke need improvement. Educational campaigns varied and were of limited influence predominantly because of their short duration and the need for financial support. The study aims to test the impact of a 3-min online video on the knowledge of stroke and factors influencing the knowledge score in four Arab countries. Methods: A cross-sectional web-based pre-post study was conducted in Egypt, Jordan, Lebanon, and the United Arab Emirates. The data were collected using the snowball technique. Participants were adults aged 18 years and above. The questionnaire sequence was conducting a pretest, followed by the educational video explaining stroke occurrence, types, risks, warning signs, preventive measures, and treatment, and finally, a posttest to evaluate the differences in knowledge from baseline. Statistical analysis included paired t-tests comparing pre-post-education stroke knowledge scores, while repeated measures ANOVA, adjusting for covariates, assessed mean changes. Results: The total number of participants was 2,721, mainly younger than 55 years. The majority had a university degree and were not healthcare professionals. A significant improvement was noted in the total knowledge score in all countries from a mean average (Mpretest = 21.11; Mposttest = 23.70) with p < 0.001. Identification of the stroke risks (Mpretest = 7.40; Mposttest = 8.75) and warning signs (Mpretest = 4.19; Mposttest = 4.94), understanding the preventive measures (Mpretest = 5.27; Mposttest = 5.39) and the importance of acting fast (Mpretest = 0.82; Mposttest = 0.85) improved from baseline with (p < 0.001) for all score components. Conclusion: The educational tool successfully enhanced public understanding of stroke risks, the identification of stroke signs, and the critical need for emergency action. The advantages of this video include its short length, free online access, use of evidence-based content in lay language, and reflective images. The ultimate goal remains the long-term improvement of sustainability by mandating full-scale trials.

The hidden dangers lurking at home: Unveiling the prevalence of leftover antibiotics and its associated factors among Lebanese households.

Background: Antimicrobial Resistance (AMR) is a major global concern. Irrational use of antibiotics including self-medication (SM) with leftovers without a medical prescription can be a leading cause. This study aimed to investigate the prevalence and related factors of leftover antibiotics (LA) in Lebanese households. Study design: A cross-sectional study of the Lebanese population was conducted between March and October 2022. Methods: Through random proportional stratified sampling, a total of 494 families participated in this study. Data collection was carried out through phone calls using a comprehensive and reviewed questionnaire. The data was then analyzed using SPSS version 26. Logistic regression was utilized to identify the factors associated with LA, with the presence of LA in households as the dependent variable and other factors such as age, region of residence, and presence of elderly individuals at home as the independent variables. Results: Among selected households, 118 households (23.89%) had LA. The most common type of antibiotic found was penicillin (59.84%). Most of the LA were in the form of tablets and capsules (94%) with valid expiration dates (87%). Antibiotics were mainly prescribed by doctors (61%), and the main reason for prescribing was acute respiratory tract infections (47.46%). SM was reported by 42.37% of the families with LA. A family with elderly patients (p = 0.002; OR = 2.23; 95% CI = 1.33-3.73) and those residing in Mount Lebanon (p = 0.019; OR = 2.28; 95% CI = 1.14-4.56) had significantly higher odds of having LA. Conclusion: Leftover antibiotics were found in nearly a quarter of the addressed Lebanese families. Therefore, public educational campaigns should be launched to limit injudicious antibiotic use including SM, and to promote proper disposal of any leftovers. It is also crucial to adopt the One Health approach by developing national programs for the safe disposal of LA and implementing regulations to restrict the distribution of antibiotics in pharmacies without a prescription.

Acinetobacter baumannii: assessing susceptibility patterns, management practices, and mortality predictors in a tertiary teaching hospital in Lebanon.

