Pharmacy Practice articles list

The kidney stones are one of the most widely spreading disorders in the world. The present study was undertaken to evaluate the efficacy of ethanolic extract of Didymocarpuspedicellata and Ashwagandha for its antiurolithiatic activity in rats. Urolithiasis was induced in adult male albino wistar rats by 0.75% of ethylene glycol for 28 days. The effect of the oral administration of the ethanolicextracts has been studied and is compared with the effect of oral administration of Cystone(Himalaya) as a standard on Wistar rat. Ethylene glycol feeding resulted in hyperoxaluria as well as increased renal excretion of calciumand phosphate. Supplementation with ethanolic extract of the plants significantly reduced the elevated urinary oxalate, showing a regulatory action on endogenous oxalate synthesis. Both the plant extract showed significant antiurolithiatic activity

Zeenath Banu

AIM: The present cross-sectional questionnaire survey was conducted to assess the knowledge, and perception related to pharmacovigilance and ADR reporting among the B.pharm Final year students. MATERIALS AND METHODS: To assess the demographic details of the pharmacy students, their knowledge and perception toward pharmacovigilance and ADR reporting; a validated pretested questionnaire was used which comprises 11 knowledge-based closed-ended questions and 14 perceptions based agree/disagree questions. RESULT: The questionnaire was distributed to the 150 respondents of B. Pharm final year students who were willing to participate in the study. A response rate of 75% was recorded. The number of female respondents 53.3% was comparatively higher than the male respondents 46.6%. Most of the respondents were between 20 -22 years of age and only 4.7% were of 25 years of age. The average positive response for the knowledge-related statements was found to be 86.5% and the average positive response for the perception-related statements was found to be 70.67%. CONCLUSION: The findings showed adequate knowledge among pharmacy students and positive perception towards pharmacovigilance and ADRs reporting. This survey strongly suggests that there is a great need for increasing knowledge in clinical pharmacy courses and practical exposure to cases in the hospitals through internship programs which are meant to provide a unique opportunity for the pharmacy students that they must learn and practice the skills required for quality ADR reporting

