Knowledge, Attitudes, and Practices in Antibiotic Dispensing amongst Pharmacists in Trinidad and Tobago: Exploring a Novel Dichotomy of Antibiotic Laws.

The inappropriate consumption, use, and dispensing of antibiotics are problems faced globally, with a pattern of inappropriate consumption differing in higher-income countries due to the ease of accessibility of antibiotics. The main drivers of consumption and inappropriate use are the over-the-counter sales of antibiotics by pharmacies. Trinidad and Tobago (T&T), a twin island state in the Caribbean, has two Acts of Parliament that regulate antibiotics: the Antibiotics Act and the Food and Drug Act, yet the Over-the-Counter (OTC) sale of antibiotics still exists. This study sought to determine the knowledge, attitudes, and practices regarding the OTC dispensing of antibiotics in T&T. A cross-sectional study gathered data from pharmacists in both the private and public sectors of Trinidad over 7 months. The results showed that antibiotic resistance and antibiotic abuse were seen as significant problems. The level of experience, gender (female), and age (younger) were significantly associated with having good overall knowledge of good dispensing habits and antibiotic laws (p = 0.036, p = 0.047, and p = 0.001, respectively). Pharmacists generally agreed that antibiotics under the Food and Drug Act may have contributed to OTC dispensing in the private sector (p = 0.013) and that all antibiotics should be under the Antibiotic Act (p = 0.002). Additionally, it was found that the dispensing of antibiotics OTC in the private sector (p = 0.006) occurred: without doctors' advice and without requesting prescriptions; because it was perceived as lawful (especially by older pharmacists); and because of the perceived motivation of profit. Regulation enforcement was perceived as deficient. OTC dispensing for reasons, such as misunderstanding of laws, occurs in T&T.

Antimicrobial Consumption from 2017 to 2021 in East Trinidad and Tobago: A Study in the English-Speaking Caribbean.

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization's Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the 'Access', 'Watch' and 'Reserve' classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the 'Watch' group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of 'Watch' group antibiotics increased from 2017 to 2021, with a drop in consumption of 'Access' antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.