Evaluation of antibiotics pack size compliance with the treatment guidelines for community-acquired pneumonia and urinary tract infections in the Lebanese population

Figures & data

Figure 1. Drugs eligible for inclusion in the study. LNDI: Lebanese National Drug Index.

Figure 2. Drugs cross-referencing with the Lebanese society for infectious diseases and clinical microbiology and infectious diseases society of America guidelines. CAP: community-acquired pneumonia, UTI: urinary tract infection, LSIDCM: Lebanese Society for Infectious Diseases and Clinical Microbiology, IDSA: Infectious Diseases Society of America Guidelines.

Table 1. Accordance of the selected drugs pack sizes with guidelines for community-acquired pneumonia.

Drug	Pack size (mg)	IDSA	Minimum number of pack	Extra units	LSIDCM	Minimum number of pack	Extra units
Amoxicillin	12 × 500	6 × 500 mg, 5 days	3	6	6 × 500 mg, 5 days	3	6
	20 × 500	6 × 500 mg, 5 days	2	10	6 × 500 mg, 5 days	2	10
	16 × 750	n/a	–	–	n/a	–	–
	10 × 1000	3 × 1000 mg, 5 days	2	5	3 × 1000 mg, 5 days	2	5
	16 × 1000	3 × 1000 mg, 5 days	1	1	3 × 1000 mg, 5 days	1	1
Amoxicillin/Clavulanate	20 × 375	n/a	–	–	n/a	–	–
	15 × 625	3 × 625 mg, 5 days	1	0	n/a	–	–
	20 × 625	3 × 625 mg, 5 days	1	5	n/a	–	–
	12 × 1000	2 × 1000 mg, 5 days	1	2	n/a	–	–
	14 × 1000	2 × 1000 mg, 5 days	1	4	n/a	–	–
	15 × 1000	2 × 1000 mg, 5 days	1	5	n/a	–	–
Azithromycin	6 × 250	2×250 mg, 1 day & 1 × 250 mg, 4 days	1	0	2 × 250 mg, 3 days	1	0
	3 × 500	n/a	–	–	1 × 500 mg, 3 days	1	0
Clarithromycin	14 × 250	4 × 250 mg, 5 days	2	8	4 × 250 mg, 5 days	2	8
	7 × 500	2 × 500mg 5 days	2	4	2 × 500mg days	2	4
	14 × 500	2 × 500 mg, 5 days	1	4	2 × 500 mg, 5 days	1	4
Cefuroxime	10 × 250	4 × 250 mg, 5 days	2	0	4 × 250 mg, 5 days	2	0
	14 × 250	4 × 250 mg, 5 days	2	8	4 × 250 mg, 5 days	2	8
	10 × 500	2 × 500 mg, 5 days	1	0	2 × 500 mg, 5 days	1	0
	14 × 500	2 × 500 mg, 5 days	1	4	2 × 500 mg, 5 days	1	4
Cefpodoxime	10 × 100	4 × 100 mg, 5 days	2	0	4 × 100 mg, 5 days	2	0
	10 × 200	2 × 200 mg, 5 days	1	0	2 × 100 mg, 5 days	1	0
Doxycycline	14 × 50	4 × 50 mg, 7 days	2	0	4 × 50 mg, 7 days	2	0
	28 × 50	4 × 50 mg, 7 days	1	0	4 × 50 mg, 7 days	1	0
	10 × 100	2 × 100 mg, 7 days	2	6	2 × 100 mg, 7 days	2	6
	15 × 100	2 × 100 mg, 7 days	1	1	2 × 100 mg, 7 days	1	1
	28 × 100	2 × 100 mg, 7 days	1	14	2 × 100 mg, 7 days	1	14
Gemifloxacin	5 × 320	1 × 320 mg, 5 days	1	0	1 × 320 mg, 5 days	1	0
	7 × 320	1 × 320 mg, 5 days	1	2	1 × 320 mg, 5 days	1	2
Levofloxacin	7 × 250	n/a	–	–	n/a	–	–
	5 × 500	n/a	–	–	n/a	–	–
	7 × 500	n/a	–	–	n/a	–	–
	5 × 750	1 × 750 mg, 5 days	1	0	1 × 750 mg, 5 days	1	0
	7 × 750	1 × 750 mg, 5 days	1	2	1 × 750 mg, 5 days	1	2
Moxifloxacin	5 × 400	1 × 400 mg, 5 days	1	0	1 × 400 mg, 5 days	1	0
	7 × 400	1 × 400 mg, 5 days	1	2	1 × 400 mg, 5 days	1	2

Table 2. Accordance of the selected drugs pack sizes with guidelines for acute uncomplicated cystitis.