Zeenath Banu

Improper use of medicines may carry possible health dangers and more evidence continues to stand that adverse drug reactions to medicines are common but often preventable. Self-medication phenomena with over the counter medicines is common among people. It is regarded as essential issue of self-care. Over the counter medicines use such as analgesics among children and adolescents is continuously increasing in Libya. This constitutes an important public health concern. The aim of this study is to focus on adolescent's self-medication phenomena about the over the counter medicines that teens frequently used to treat minor and serious diseases. This work collected information throughout survey-comprised number of questions for the teenagers bought medicines from private pharmacies at two different secondary schools in Benghazi city, Libya, without prescription. The sample size was 120 students, 58 males and 62 females in age range of 15-18 years. Data collected from questionnaire were analyzed for pattern of medicine use. Male adolescents bought toothache and muscle-spasm medicines more frequently than female adolescents. On the other hand, female adolescents administered more over the counter medications monthly than males. The use of over the counter medicines has been found highly rated and exaggerated among secondary school teenagers. In conclusion, adolescents have to be educated regarding over the counter medicine use in Libya. The need for promoting the appropriate use of medicines healthcare system is an important issue. This can be achieved through an educational strategy involved different public sectors such as health and education authorities.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Self-medication with antibiotics is becoming a trend that threats the health systems worldwide through developing bacterial resistance which is associated with high health care costs and increased rate of morbidity and mortality. The main objective of this study is to assess antibiotic self-medication practice among Libyan university pharmacy students. This is a cross-sectional study conducted among pharmacy students at Sabratha University in the western region of Libya. A validated questionnaire was used to collect relevant data which were statistically analyzed. A total of 170 undergraduate Pharmacy students participated in the study during spring 2021. About 80% of the participants reported the use of antibiotics without consulting a physician. The major reason for using antibiotics was to get a quick relief of emergency conditions which was reported by 35% of the students. About 25% of the students used antibiotics to relieve their pains and aches. The most commonly used antibiotic was amoxicillin (55%). Most antibiotics were obtained over the counter from community pharmacies (85%). Half of the participants were not sure if they can advise patients to use antibiotics without a prescription, although 60% of them believed that it was good practice. In conclusion, prevalence of antibiotic self-medication among university pharmacy undergraduate students is high. Thus, serious interventions are required to ensure safe and effective use of antibiotics among the population in Libya.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Community pharmacies not only act as sites of drug purchase but also as healthcare setting. The aim of this study is to examine the extent of public’s use of community pharmacy and their reasons of visiting to Sabha, South part of Libya. Thus, a descriptive, cross-sectional survey with self-administered questionnaire was developed and validated. Data was collected during 2019 by registered pharmacists using the self-designed prepared questionnaire for community pharmacies in Sebha. Of all 600 questionnaires were handed during 2020, 462 forms were returned (77%, response rate). The majority of the respondents reported they had visited the community pharmacies at least once in a month (n = 343, 74%). The highest reason of visiting reported by the respondents was dispensing their prescription medications (n = 304, 65%) while purchasing medication without prescriptions was accounted with n = 162, (35%). The highest rate of the respondents was given advice about antibiotic use (n = 224, 48%) followed by physical exercises (n = 178, 39%) and healthy eating (n = 173, 37%). The majority of the respondents preferred to visit community pharmacy over other healthcare centers because of minor health problems (n = 358, 77%). The major factors influence the consumers choose any particular pharmacy were the professionalism of pharmacy staff (n = 254, 55%) and the availability of the medical products (n = 221, 48%). The respondents incline to choose community pharmacy as a primary health center when they faced drug related problem (n = 248, 54%). In conclusion, the current study revealed that the majority of Libyan people are regular users of community pharmacies and various services and topics of advice have been given by their staff. However, shortage of professional pharmacists in community pharmacies can undermine the opportunity of given reliable pharmaceutical care from these communications.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Hypoglycemia is a common complication of intensive diabetes mellitus therapy. This study was aimed to review the profile of admitted Libyan cases of non-pregnant adults and adolescents. A retrospective study for patients admitted to Tripoli Diabetes Hospital, Tripoli, Libya. Data were collected from medical files of diabetic patients with hypoglycemia from January 2017 to July 2018. Thus, during this period, a total of 29 cases with hypoglycemia were admitted to the hospital. Their age was ranged from 18 to 86 years in which 76.0% were female, 25.0% were non-smokers, 59.0% were married and 55.0% were non-employers. Patients with diabetes mellitus (86%) showed hypoglycemia attack per month of 3.90 ± 2.25. From the 25 cases with diabetes mellitus, 7.0% were newly diagnosed (> one year), 45.0% their duration of diabetes mellitus were more than 9 years and 35.0% were less than nine years. Their Hemoglobin A1C was on target (6.5–7.0%) in 21.0% of the cases, in which 17.0% were on below target range (< 6> 7.0%). 14.0% were on glibenclamide, 3.0% on glimepiride and 69.0% on insulin. Patients on insulin therapy twice daily in 28.0%, triple in 17.0% and basal bolus regime in 24.0%. Hypoglycemia unawareness was presented in 17.0%, hypoglycemia was major in 45.0% of the cases, and in 38.0% were in daytime. Insulin induced hypoglycemia were in 66.0%, and suicidal attempt were in 10.0%. Exercise induced hypoglycemia 10.0% and 3.0% of cases with malignancy induced hypoglycemia. Co-exist systemic illness was mainly absent in 69.0% but cardiovascular diseases in 14.0% and renal diseases in 7.0%. Majority of cases were discharged in good condition (86.0%) and 14.0% discharged against medical advice. Hypoglycemia mostly occurs in patients with diabetes mellitus treated with insulin and in most the cases were reversible and saved with good management. Thus, patient education is a fundamental issue in prevention and reducing complications of hypoglycemia in patients with diabetes mellitus.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Community pharmacy has undergone a rapid expansion with various services moving away from the traditional supply function to other patient-focused services. Thus, the aim of this study is to examine consumer views and expectations toward the services provided in Libyan private community pharmacies, as well as customers' skepticism and their general satisfactions toward these services. The study is descriptive, cross-sectional survey and self-designed administered questionnaire. Study population comprised 0f adult patients or costumers who visited the community pharmacies. Out of the 600 questionnaires were personally handed, 462 of the distributed questionnaires were returned (response rate 77%). The majority of the participants reported that community pharmacy staff dealing with customers in polite ways (75%) and providing privacy and sufficient consideration (60%). Respondents agreed that the staff listens attentively and satisfied with encounter time by 60% and 50%, respectively. For provision of drug information as “how the drug work in the first-time use”, “customer experience of the side effects” and “their ability to using the prescribed medicine properly” were reported by 45%, 30% and 30%, correspondingly, while 60% of the respondents denied that staff provided the medication storage information. Regarding the customer skepticism toward community pharmacy services, 55% respondents agreed that services of community pharmacies tend to just concern on commercial aspects and 60% of respondents believed that services concern toward the business matter more likely than patient health. Interestingly, 85% of the respondents acknowledged the role of community pharmacy as indispensable healthcare setting. The availability of the pharmaceutical product and the cost of pharmacy products satisfied by 40% and 20% of the respondents, respectively. In conclusion, this study demonstrated low customer satisfaction with regard to community pharmacy services in the southern region of Libya. Community pharmacy staff should have an understanding of the codes of conduct and the ethical requirements for their practice of pharmacy profession.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