BACKGROUND: Acinetobacter baumannii is a major nosocomial pathogen capable of causing life-threatening infections. This bacterium is highly resistant to antibiotics and associated with high mortality rates. Therefore, this study aimed to evaluate A. baumannii's susceptibility patterns to antimicrobials, assess the appropriateness of the initiated antimicrobial therapy, determine the mortality rate, and identify predictors associated with mortality. METHODS: A retrospective observational study was conducted among patients infected with A. baumannii at a university hospital in Lebanon through the revision of medical records. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. RESULTS: The records of 188 patients were screened, and 111 patients with A. baumannii infection were enrolled. Almost all isolates were resistant to carbapenem, and 43% of the isolates were extensively-drug resistant. Almost half of the patients received initial inappropriate antimicrobial therapy (n = 50, 45.1%). The 30-day mortality rate associated with A. baumannii infection was 71.2% (79/111). The time to mortality in patients who received inappropriate antimicrobial therapy (5.70 ± 1.07 days) was significantly shorter than in those who received appropriate antimicrobial therapy (12.43 ± 1.01 days, P < 0.01). Binary logistic regression revealed that inappropriate antimicrobial therapy (adjusted odds ratio [AOR] = 16.22, 95% CI 2.68-9.97, P = 0.002), mechanical ventilation (AOR = 14.72, 95% CI 3.27-6.61, P < 0.001), and thrombocytopenia (AOR = 8.82, 95% CI 1.12-9.75, P = 0.003) were more likely associated with mortality. CONCLUSIONS: A. baumannii exhibits an alarming mortality rate among infected patients. Thrombocytopenia, mechanical ventilation, and inappropriate antibiotic administration are associated with mortality in patients infected with A. baumannii. The prompt initiation of appropriate antimicrobial therapy, infection control measures, and effective stewardship program are crucial to reduce the incidence of A. baumannii and improve the treatment outcomes.

Oral contraceptive pills shortage in Lebanon amidst the economic collapse: a nationwide exploratory study.

BACKGROUND: The political instability, economic crisis, and devaluation of the national currency left Lebanese females suffering from a scarcity of oral contraceptive pills (OCPs). Therefore, we aimed to identify the incidence of OCPs shortage in Lebanon and its impact on women's sexual and reproductive health, as well as physical and psychological well-being. METHODS: Community pharmacies were selected randomly across Lebanon, using a stratified sampling approach, where female clients asking for OCPs were interviewed using a standardized data collection form. RESULTS: A total of 440 females were interviewed. More than three-quarters of the participants (76.4%) reported not finding their preferred OCPs brands, almost 40% were affected by the increased prices, and 28.4% declared stockpiling OCPs. More than half of the participants using OCPs for pregnancy prevention reported adopting alternative traditional contraceptive methods (55.3%). Unplanned pregnancy was reported by 9.5% of participants, where 75% of them disclosed intentional abortion while the remaining (25%) reported experiencing a spontaneous miscarriage. Other consequences of OCPs shortage included mood disturbances (52.3%), dysregulation of menses (49.7%), dysmenorrhea (21.1%), weight gain (19.6%), acne (15.7%), and hirsutism (12.5%). Of the participants taking OCPs for birth control, 48.6% reported a reduced frequency of sexual intercourse, which led to conflicts with their partners (46%) and a decreased libido (26.7%). CONCLUSIONS: OCPs shortage has seriously and negatively exposed women to various undesirable consequences including unplanned pregnancy and dysregulation of menses. Therefore, there is an urgent need to bring the attention of healthcare authorities to support the national pharmaceutical industry in manufacturing affordable OCPs generics to meet women's reproductive health demands.

The mediating effect of body appreciation between muscle dysmorphia and bulimia nervosa among Lebanese adolescents.

BACKGROUND: Muscle dysmorphia (MD) is a common psychological disorder present in Lebanese adolescents. Several disorders can be present concomitantly with MD such as bulimia nervosa and exercise addiction. This study aims to explore the mediating effect of body appreciation between Muscle dysmorphia and bulimia nervosa, and to validate the exercise addiction inventory scale in Lebanese adolescents. METHODS: This was a cross-sectional designed study, conducted between August-September 2022, and enrolling 403 adolescents currently residing in Lebanon (15 to 18 years old), from all Lebanese governorates (Beirut, Mount Lebanon, North, South, and Bekaa). Our sample was chosen using the snowball technique, a soft copy of the questionnaire was created using google forms software, and an online approach was conceived to proceed with the data collection. RESULTS: The mean age of the participants was 16.63 ± 1.46 years with 57.3% females. The factor analysis for the Exercise Addiction Inventory suggested one factor, which explained 62.58% of the common variance. The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ2/df), SRMR, CFI, TLI, and AVE. The mediation analysis showed that the direct relation between bulimia and MD was not significant after eliminating the effect of body appreciation (r = .12, p < .001). However, body appreciation was significantly associated with bulimia nervosa (r=-1.06, p < .001) and MD (r=-.28, p < .001). CONCLUSION: Body appreciation was found to be a mediator between muscle dysmorphia and bulimia nervosa and thus it is the main factor leading to both disorders. Therefore, body appreciation should be addressed in the evaluation and management of Muscle Dysmorphia.

