Background. Drug shortages are an increasing and worldwide problem. Oral antibiotics are one of the most used medicines worldwide and have recently been affected by drug shortages. Despite this, little is known about the impact of antibiotic shortages on clinical and prescribing practices. Aim. To explore the impact of oral antibiotic shortages on national antibiotic utilisation. Methods. A longitudinal study of oral antibiotic shortages and antibiotic utilisation was conducted using Australian reimbursement and regulatory data from January 2022 to December 2023. All nationally reimbursed oral antibiotics were included in the study. The number and duration of reported antibiotic shortages per product were determined for each active ingredient. The clinical impact was assessed using national utilisation in Defined Daily Doses per 100,000 inhabitants. Changes in trends were analysed using Joinpoint regression. Results. Shortages were reported for eighteen of the twenty-one (86%) oral antibiotics reimbursed in Australia. No clear relation between the number and duration of shortages was observed for most antibiotics. Changes in utilisation coinciding with shortages were observed for eight active ingredients. For cefaclor (-20% decrease in utilisation) and roxithromycin (-26% decrease), the impact of shortages is most clearly reflected by decreases in utilisation. For the other six, either minor or mixed changes in utilisation were observed. Conclusions. Antibiotic shortages were common in Australia during 2022 and 2023. The impact of shortages appears complex with various factors most likely influencing impact. Australia’s healthcare professionals seem successful in mitigating the effects of shortages on drug utilisation.

Aims. To provide an overview of the types of interventions performed by community pharmacists and describe their effects on patients with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). Methods. This review was conducted according to the PRISMA-Scr guidelines. PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for (non-) randomized controlled, before-after, and interrupted time series design. There was no restriction in the publication language. Included interventions had to be delivered by community pharmacists in primary care and community settings. The study quality was assessed using the National Institute of Health tools. Results were analyzed descriptively. Results. Twenty-eight studies were included representing 4,434 patients (mean age from 47.4 to 59.5 years, 55.4% female). Four studies were single- and the remaining studies were multiple-component interventions. Face-to-face counseling of patients was the most common intervention, often combined with providing printed materials, remote consultations, or conducting medication reviews. Generally, studies showed improved outcomes in the intervention group, including clinical, patient-reported and medication safety outcomes. In most studies at least one domain was judged to be of poor quality, with heterogeneity among studies. Conclusions. Community pharmacist-led interventions among T2DM patients showed positive effects in LMICs, but the quality of the evidence was poor. Face-to-face counseling of varying intensity, often combined with other strategies, was the most common type of intervention. Although these findings support the expansion of the role of the community pharmacist in diabetes care in LMICs, better quality studies are needed to evaluate further impact.

Objectives. The aim of this systematic review is to assess the effects of community pharmacist-led interventions to optimize the use of antibiotics and identify which interventions are most effective. Methods. This review was conducted according to the PRISMA-P guidelines (PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for (randomised) controlled trials. Included interventions were required to target antibiotic use, be set in the community pharmacy context and be pharmacist-led. Primary outcomes were quality of antibiotic supply and adverse effects while secondary outcomes included patient reported outcomes. Risk of bias was assessed using the ‘Cochrane suggested risk of bias criteria’ and narrative synthesis of primary outcomes conducted. Results. Seventeen studies were included covering in total 3,822 patients (mean age 45.6 years, 61.9% female). Most studies used educational interventions. Three studies reported on primary outcomes, twelve on secondary outcomes and two on both. Three studies reported improvements in quality of dispensing where interventions led to more intensive symptom assessment and a reduction of OTC or wrong choice antibiotic supply. Some interventions led to higher consumer satisfaction, effects on adherence were mixed. All studies had unclear or high risks of bias across at least one domain, with large heterogeneity between studies. Conclusions. Our review suggests some possible positive results from pharmacist-led interventions, but the role of the pharmacist needs to be expanded. This review should be interpreted as exploratory research, as more high-quality research is needed. Authors did not receive funding for the review.