In health care delivery systems, if you are not part of the solution, then you must be part of the problem. Over the last few decades, clinical pharmacy encourages pharmacists and pharmacy support staff to move their focus from product-oriented role towards new direct engagement with patients, to make the most of the benefits that patients obtain from the medicine they take, or the problems they encounter with their medicines use. In the USA, pharmacists’ participation in physicians ward rounds was shown to reduce adverse drug events by 78% and 66% in general medical and intensive care settings [1. 2]. A study covering 1 029 US hospitals indicated that centrally based and patient-specific clinical pharmacy services are associated with reduced mortality rates [3]. The services involved were medicine information, clinical research performed by pharmacists, active pharmacist participation in resuscitation teams and pharmacists undertaking admission medication histories. New pharmacists’ roles in healthcare systems around the globe have moved and developed significantly over the past few years, particularly with expansion of the scope of practice which allows pharmacists to focus on the clinical aspects of direct patient care [4, 5]. Pharmacists are drug therapy experts of health care team. Therefore, pharmacists, today, are the arbiters of effective and safe use of medicines. Medication therapy management is one of the major areas in which physicians more and more rely on pharmacists to benefit their patients.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Aging seldom comes alone and it is considered to be the major factor for many diseases and comorbidities and disabilities. The objectives of the study are to examine demographic characteristics and prevalence of comorbidities and polypharmacy of elderly patients who were admitted at Sebha Medical Center according to the selected period. This study is descriptive and retrospective cross-sectional study conducted in Sebha during 2021. From 195 participants of the study, the highest rate of patients was from the age group of 65 - 74 years which accounted for 86 participants (44%) and followed by those age group of 75 - 84 years which was reported by 65 participants (33%). The majority of elderly patients have hypertension, (n = 116, 59%) and over one-third of the patients (n = 73, 37%) have diabetes mellitus while nearly one-quarter of patients have both diseases at the same time (n = 47, 24%). Nearly, three-quarters of patients have electrolytes imbalance (n = 142, 72%). Nearly, two-thirds of the patients had three to five comorbidity diseases (n = 122, 63%). Whereas, over one-third of the patients had just one or two comorbidities (n = 70, 36%). Almost all the participants have polypharmacy (n = 187, 96%). Just above half of the patients have five - ten medications (n = 100, 51%) compared with 45% of the patients from those who have more than ten medications (n = 87). This study showed that there is a strong relationship between the prevalence of polypharmacy and the number of comorbidities. A Spearman correlation test indicated that rate of comorbidities was related to polypharmacy with a significant correlation (P < 0.01). The present study found high prevalence of comorbidities and polypharmacy among elderly inpatients. Based on this high prevalence, practicing pharmaceutical care could play an effective role to reduce the risk of inappropriate polypharmacy among hospitalized elderly patients through encouraging clinical pharmacist to engage in clinical activities in hospitals.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Newborn or neonate denotes to an infant in the first few days after birth. They are not small children when it comes to medicinal use and formulation development. Neonates include term, post-term and preterm babies. The neonatal period for preterm newborn infants is defined as the day of birth through to the expected date of delivery plus 27 days. The majority of drugs used in sick newborns receiving intensive care are unlicensed and off-label, exposing infants to a greater risk of adverse drug reactions (ADRs). This study is extremely important due to the presence of a variety of drug information sources if used together lead to medication errors. From this point of view, this approach is suggested to eliminate or minimize these varieties. Where the most important challenges in neonatal intensive care unit (NICU) is proper and correct calculations and administration. Drug-related events in a hospital setting are the highest cause of recorded errors such as in the USA and UK