Evaluation of stroke pre-hospital management in Lebanon from symptoms onset to hospital arrival and impact on patients' status at discharge: a pilot study.

BACKGROUND: Hospital arrival time after acute ischemic stroke onset is the major factor limiting the eligibility of patients to receive intravenous thrombolysis. Shortening the prehospital delay is crucial to reducing morbidity and mortality for stroke patients. The study was conducted to investigate the factors that influence hospital arrival time after acute stroke onset in the Lebanese population and to assess the effect of the prehospital phase on patients' prognosis at discharge. METHOD: A prospective cross-sectional study was performed in eleven hospitals from April to July 2021 including 100 patients having stroke symptoms or transient ischemic attack (TIA). Two questionnaires were used to collect data addressing patient management in the pre-hospital phase and the in-hospital phase. Descriptive and bivariate analyses were done to evaluate the potential associations between prognosis, pre-hospital characteristics, and other factors. RESULTS: The patients' mean age was 70.36 ± 12.25 years, 43 (53.8%) of them were females, and 79 (85%) arrived within 3 hours after symptoms onset. Diabetic patients had a significant delay in hospital arrival compared with non-diabetics (27.0%vs.7.1%, p-value = 0.009). Moreover, 37 (75.5%) of school-level education patients arrived early at the hospital compared to 7 (100%) of university-level education (p-value = 0.009). The modified Rankin Scale (mRS) at discharge in patients with hemorrhagic stroke (10 (90%)) was worse than that in patients with ischemic stroke (38 (80%)) or TIA (3 (15%)) (p-value< 0.001). CONCLUSION: The study findings make it imperative to raise awareness about stroke symptoms among the Lebanese population. Emergency Medical Services should be utilized appropriately in the transportation of stroke patients to achieve optimal patient outcomes.

First trend analysis of antifungals consumption in Lebanon using the World Health Organization collaborating center for drug statistics methodology.

BACKGROUND: Antimicrobial resistance has reached an alarming rate globally, especially in middle-income countries such as Lebanon. The development of antifungal resistance is associated with the increased population's injudicious consumption. This study aims to measure antifungals consumption in Lebanon as a trend analysis of national data from 2004 to 2018. METHODS: This is a trend analysis of the consumption of antifungal agents in the Lebanese community. Data were obtained from the Intercontinental Marketing Statistics Database between 2004 and 2018. It measures the total consumptions per year, per drug, and the percentage of its correspondents for three routes of administration (oral, parenteral, and topical). Results were reported by Defined Daily Dose (DDD) per 1000 inhabitants per day and the total number of DDDs. RESULTS: Community consumption of antifungals in Lebanon has increased by approximately 18.64% between 2004 and 2018, as measured by the number of DDDs per 1000 inhabitants per day; and amplified by approximately 87.76% as measured by the number of DDDs. The highest consumption level was noted in 2017, with 1.52 DDDs/1000 inhabitants/day and 3,386,930 DDDs. Fluconazole was the most consumed antifungal while micafungin was the least with 6,723,869.2 (20.99%) and 48.5 (0.0002%) DDDs respectively. Topical antifungals ranked the first type consumed followed by oral and parenteral antifungals representing 51.72%, 48.24%, and 0.033% of the total consumption respectively. CONCLUSION: The findings from this study indicate a marked increase in antifungal consumption in the Lebanese community. This accelerates the need of implementing disease management guidelines and national antifungal stewardship. Moreover, these findings may be used in further benchmark utilization and antimicrobial resistance studies in Lebanon.

Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates.

Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. It is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. In particular, PD negatively impacts the quality of life (QOL) of young females and is the main reason behind their absenteeism from school or work. It is suggested that increased intrauterine secretion of prostaglandins F2α and E2 are responsible for the pelvic pain associated with this disorder. Its associated symptoms are physical and/or psychological. Its physical symptoms include headache, lethargy, sleep disturbances, tender breasts, various body pains, disturbed appetite, nausea, vomiting, constipation or diarrhea, and increased urination, whereas its psychological symptoms include mood disturbances, such as anxiety, depression, and irritability. While its diagnosis is based on patients' history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed.

