Dispensing Patterns of Anxiolytics and Sedative-Hypnotics: A Feasibility Study Comparing Datasets from a Developed and a Developing Country (Australia and South Africa).

BACKGROUND: Dispensing patterns reflect drug usage trends. Benzodiazepines are known as drugs with potential for misuse, and frequent dispensing may be a surrogate marker of misuse. OBJECTIVE: The primary aim of this study was to obtain a comparative snapshot of anxiolytic and sedative-hypnotic dispensing in a developing country and a developed country, to determine whether further research about benzodiazepines is warranted. METHOD: A cross-national, cross-sectional retrospective drug utilisation study was conducted on benzodiazepines and z-drugs. The South African database was obtained from a national medical insurance administrator and the Australian data were de-identified and extracted from pharmacies in the city of Brisbane in Queensland. RESULTS: Diazepam was the most frequently dispensed anxiolytic in the Australian dataset (26.4%; n=1057/4010) while in the South African data, diazepam dispensing (17.2%; n=11597/67354) was superseded by alprazolam (17.8%; n=12009/67354) and followed by bromazepam (13.6%; n=9146/67354). The most frequently dispensed hypnotic in the South African data was zolpidem which accounted for 18.7% of records (n=12603/67354), while in the Australian data it was temazepam (24.9%; n=998/4010). Zolpidem was dispensed more frequently than zopiclone in both datasets. CONCLUSION: In South Africa there was relatively frequent use of alprazolam, bromazepam and zolpidem while in the Australian data diazepam, oxazepam and temazepam were most frequently dispensed. The use of alprazolam, identified as a drug of abuse in Australia, warrants further research in South Africa. The indicator described in this paper permitted a (qualitative) cross-sectional comparison of anxiolytics and sedative-hypnotics between a developed and a developing country (Australia and South Africa).

'Repeat' prescriptions and antibiotic resistance: findings from Australian community pharmacy.

OBJECTIVE: Australians are among the highest users of antibiotics in the developed world. The primary aim was to determine the 'age' of antibiotic prescriptions at the time of dispensing as a possible contributor to antibiotic misuse and ultimately, resistance. The secondary aim was to test customised software to permit extraction and de-identification of dispensing records for analysis. METHODS: Data were extracted and de-identified from computerised dispensing systems in three community pharmacies in Brisbane, Australia, according to a strict ethical protocol. All prescription records dispensed between 1 January 2010 and 31 December 2012 were merged to form a complete dataset of 1 158 871 de-identified dispensing records which were analysed using Microsoft Excel® . A retrospective drug utilisation study was conducted on a subset of 100 573 antibiotic records. In a substudy conducted at a single pharmacy site, all antibiotic records dispensed over a 4-month (winter) period were examined to determine the age of prescriptions. KEY FINDINGS: Nearly one in ten antibiotics (9.0%) was dispensed from prescriptions that were more than a month old, and over one in five (22.1%) were dispensed from a repeat prescription. CONCLUSIONS: Health system factors may contribute to inappropriate antibiotic use in Australia, including availability and validity of repeat antibiotic prescriptions. Government health departments, prescribers, pharmacists, other health professionals and consumers have to share the responsibility of ensuring that antibiotics are used appropriately.

Consumer knowledge and perceptions about antibiotics and upper respiratory tract infections in a community pharmacy.

BACKGROUND: Overuse of antibiotics is a global concern and the World Health Organisation (WHO) has warned of relapsing to an era with no effective antibiotics. In Australia, various national consumer campaigns had been running since 2000, and the concern was prioritised in 2011, when the need for a national approach to address antibiotic resistance was identified. OBJECTIVE: The aim of this study was to explore consumer attitudes and knowledge about (upper respiratory tract) infections, colds and flu, and antibiotics, and to identify factors contributing to antibiotic misuse which could be addressed by tailored patient counselling. SETTING: A community pharmacy in an area of Brisbane, Australia. METHOD: A self-administered anonymous questionnaire was distributed among pharmacy consumers. Perceptions of, and knowledge about antibiotics were measured using a 5-point Likert-type scale of agreement/disagreement. MAIN OUTCOME MEASURE: The proportion of self-diagnosers and non self-diagnosers who agreed/disagreed with the attitude statement, "I know that I need antibiotics before I visit my doctor"; and the proportion of mistaken and non-mistaken who agreed/disagreed with the statement, "I will get better faster if I take antibiotics when I have a cold or flu". RESULTS: Over a third of the 252 participants believed that they would recover faster by taking antibiotics when suffering from a cold or flu, and nearly one-fifth felt that antibiotics would cure viral infections. More females (62.2 vs. 43.9 %) self-diagnosed (p = 0.002) although more males (42.1 vs. 30.8 %) were mistaken about the efficacy of antibiotics for treating colds and flus. Mistaken respondents were more likely than non-mistaken respondents to self-diagnose (p = 0.01). CONCLUSION: This study confirms a lack of knowledge among consumers about the efficacy of antibiotics in treating viral infections despite education campaigns. The findings strongly suggest there is a need for pharmacists and other health care professionals to elicit consumer beliefs and understanding about antibiotics and to tailor their advice appropriately.

Modeling nitrogen uptake in oilseed rape cv Capitol during a growth cycle using influx kinetics of root nitrate transport systems and field experimental data.

The use of kinetic equations of NO3- transport systems in oilseed rape (Brassica napus), determined by 15NO3- labeling under controlled conditions, combined with experimental field data from the INRA-Châlons rape database were used to model NO3- uptake during the plant growth cycle. The quantitative effects of different factors such as day/night cycle, ontogenetic stages, root temperature, photosynthetically active radiation, and soil nitrate availability on different components of the constitutive high-affinity transport systems, constitutive low-affinity transport systems, inducible low-affinity transport systems, and inducible high-affinity transport systems of nitrate were then determined to improve the model's predictions. Simulated uptake correlated well with measured values of nitrogen (N) uptake under field conditions for all N fertilization rates tested. Model outputs showed that the high-affinity transport system accounted for about 89% of total NO3- uptake (18% and 71% for constitutive high-affinity transport systems and inducible high-affinity transport systems, respectively) when no fertilizer was applied. The low-affinity transport system accounted for a minor proportion of total N uptake, and its activity was restricted to the early phase of the growth cycle. However, N fertilization in spring increased the duration of its contribution to total N uptake. Overall, data show that this mechanistic and environmentally regulated approach is a powerful means to simulate total N uptake in the field with the advantage of taking both physiologically regulated processes at the overall plant level and specific nitrate transport system characteristics into account.