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

In April 2020, Food and Drug Administration (FDA) requested immediate withdrawal of all prescription and over the counter ranitidine products. Ranitidine recalled due to the presence of unacceptable level of carcinogenic substance N-nitosodimethylamine (NDMA). Several pharmaceutical manufacturers have issued ranitidine product recalls including brand and generic ranitidine. FDA alerts patients to stop using ranitidine and advised to talk with their health care professional about alternative treatments. In Libya, limited studies have been conducted to address people awareness and knowledge in this regard. The objective of this study was to assess people's awareness and behavior towards ranitidine recall and related issues. A cross-sectional study was conducted in Zawia city for two months. Online questionnaire was distributed to 300 participants. Descriptive statistics analysis using statistical package for social sciences (SPSS) version 26.0 was used. The study found that more than half of the participants and their family member were likely to utilize ranitidine inappropriately. They seem to consume ranitidine more often without medical consultation. The findings also showed that 82.5% of the participants that were using ranitidine obtained the drug from pharmacies after the date of announcing ranitidine withdrawal from the market by FDA. Furthermore, the vast majority of the participants were poorly informed or even they had no information about ranitidine toxicity and their perception of the dangers of continue use of this drug is limited. The participants argued that pharmacists do not provide slightly information about dispensed ranitidine. In conclusion, all results reported as benefits of the participants in the study whereas the participant's perception and awareness increased when a brief notification regarding the reason of ranitidine toxicity was provided.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Prescribing drugs for elderly patients is not an easy task since elderly patients are frequently with comorbid conditions. In Libya, there are no guidelines for the management of medications used in elderly patients and no specialized geriatric health institutions. The aim of this study is to assess the pattern of medication use among hospitalized elderly patients in Sebha Medical Centre and the drug-related problems associated with these patterns. This report is descriptive and retrospective cross-sectional study that is conducted at Sebha Medical Center during 2021. Potential drug-related problems were assessed based on the classification of Hepler and Strand. In this study, out of 195 participants, most of the patients have been given antibiotics (92%). The majority of patients have been prescribed anti-gastric agents, vitamins and anti-thrombotic agents which accounted for 75%, 62% and 55%, respectively. To less extent, anti-hypertensive agents, analgesics and anti-hyperlipidemics were reported by 45%, 43% and 38%, correspondently. Almost all the patients have at least one event of drug-related problem and more than three-quarters of the patients had more than one event of drug-related problems. The highest rate was untreated indications which were reported for 77% then followed by drug use without indication nearly a half of the events 48%. To fewer extent rates were reported: “in improper drug selection”, “drug interaction” and “adverse effects” which were reported for 25%, 23% and 18% of the total events, respectively. Almost all elderly patients have been prescribed antibiotics, analgesics and vitamins. Drug-related problems are predominant prevalent in the clinical practice at the center. This study highlights the importance of activation of clinical pharmacist interventions at hospitals which can contribute to reducing the chance of risk of drug-related problems events among hospitalized elderly patients and ensuring rational drug prescribing in the geriatric clinical settings.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

