Background
Improper disposal of medications potentially poses a significant environmental risk and storage of expired and unused medications in households provides an increased risk of accidental ...childhood poisonings.
Objective
The objective of this study was to investigate the storage and disposal habits of medications amongst the population in the South Bačka District of Serbia, and to gain insight into the attitudes and knowledge of the population about the proper disposal of medications.
Setting
Households in South Bačka District.
Method
The study was conducted during the 6-month period from February 2010 to July 2010 and involved a random sample of households. The questionnaire-based study was performed by a trained interviewer.
Main outcome measure
number of expired and unused medications in families, behavior and knowledge about the disposal of medications.
Results
Of 230 families, 208 (108 urban and 100 rural) agreed to participate and complete the questionnaire(90 % response rate). The drugs were mostly kept in a specific place-home pharmacy (89.8 % urban and 89.0 % rural). Exposure of children to medications in the home environment was similar in urban and rural families (19.6 % urban and 23.1 % rural). The frequency of expired medications was not observed to be different between the urban and rural households (10.3 % urban and 11.8 % rural). The most common method for disposal of household medications is disposal in the garbage (85.6 % urban and 74.5 % rural) or in the toilet (8.7 % urban and 6.4 % rural). However, inconsistent with disposal practices, half of the urban and rural participants thought that throwing medications in the garbage, toilet, or sink has a detrimental effect on the environment.
Conclusion
Public services in Serbia, including government and health sectors, need to be more proactive about educating people on how to store and dispose medications, as well as finding a way for implementation of the law on medications wastage destruction.
The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population.
The study sample consisted of adult subjects who consulted ...general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%).
The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection.
Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.
An ongoing issue of expired medications accumulating in some households is a universal problem around the world. The aim of the study was to investigate the extent and structure of expired ...medications in Serbian households, and to determine which therapeutic groups generated the most waste.
This was an observational, cross-sectional study conducted in households in the city of Novi Sad, Serbia. The study had been performed over 8 month period (December 2011 - July 2012) and it consisted of personal insights into the medication inventory in households.
Of 1008 families, 383 agreed to participate and complete the questionnaire (38.3% response rate). In almost a half of households (44.4%), expired medications were maintained. The amount of expired medications was 402 items, corresponding to 9.2% of total medications presented in surveyed households. The majority of expired medications (64.7%) was in solid dosage (tablets, capsules, granules, lozenges), following semisolid (ointments, creams, gel, suppositories) and liquid dosage forms (drops, syrups). Expired medications in the households belonged mostly to 3 categories: antimicrobials for systemic use (16.7%), dermatological preparation (15.9%) and medications for alimentary tract and metabolism (14.2%).
This study revealed that there were relatively large quantities of expired medications in Serbian households, with a high prevalence of antibiotics for systemic use, anti-inflammatory and antirheumatic products, and medications for alimentary tract and metabolism.
Antibacterial drugs, including fluoroquinolones, can exert their therapeutic action only with adequate penetration at the infection site. Multiple factors, such as rate of protein binding, drug ...liposolubility and organ blood-flow all influence ability of antibiotics to penetrate target tissues. Microdialysis is an in vivo sampling technique that has been successfully applied to measure the distribution of fluoroquinolones in the interstitial fluid of different tissues both in animal studies and clinical setting. Tissue concentrations need to be interpreted within the context of the pathogenesis and causative agents implicated in infections. Integration of microdialysis -derived tissue pharmacokinetics with pharmacodynamic data offers crucial information for correlating exposure with antibacterial effect. This review explores these concepts and provides an overview of tissue concentrations of fluoroquinolones derived from microdialysis studies and explores the therapeutic implications of fluoroquinolone distribution at various target tissues.
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The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010-2019). The ...results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.