Drug	Pack size (mg)	IDSA	Minimum number of pack	Extra units	LSIDCM	Minimum number of pack	Extra units
Amoxicillin/clavulanate	20 × 375	n/a	–	–	n/a	–	–
	15 × 625	3 × 625 mg, 5 days	1	0	n/a	–	–
	20 × 625	3 × 625 mg, 5 days	1	5	n/a	–	–
	12 × 1000	n/a	–	–	2 × 1000 mg, 7 days	2	10
	14 × 1000	n/a	–	–	2 × 1000 mg, 7 days	1	0
	15 × 1000	n/a	–	–	2 × 1000 mg, 7 days	1	1
Cephalexin	12 × 500	2 × 500 mg, 5 days	1	2	n/a	–	–
	20 × 500	2 × 500 mg, 5 days	1	10	n/a	–	–
Cefixime	6 × 200	n/a	–	–	2 × 200 mg, 7 days	3	4
	8 × 200	n/a	–	–	2 × 200 mg, 7 days	2	2
	14 × 200	n/a	–	–	2 × 200 mg, 7 days	1	0
	5 × 400	n/a	–	–	1 × 400 mg, 7 days	2	3
	6 × 400	n/a	–	–	1 × 400 mg, 7 days	2	5
	10 × 400	n/a	–	–	1 × 400 mg, 7 days	1	3
Cefpodoxime proxetil	10 × 100	2 × 100 mg, 5 days	1	0	4 × 100 mg, 7 days	3	2
	10 × 200	n/a	–	–	2 × 200 mg, 7 days	2	6
Cefdinir	10 × 300	2 × 300 mg, 5 days	1	0	2 × 300 mg, 7 days	2	6
Cefuroxime	10 × 250	n/a	–	–	4 × 250 mg, 7 days	3	2
	14 × 250	n/a	–	–	4 × 250 mg, 7 days	2	0
	10 × 500	n/a	–	–	2 × 500 mg, 7 days	2	6
	14 × 500	n/a	–	–	2 × 500 mg, 7 days	1	0
Ciprofloxacin	10 × 250	2 × 250 mg, 3 days	1	4	4 × 250 mg, 5 days	2	0
	14 × 250	2 × 250 mg, 3 days	1	8	4 × 250 mg, 5 days	2	8
	10 × 500	n/a	–	–	2 × 500 mg, 5 days	1	0
	12 × 500	n/a	–	–	2 × 500 mg, 5 days	1	2
	14 × 500	n/a	–	–	2 × 500 mg, 5 days	1	4
	20 × 500	n/a	–	–	2 × 500 mg, 5 days	1	10
	10 × 750	n/a	–	–	n/a	–	–
Levofloxacin	7 × 250	1 × 250 mg, 3 days	1	4	2 × 250 mg, 5 days	2	4
		2 × 250 mg, 3 days	1	1	n/a	–	–
	5 × 500	1 × 500 mg, 3 days	1	2	1 × 500 mg, 5 days	1	0
	7 × 500	1 × 500 mg, 3 days	1	4	1 × 500 mg, 5 days	1	2
	5 × 750	n/a	–	–	n/a	–	–
	7 × 750	n/a	–	–	n/a	–	–
Ofloxacin	6 × 100	n/a	–	–	4 × 100 mg, 5 days	4	4
	10 × 200	n/a	–	–	2 × 200 mg, 5 days	1	0
	20 × 200	n/a	–	–	2 × 200 mg, 5 days	1	10
Prulifloxacin	5 × 600	n/a	–	–	1 × 600 mg, 5 days	1	0
Nitrofurantoin monohydrate/macrocrystal	20 × 100	2 × 100 mg, 5 days	1	10	2 × 100 mg, 5 days	1	10
Trimethoprim/Sulfamethoxazole	20 x (400 + 80)	4 × (400 + 80 mg), 3 days	1	8	n/a	–	–

Table 3. Accordance of the selected drugs pack sizes with guidelines for acute uncomplicated pyelonephritis.