Prevalence, risk factors, and management practices of primary dysmenorrhea among young females.

BACKGROUND: Primary dysmenorrhea (PD) is one of the most common gynecological conditions among young females, which has a significant negative impact on health-related quality of life and productivity. Despite its high prevalence, the evidence is limited regarding the management-seeking practices and its perceived effectiveness among females with PD. METHODS: This is a cross-sectional study conducted among 550 female students in six universities across Lebanon. The prevalence of PD, associated risk factors, and management-seeking practices were assessed using a self-administered questionnaire. RESULTS: The prevalence of PD was 80.9%. Most of the females with PD described their menstrual pain as moderate (56%) to severe (34.6%), which significantly affected their daily activities and studying ability (P < 0.001). The major risk factors associated with PD included heavy menstrual flow (adjusted odds ratio [AOR] = 10.28), family history of PD (AOR = 2.52), history of weight loss attempt (AOR = 2.05), and medical specialization (AOR = 1.663). Only 36.9% of females with PD sought formal medical advice. Most dysmenorrheic females (76.4%) received medications for the management of PD, and remarkably none of them took hormonal contraceptives. Drugs commonly used for PD were mefenamic acid (26.2%), ibuprofen (25%), and paracetamol (11.5%), which were administered when the pain started (58.2%). All medications were significantly effective in reducing the pain score (P = 0.001), and most NSAIDs were more potent than paracetamol in managing PD (P = 0.001). However, no significant difference in adverse effects among medications was revealed. Moreover, no superiority of any individual NSAID for pain relief was established. Nevertheless, mefenamic acid was associated with the lowest risk of abdominal pain (OR: 0.03, P = 0.005) and the highest risk of flank pain (OR = 12, P = 0.02). CONCLUSIONS: Suboptimal management of PD is practiced among university students in Lebanon. Therefore, health care providers should educate dysmenorrheic females to optimize the self-management support of PD. Furthermore, future research is required to investigate females' misconceptions about hormonal contraceptives in the management of PD, aiming to raise awareness and correct misconceptions.

Provision of pharmaceutical care to suspected high-risk COVID-19 patients through telehealth: a nationwide simulated patient study.

BACKGROUND: The COVID-19 pandemic has overburdened the healthcare facilities, which demanded the use of alternative and effective methods for delivering healthcare services. The use of telehealth has become a necessity to provide initial health services. OBJECTIVE: To identify the pharmaceutical care provided by community pharmacists to suspected high-risk COVID-19 patients using telehealth. METHODS: A simulated patient (SP) phoned 100 randomly-selected community pharmacies throughout Lebanon using a standard scenario of uncontrolled diabetes mellitus with typical symptoms of COVID-19. Pharmacists' responses were compared with pre-defined ideal recommendations using a special form. RESULTS: The mean of the retrieved medical information score obtained by the pharmacists was 2.48 ± 2.79 (out of 21), with 34 % of the participants not retrieving any relevant medical data from the SP. The relative patient information, the exposure to COVID-19, and the possible COVID-19 symptoms were not retrieved by 61 %, 70 %, and 41 % of the pharmacists, respectively. Two percent of the pharmacists assured that the SP's symptoms were related to common cold, while 5 % confirmed that the SP is infected with COVID-19. Notably, 35 % of the pharmacists did not offer any recommendation. Among them, 14 % claimed that they were too busy to respond. Only 39 % of the pharmacists provided an appropriate recommendation by referring the SP to her physician to seek medical attention within 24 h since the SP is a high-risk patient, and 41 % recommended doing a PCR test. Antipyretics, antibiotics, and dietary supplements were recommended by 27 %, 7 %, and 16 % of the pharmacists, respectively. Less than 16 % of the pharmacists recommended using protective measures against COVID-19. In addition, the overall communication skills of the pharmacists were generally below expectations. CONCLUSIONS: This study is the first to assess the quality of pharmaceutical care provided by community pharmacists in the Middle East via Telehealth. An unsatisfactory level of preparedness through means of telehealth technology was evident. This resulted in the quality of pharmaceutical-care services provided to high-risk patients via telehealth to be below expectations. Therefore, health authorities should encourage community pharmacists to effectively adopt telehealth, by providing appropriate training, as well as recognizing their extra efforts with financial compensations, aiming to optimize patients' health outcomes.