The application of clinical pharmacokinetic is the responsibility of all pharmacists providing pharmaceutical care. An appropriately applied clinical pharmacokinetic is expected to result in improved patient outcomes: decreased mortality, reduced length of treatment, reduced length of hospital stays and cost-savings. Data on the extend of pharmacokinetic application in Libyan hospitals remain scarce but available subjective evidence suggests that services related to clinical pharmacokinetic are mostly provided and performed by professionals other than clinical pharmacists. To explore the training background and perceptions of pharmacists on the pharmacokinetic course contents they received during their undergraduate pharmacy programs. Also, to determine the attitudes and barriers experienced by the pharmacists when applying pharmacokinetic principles in their current practice. This is a cross-sectional, descriptive study that was conducted between July 2018 and November 2019 using a self-administered survey. The study targeted hospital pharmacists practicing in different hospitals in Libya. A total of 104 pharmacists completed the questionnaire and submitted it back. The majority of participants learned pharmacokinetic courses as a mandatory course during undergraduate courses 81.0% with 37.0% selecting that course was taught as a separate course or courses. Around 80.0% of the participants agreed or strongly agreed that pharmacokinetic courses received in undergraduate studies are useful in pharmacy practice with over 75.0% of the participants agreeing or strongly agreeing on relevance of those course to their current clinical practice. About 40.0% of the participants described their current skills in allowing optimal patient care as can be better. Different barriers were highlighted by the participants to allow sufficient clinical pharmacokinetic practice including lack of sufficient information, lack of awareness of pharmacists’ role and skills in applying clinical pharmacokinetic by other pharmacists and by other health care providers. Thus, this study shows that most practicing pharmacists showed a positive attitude of current pharmacokinetic practice and to the impact of their undergraduate studies on their successful practice. However, they have clearly addressed the room for improvement.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

One must accept the complexity of modern society as a multifaceted influence which will direct the future of all social organizations. Technology has brought the people of the world into almost instant communication. Biomedical science has conquered most infectious, acute diseases and has provided several medicines for a successful maintenance therapy of chronic diseases. The life style of some people as smoking and drug addiction remain a strong factor to their achievement of health goals of the good life. Universally, economic inflation and international business have created an economic interdependence among nations and dealing of the economic problems of one country must take into account this interdependence. When one views the future within this technologic-social-economic framework, he has difficulty sorting out certain directing influences that may shape the future of pharmacy practice in Libya. Currently, the duties, functions and roles undertaken by pharmacists in Libya range from those limited to traditional dispensing duties to highly clinically oriented roles [1]. In this regard, the Libyan health service providers request for the expanded roles of pharmacists in the society. Many of them ask for a number of clinical and patient-oriented functions as oncology, patient counseling, chronic care, hypertension, pediatric, diabetes, psychiatric, cardiology and others. They also question for protocols, standing orders and procedures for pharmacist management of drug therapy and provide information to use as a basis for initiation of clinically oriented services. The treatment of chronic diseases will be refined and drug therapy in many instances will be improved through the application of pharmacokinetic principles and improved methods of monitoring. There is no doubt that pharmacy practice has made clear steps in its own professionalization in hospitals during the past years. With an increase in the number of pharmacists practicing in hospitals and drug stores has come other changes in pharmacy manpower. Technicians and assistant pharmacists now perform many of the routine tasks in drug distribution under pharmacist's supervision. The latter, therefore, is available to participate in clinical programs in inpatient areas and in outpatient clinics. The practice of technicians and assistant pharmacists both in and out of hospitals remains a controversial issue in Libya (absence of a clear national medical policy). Many pharmacists in Libya who provide services hold Bachelor degree in Pharmacy or Pharmaceutical Sciences or Doctor of Pharmacy (Pharm D) or have completed a short or long term diploma training in teaching hospitals or postgraduate academics. Some hold appointments in other health professions institutions. Libyan Association for Pharmacists (LAP) and Libyan Medical Board are currently planning for a program in clinical pharmacy in different clinical branches. Nevertheless, professional pharmacy personnel must be upgraded in the future in both educational background and competence if continued professionalization is to be achieved [2]. The future will see continued stratification of professional personnel according to specialized functions in management and clinical and other professional; services particularly in large hospitals. The scope of the educational function of pharmacy will expand and become an increasingly important activity in the future in Libya. Some hospitals will maintain health education facilities as part of their physical plant. Others will participate in the program of area health education centers. Pharmacy's responsibility in this effort will require not only an increased commitment, but likewise, increased capability and capacity to provide educational services.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences

Background: The determinants of medication adherence in people with diabetes may differ between populations of an area due to social environment, cultural beliefs, socioeconomic conditions, education, and many other factors differences. Objective: Therefore, this study aims to explore, identify and classify the determinants of medication adherence in several Asian regions. Methods: A systematic literature review was conducted to gain insight into the determinants of medication adherence. Seven relevant databases (EBSCO, ProQuest, PubMed, ScienceDirect, Scopus, Wiley, dan Taylor, and Francis) and hand-searching methods were conducted from January 2011 to December 2020. Keywords were compiled based on the PICO method. The selection process used the PRISMA guidelines based on inclusion, and the quality was assessed using Crowe’s critical assessment tool. Textual summaries and a conceptual framework model of medication adherence were proposed to aid in the understanding of the factors influencing medication adherence. Results: Twenty-six articles from countries in several Asian regions were further analyzed. Most studies on type 2 diabetes patients in India used the MMAS-8 scale, and cross-sectional study is the most frequently used research design. The medication adherence rate among diabetic patients was low to moderate. Fifty-one specific factors identified were further categorized into twenty-three subdomains and six domains. Furthermore, the determinants were classified into four categories: inconsistent factors, positively related factors, negatively related factors, and non-associated factors. In most studies, patient-related factors dominate the association with medication adherence. This domain relates to patient-specific demographics, physiological feelings, knowledge, perceptions and beliefs, comorbidities, and other factors related to the patient. Several limitations in this review need to be considered for further research. Conclusion: Medication adherence to diabetic therapy is a complex phenomenon. Most determinants produced disparate findings in terms of statistical significance. The identified factors can serve various goals related to medication adherence. Policymakers and health care providers should consider patient-related factors.

Much Ilham Novalisa Aji Wibowo

Diabetes mellitus (DM) is considered as ”the mother of all diseases" because it causes many complications. Knowing and measuring medication adherence may have a greater effect on DM patients. Several studies in Indonesia used a questionnaire scale to measure adherence, however they do not validate the study population, so it could still be found anomalous correlation analysis between adherence and clinical data even though it measured in the same country and scale. This study measure the adherence level of type 2 diabetes patients, evaluates the validity of the medication adherence scale, and analyze the correlation with the clinical outcome of type 2 diabetes patients in four health centers in Banyumas district. The study uses a cross-sectional design in Prolanis type 2 DM patients of January -April 2020. The adherence is measured by MARS-10, backward-forward translation method followed by content and internal validation. Clinical outcome is evaluated based on fasting blood glucose measurement. The results of the MARS-10 Gregory index analysis showed content validity in the high category (IG ≥ 0.8). The content validity showed the results of 9 questions with the value of r count> r table (n = 30, r table = 0.361). Reliability analysis showed Cronbach's Alpha 0.747> 0.6. The measurement showed 80.3% were adherent patients and 19.3% were non-adherent patients. Correlation analysis showed that there was no significant relationship (p> 0.05) between patient adherence and clinical outcome. Those results showed that type 2 diabetes mellitus patients in 4 health centers were categorized as adherent but not correlated with the clinical outcome. This was enabled due to the clinical outcome was simultaneously influenced by several factors: general factors, individual factors, and unpredictable factors.

Much Ilham Novalisa Aji Wibowo

The government has implemented the Healthy Living Community Movement (GERMAS) program by promoting the pharmaceutical sector related to drug storage at home. However, many problems still exist in storing household medicines in the community. This activity was carried out through a community empowerment approach using the community capacity-building method for a community organization, Aisyiyah, which consists of Muslim women in the Grendeng village, Purwokerto. This activity was carried out in stages, namely pre-test methods, lectures, group teaching, self-empowerment through peer teaching and training, and measuring the success of activities using post-tests. Based on the activities, partners' knowledge about storing medicines at home has increased in a good category.