This study aimed to compare existing dosing regimens of cefaclor with recommended pharmacokinetic/pharmacodynamic (PK/PD) parameters and to see if the proposed dosing regimen could have been the ...reason for development of bacterial resistance. PKs of cefaclor were determined after administrating the highest therapeutic dose of 750 mg in standard release (SF) and modified release form (MRF) in 12 volunteers. The study was performed on clinical isolates of the most frequent causative agents in urinary and respiratory infections. Minimum inhibitory concentration (MIC), postantibiotic effect, and PK/PD efficacy indices were determined. Peak plasma concentrations of 23.142 ± 5.67 (SF) and 8.7 ± 2.09 μg/mL (MRF) were observed after 40-60 min and 3.04 ± 0.75 h, respectively. MIC for investigated bacterial strains ranged from 1 to 4 mg/L. Postantibiotic effect lasted from 2.10-2.18 ± 0.2 h for Gram-positive to 0.58-0.90 ± 0.05 h for Gram-negative bacteria. PK/PD indices (t > MIC) ranged from 27.08 ± 5.93% to 43.23 ± 6.54% of 8-h dosing interval (SF) and 22.57 ± 8.93% to 49.65 ± 1.95% of 12-h dosing interval (MRF). Plasma levels were below MIC for more than 50% of the dosing interval even for the most sensitive pathogens (MIC = 1 mg/L). During both dosing intervals the total "antibacterial activity" was not longer than 6 h for Gram-positive and 5 h for Gram-negative bacteria for SF and 9 h for Gram-positive and 5 h for Gram-negative bacteria for MRF.
High concentrations of pesticides and toxic metal pollutants in the environment, often present in surface waters in nature, can accumulate in wild animals and are a significant public health concern. ...Serbia is a moderately developed, south European country in transition, with a long tradition in agriculture, particularly in the northern part, Vojvodina. Our study aimed to assess the presence of pesticides and to measure concentrations of toxic metals in the district of Backi Petrovac, Vojvodina. Water samples were analyzed from canals, ditches, fish from the canals and wild animals caught in the Backi Petrovac district. We identified nine pesticides in water samples. Of all detected pesticides, one was a hormonal disruptor. There were no pesticides in animals, fish and organs in a concentration above the limit of detection (LOD) in observed periods. The concentrations of toxic metals detected in superficial water (Cd, Pb, Hg, As, Mn, Cu) were below the permitted limits, as well as the concentrations of Cd, Pb, Hg, As and Mn in the whole bodies of fish. Concentrations in kidneys and livers of wild animals (rabbit and roe deer) were below the permitted limits, with the exception of cadmium, whose concentrations in some animal samples were above the permitted limit. Based on the obtained results, we concluded that in the developed agricultural region unencumbered by heavy industry, pollution by pesticides and heavy metals can be controlled.
A surveillance study was performed in an intensive care unit in the largest tertiary health care center in Vojvodina, Serbia from 2014 to 2018. Antibiotic prescription data were collated in the WHO ...anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated using cross-correlation analysis. An overall decrease in antibiotic utilization was observed. The prescription rates of piperacillin-tazobactam increased significantly, while consumption of 3rd and 4th generation cephalosporins and fluoroquinolones decreased. There were rising incidence densities of doripenem resistant Acinetobacter spp., piperacillin-tazobactam resistant Pseudomonas aeruginosa and carbapenem and colistin resistant Klebsiella pneumoniae. These results can serve as a basis for the development of antimicrobial stewardship strategies in the current setting.
Background
Irregular antibiotic use, including self-medication contributes to the development of antibiotic resistance. One method of accessing antibiotic use in the community is through obtaining an ...in house inventory of drugs.
Objective
The aim of this study was to investigate the extent of storage and self-medication with antibiotics agents in households in Novi Sad, Serbia.
Setting
Households in Novi Sad.
Method
The study was performed during a 4-month period (October 2015–January 2016) using a sample of 112 households in Novi Sad, Serbia. Two trained interviewers performed the survey by visiting each household. The study consisted of making an inventory of all drugs in household and a semi-structured interview about drug use practices and perceptions.
Main outcome measure
Number of antibiotics obtained without prescription.
Results
Out of 112 surveyed households, antibiotics were encountered in 55 (49.1%). Antibiotics constituted 11.98% (92/768) of total number of drug items in households. Out of all antibiotics in households, 41 (44.57%) were not in current use, and presented left-overs from previous treatment. Antibiotics were usually acquired with prescription (67, 67.7%), while about a quarter of packages were used for self-medication—purchased at pharmacy without prescription (19, 20.65%) or obtained through friends or family member (6, 6.52%).The most commonly used antibiotics for self-medication was amoxicillin (reported indications included common cold, cough, pharyngitis and tooth-ache).
Conclusion
Antibiotics were present in large share of households in Novi Sad. Self-medication with antibiotics and sale of antibiotics without prescription represent an important problem in Serbia.
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