The Health Status of Lebanese Community Pharmacists: Prevalence of Poor Lifestyle Behaviors and Chronic Conditions.

BACKGROUND: Community pharmacists are drug therapy experts providing pharmaceutical care for various patients. Their stressful daily tasks can affect their lifestyle and wellbeing. OBJECTIVES: To assess the health status of the Lebanese community pharmacists, to determine the prevalence of chronic conditions and unhealthy lifestyle behaviors, and their association with pharmacists' professional responsibilities. METHODS: A cross-sectional study was conducted on 300 randomly selected pharmacists between May and August 2017. A four-page questionnaire was carried out targeting their health characteristics, lifestyle factors, and job details. RESULTS: Thirty-seven percent of the studied sample were males, with a mean age of 30.9 ± 9.1 years and mean Body Mass Index (BMI) of 23.4 ± 3.71 kg/m2. Twenty-six percent were smokers and smoking was significantly related to gender, BMI, workplace region, work shifts, educational level, number of patients/day, and transportation time to work (p < 0.05 for all). Twenty-one percent were alcohol consumers, 89.3% were caffeine consumers, and 41.7% were physically active. Moreover, 72% were fast food consumers, 89.7% consumed sweets, and 87.7% consumed salted food. Concerning chronic diseases, 6.3% were hypertensive and hypertension was significantly related to age, marital status, education level, working hours per day, working days per week, owning a pharmacy, work shift, and the number of patients per day (p < 0.05 for all). CONCLUSION: Lebanese pharmacists might have a lower prevalence of chronic diseases compared to the general population. However, the prevalence of bad lifestyle behaviors such as low physical activity, smoking, consumption of salt, sweet, fast food, and caffeine is considered high among the study sample and this would raise a concern about pharmacists' awareness and role as healthcare providers.

Trends in the consumption of antibiotics in the Lebanese community between 2004 and 2016.

Background Antibiotic resistance has reached an alarming rate globally especially in middle-income countries such as Lebanon. The development of antibiotic resistance is strongly linked to the increased population's injudicious consumption of antibiotics. Objective This study aims to explore the trends of antibiotics consumption in the Lebanese community, between 2004 and 2016, to inform rational use of antibiotics. Setting The study was performed using the Intercontinental Marketing Statistics (IMS) Health Lebanon database Method This is an observational longitudinal study conducted through a review of the IMS database. The annual antibiotics consumption was determined by the Defined Daily Dose (DDD)/1000 inhabitants/day (DID). The trends of antibiotics consumption were then categorized by antibiotic class and spectrum of activity. Main outcome measure The total consumption of antibiotics in Lebanon and the classes of antibiotics used by the community. Results Total community consumption of antibiotics, measured by DDD/1000 inhabitants/day (DID), significantly increased from 18.71 in 2004 to 31.26 in 2016. Penicillin combinations, quinolones, third-generation cephalosporins, tetracyclines, and carbapenems showed significant uptrends, in contrast to first-generation cephalosporins, sulfonamides and diaminopyrimidines, and beta-lactamase resistant penicillins. Broad-spectrum antibiotics showed a marked increase in their consumption from 11.50 DID in 2004 to 22.51 DID in 2016 whereas intermediate-spectrum antibiotics had only a slight increase in their consumption from 7.18 DID in 2004 to 8.51 DID in 2016, and narrow-spectrum antibiotics had a severe decline in their consumption from 0.006 DID in 2004 to 0.0003 DID in 2016. Conclusion There is an alarming increase in antibiotics consumption in Lebanon, particularly broad-spectrum antibiotics. This should be complemented with evidence on the determinants of antibiotic consumption such as prescriber and patient-related factors and drug promotional activities to minimize antibiotics overuse.

Work fatigue among Lebanese community pharmacists: prevalence and correlates.