Much Ilham Novalisa Aji Wibowo

Using off-label drugs in obstetric-gynecology patients requires caution because of the high risk of pregnancy. Although there is still debate, data profiling its use in clinical practice is lacking. This study aims to observe the use of off-label drugs in obstetrics and gynecology patients in private hospitals, especially the pill Misoprostol. This study used a descriptive observational approach to hospital medical record data. Retrieval of research data retrospectively at Bunda General Hospital (X Hospital) for July 2017 – December 2017 and Sinar Kasih Hospital (Y Hospital) for January 2018 – December 2018. The number of samples was determined using the Slovin formula, with a systematic random sampling technique at X Hospital and total sampling at Y Hospital. The samples were 220 RM at X 130 Hospital and Y 90 Hospital. The research was conducted in the period January 2019 - March 2019. The results were analyzed univariately using several related references. The results showed 26.92% of misoprostol off-label use in X Hospital and 4% in Y Hospital. The off-label drug found was Misoprostol which belongs to the category of off-label indications (Missed Abortion, Incomplete Abortion, Blighted Ovum, and Induction of labor in cases of Serotinus, KPD, and IUFD), off-label doses (50 µg, 100 µg, and 400 µg), and off-label routes of administration (sublingual and vaginal). ​

Much Ilham Novalisa Aji Wibowo

Compliance with pharmacological therapy is the primary key to treating diabetes, but it has not received full attention from clinicians. Several systematic reviews of compliance factors have been conducted in several regions of the country. However, it does not feature studies from Indonesia. This study aims to systematically review the factors that can influence adherence to diabetes mellitus (DM) medication in Indonesia. A systematic literature review was conducted by searching the National (Garuda and Sinta) and International (PubMed and Science Direct) journal databases. Research that met the inclusion criteria was published from January 2011 to December 2020. The quality of the study was assessed using the SQAT guidelines. The research reporting method uses the PRISMA guidelines. Compliance factors are classified based on the domain of compliance factors, according to the World Health Organization (WHO). A total of 370 scientific research articles from the Garuda database (n=36); Science Direct (n = 108); PubMed (n = 18); Sinta (n= 208). Three hundred forty-one research articles were excluded, 29 full-text screening articles, and 16 research articles met the inclusion criteria for analysis. Factors that influence adherence to taking diabetes medication are social and economic (income, education level, and occupation), factors of personnel and health systems (health workers), factors of patient therapy (amount of diabetes medication, frequency of taking medication, and drug products), factors patient's disease (blood sugar levels, disease duration), patient factors (gender, emotional factors, social support, level of knowledge, and treatment satisfaction), and disease management factors (pharmacy counseling and education). Factors that influence adherence to taking DM medication in Indonesia are very diverse and are multi-factor. These factors can serve as relevant intervention targets. Clinicians must consider adjusting the frequency of taking medication and providing social support to DM patients.

Much Ilham Novalisa Aji Wibowo

Self-medication of antibiotics is an irrational use of drugs, contributing to microbial resistance, increasing health care cost and higher mortality and morbidity. This study was aimed to assess self-medication with antibiotics without a medical prescription in the community of Libya. This is a cross-sectional study conducted from June to December, 2022 and the total number of participants was 200. The design of the study and sample size were modified according to the proficiency of pharmacists and the medical and non-medical population of Libya. The questionnaire was developed in English and Arabic language and was distributed through social media platforms. The questions were used after a thorough literature search and assessing the validity and reliability. The significant signs regarding reasons for the treatment by self-medication drugs of antibiotics, because of its various drugs of antibiotic by pharmacist (n = 80, 40.0%) and family (n = 90, 45.0%) compare with experience and physicians by used prescription was 13 (06.50%) and significant sings regarding by nasal congestion self-medication of various antibiotics (n = 100, 50.0%). This sign must be practiced based on a previous physician’s prescription. The antibiotics are often self-administered as patient feel that they will save money and time but this can lead to substantial adverse drug reaction, antibiotic resistance, treatment failure and drug-related toxicity. This study respondent's medical and non-medical public of Libya who should be relatively informed and educated about the risk of treatment by self-medication of antibiotics with the development of resistance.

Mediterranean Journal of Pharmacy and Pharmaceutical Sciences