The inappropriate use of antibiotics in recent years has led to the rise of drug-resistant bacteria that now pose a serious threat to global public health. For example, according to the US Centers for Disease Control and Prevention, in the European Union alone, resistance to antibiotics resulted in 25,000 deaths per year as of 2017; in developing countries, the situation is even more critical.

The School of Pharmacy’s (SOP) Wissam Kabbara — a clinical associate professor of pharmacy practice and board-certified pharmacotherapy specialist with added qualifications in infectious diseases — has devoted some of his research efforts to evaluating antibiotic use in Lebanon.  “I’m passionate about it as it is a worldwide public health concern,” he says. “My main concern is to avoid ‘the post-antibiotic world’ and millions of human deaths due to bacterial resistance.” 

Recently, Dr. Kabbara teamed up with other local investigators to co-author a study titled “Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon,” published by the Canadian Journal of Infectious Diseases and Medical Microbiology. “In Lebanon,” says Kabbara, “the resistance of Gram-negative bacteria, especially those causing urinary tract infections, is increasing alarmingly.” 

To document the extent of the problem, Kabbara and his colleagues conducted a survey at 15 Lebanese community pharmacies. Over the period of one year, they administered a questionnaire to a total of 376 patients visiting the pharmacies to fill their antibiotic prescriptions after they had been diagnosed with uncomplicated urinary tract infections (UTI).

The questionnaire “consisted of questions about patients’ demographics, medical history and prescribed antibiotics regimen,” explains Kabbara. The drug choice, dose and duration of treatment were evaluated and marked as appropriate or inappropriate according to the guidelines of the Infectious Diseases Society of America (IDSA). “If all three were appropriate, then the overall treatment regimen was considered appropriate.”

The results were unnerving. “The prescribed antibiotic was appropriate in only 35 percent of the patients,” Kabbara says. Furthermore, the frequency of infections per year significantly affected the choice of antibiotics used: “23 percent of patients with three different episodes of UTI or more per year received an appropriate antibiotic, versus 37.5 percent of those with less than three episodes.”

Overall, only 21 percent of the patients surveyed were prescribed a regimen of antibiotics appropriate for their cases; perhaps even worse, a high percentage were inappropriately treated with the fluoroquinolone class of antibiotics, which pose an increased risk of collateral damage and have raised recent safety concerns by the US Food and Drug Administration. In addition, fluoroquinolone antibiotics are relatively more expensive in Lebanon than cheaper narrow spectrum antibiotics currently recommended by IDSA for the treatment of uncomplicated UTIs.

For SOP Dean Dr. Imad Btaiche, “This survey highlights the magnitude of inappropriate antibiotics use and the pressing need for collaboration between concerned health professionals and authorities to increase awareness about microbial resistance with robust initiatives to prevent infections and judiciously use antibiotics,” he says.

Pharmacists can play important roles in this arena such as through interprofessional collaboration on infection control and antimicrobial stewardship,” he adds. 

According to Kabbara, “this is the first such survey study to evaluate antibiotic prescribing practices and adherence to IDSA guidelines for the treatment of uncomplicated UTIs in Lebanon.” His hope is that the results will lead to “awareness and educational interventions that improve the use of antibiotics” in the country.