OBJECTIVE: To assess work fatigue and its associated factors among community pharmacists in Lebanon. METHODS: This cross-sectional study was conducted between March and July 2018. A proportionate sample of 435 community pharmacists was selected from all regions of Lebanon. A standardized self-administered questionnaire, distributed by trained interviewers, was used to assess the studied variables. RESULTS: The results showed that 50.12% of the pharmacists had emotional work fatigue [95%CI 0.454-0.549], 55.01% had mental work fatigue [95%CI 0.503-0.597], and 54.78% had physical work fatigue [95%CI 0.501-0.595]. Higher mental work fatigue was significantly associated with higher stress (Beta=0.185) and having a master's degree compared to a bachelor's degree (Beta=2.23). Higher emotional work fatigue was significantly associated with higher stress (Beta=0.219), working more than 40 hours compared to ≤ 16 hours (Beta=2.742), and having 6 months to less than 1 year of practice compared to less than 6 months (Beta=-5.238). Higher physical work fatigue was significantly associated with higher stress (Beta=0.169) and having better soft skills (Beta=-0.163). CONCLUSIONS: Work-related fatigue is high among community pharmacists and touches all aspects: physical, mental, and emotional. In our study, community pharmacists' fatigue levels were associated with educational level, years of experience, working hours, stress, depression, and soft skills, while no relation was found with gender, age, position in the pharmacy, and economic status. Interventions are recommended to tackle this public health problem that affects pharmacists, and eventually, patients.

Antibiotic Prescribing Rate in Lebanese Community Pharmacies: A Nationwide Patient-Simulated Study of Acute Bacterial Rhinosinusitis.

This study aims to evaluate the antibiotic prescribing rate for acute bacterial rhinosinusitis in community pharmacies and to study the corresponding attitude and behavior of participants. A cross-sectional, nationwide study was conducted using a patient-simulated case of bacterial rhinosinusitis. Descriptive data were reported for the medications prescribed, questions asked, and recommendations made. Bivariate analysis was conducted to identify factors affecting the aforementioned. Out of the 250 community pharmacies visited, 77 (30.8%) prescribed antibiotics, 15 (6%) referred the patient to a physician, and 79 (32%) made the right diagnosis. Amoxicillin/clavulanic acid (69.7%) was the most prescribed antibiotic. The majority of the participants prescribed antibiotics according to guidelines. Overall, 108 (43.2%) participants questioned about symptoms and few questioned about patient age, pregnancy, and history of rhinosinusitis. None counseled about interactions or in case a dose is missed. We concluded that antibiotics are easily prescribed in Lebanese community pharmacies. This misuse should be tackled by legislative authorities to restrict such practices.

Antibiotic prescribing for acute uncomplicated cystitis in Lebanese community pharmacies using a simulated patient.

BACKGROUND: Urinary tract infections are considered as one of the most frequent bacterial infections in the community and hospital settings. In this era of increasing antimicrobial resistance, antimicrobial stewardship has become highly important in the struggle to preserve the effectiveness of available drugs. One the main causes of antibiotic resistance is the inappropriate prescribing of antibiotics; which evidence show that community pharmacists contribute to. OBJECTIVE: This study aims to evaluate antibiotic prescribing rate and responses of the contact persons in community pharmacies and to assess the conformity of the prescribed antibiotics with international guidelines. It also aims to evaluate the responses with sociodemographic characteristics. METHODS: A cross-sectional, nationwide study conducted between February and May 2017 using a simulated patient case of acute uncomplicated cystitis. Two hundred fifty pharmacies were included. Descriptive data was reported for the medications prescribed, conformity, questions asked and counseling. Bivariate analysis using the Pearson chi-squared, Fisher's exact and Student's t-tests were used to identify possible factors affecting the prescribing rates and responses in community pharmacies. RESULTS: The prescribing rate of antibiotics was 83.6% (n=209) with ciprofloxacin being the most prescribed (50.2%, n=105). The global conformity to international guidelines was 3.8% (n=8) with the highest conformity rate for the antibiotic choice (91.4%, n=191). Counseling about what to do in case symptoms persist was 12.8% (n=32) and that of non-pharmacological management was 53.6% (n=134). Male participants (88.1%) had a higher prescribing rate than female participants (77.6%) (p<0.05). The number of questions asked was higher in pharmacists and in female participants (p<0.05). Other results showed non-significant differences in diagnosis, antibiotic prescribing, conformity rates, referral rates and counseling points between the pharmacists and assistants. CONCLUSIONS: The high antibiotic prescribing rate in Lebanese community pharmacies is alarming and calls for action. This should be tackled by legislative bodies, which should enforce laws that restrict such practices.