Drug	Pack size (mg)	IDSA	Minimum number of pack	Extra units	LSIDCM	Minimum number of pack	Extra units
Amoxicillin	12 × 500	n/a	–	–	4 × 500 mg, 14 days	5	4
	20 × 500	n/a	–	–	4 × 500 mg, 14 days	3	4
	16 × 750	n/a	–	–	n/a	–	–
	10 × 1000	n/a	–	–	2 × 1000 mg, 14 days	3	2
	16 × 1000	n/a	–	–	2 × 1000 mg, 14 days	2	4
Amoxicillin/clavulanate	20 × 375	n/a	–	–	n/a	–	–
	15 × 625	n/a	–	–	n/a	–	–
	20 × 625	n/a	–	–	n/a	–	–
	12 × 1000	n/a	–	–	2 × 1000 mg, 14 days	3	8
	14 × 1000	n/a	–	–	2 × 1000 mg, 14 days	2	0
	15 × 1000	n/a			2 × 1000 mg, 14 days	2	2
Cefpodoxime proxetil	10 × 100	4 × 100 mg, 10 days	4	0	n/a	–	–
	10 × 200	2 × 200 mg, 10 days	2	0	n/a	–	–
Cefdinir	10 × 300	n/a	–	–	2 × 300 mg, 14 days	3	2
Cefixime	6 × 200	n/a	–	–	2 × 200 mg, 14 days	5	2
	8 × 200	n/a	–	–	2 × 200 mg, 14 days	4	4
	14 × 200	n/a	–	–	2 × 200 mg, 14 days	2	0
	5 × 400	n/a	–	–	1 × 400 mg, 14 days	3	1
	6 × 400	n/a	–	–	1 × 400 mg, 14 days	3	4
	10 × 400	n/a	–	–	1 × 400 mg, 14 days	2	6
Ciprofloxacin	10 × 250	4 × 250 mg, 7 days	3	2	4 × 250 mg, 7 days	3	2
	14 × 250	4 × 250 mg, 7 days	2	0	4 × 250 mg, 7 days	2	0
	10 × 500	2 × 500 mg, 7 days	2	6	2 × 500 mg, 7 days	2	6
	12 × 500	2 × 500 mg, 7 days	2	10	2 × 500 mg, 7 days	2	10
	14 × 500	2 × 500 mg, 7 days	1	0	2 × 500 mg, 7 days	1	0
	20 × 500	2 × 500 mg, 7 days	1	6	2 × 500 mg, 7 days	1	6
	10 × 750	n/a	–	–	n/a	–	–
Levofloxacin	7 × 250	3 × 250 mg, 5 days	3	6	2 × 250 mg, 7 days	2	0
	n/a	n/a	–	–	3 × 250 mg, 7 days	3	0
	5 × 500	n/a	–	–	1 × 500 mg, 7 days	2	3
	7 × 500	n/a	–	–	1 × 500 mg, 7 days	1	0
	5 × 750	1 × 750 mg, 5 days	1	0	1 × 750 mg, 7 days	2	3
	7 × 750	1 × 750 mg, 5 days	1	2	1 × 750 mg, 7 days	1	0
Ofloxacin	6 × 100	n/a	–	–	4 × 100 mg, 7 days	5	2
	10 × 200	n/a	–	–	2 × 200 mg, 7 days	2	6
	n/a	n/a	–	–	4 × 200 mg, 7 days	3	2
	20 × 200	n/a	–	–	2 × 200 mg, 7 days	1	6
	n/a	n/a	–	–	4 × 200 mg, 7 days	2	12
Prulifloxacin	5 × 600	n/a	–	–	1 × 600 mg, 7 days	2	3
Trimethoprim/ Sulfamethoxazole	20 × (400 + 80)	4 × (400 + 80 mg), 14 days	3	4	4 × (400 + 80 mg), 10 days	2	0

Table 4. Socio-demographic and working characteristics of the study participants.

Variables	Number (percentage)
Gender
Male	44 (24%)
Female	140 (76%)
Age
18–24	56 (31%)
25–34	65 (35%)
35+	63 (34%)
Married
Yes	101 (55%)
No	83 (45%)
Occupation
Employed	106 (58%)
Unemployed	78 (42%)
Education level
Illiterate	7 (4%)
Educated (school level)	36 (20%)
Highly educated (university level)	141 (76%)
Monthly income
< 500 $	89 (49%)
500–1000 $	52 (28%)
> 1000 $	43 (23%)

Table 5. Behaviors toward antibiotic use to treat community-acquired pneumonia and urinary tract infection among Lebanese population.

Statements	Responses	Number (percentage)
I consult a physician	Yes	148 (80%)
	No	36 (20%)
I consult a pharmacist	Yes	114 (62%)
	No	70 (38%)
I substitute the prescribed antibiotic by different available one	Yes	43 (23%)
	No	141 (77%)
The price of the prescribed antibiotic affects my compliance with the treatment	Yes	56 (30%)
	No	128 (70%)
The antibiotic pack size affects my compliance with the treatment	Yes	71 (39%)
	No	113 (61%)
The shorter the length of treatment the more compliant I am	Yes	83 (45%)
	No	101 (55%)
If I miss a pill on its time, I take a double dose instead	Yes	11 (6%)
	No	173 (94%)
I stop medication in case of symptoms improvement	Yes	82 (45%)
	No	102 (55%)
I save and share the left over antibiotic for a possible future use	Yes	109 (59%)
	No	75 (41%)

Table 6. Association between socio-demographic characteristics and behaviors toward antibiotic use to treat community-acquired pneumonia and urinary tract infection among Lebanese population.

Statements	Socio-demographic characteristics			p^a
I consult a pharmacist	Occupation Number (percentage)	Unemployed	55 (42.4%)	0.04
		Employed	59 (51.8%)
I substitute the prescribed antibiotic by different available one	Education Level Number (percentage)	Illiterate	4 (9.3%)	0.08
		school level	9 (20.9%)
		university level	30 (69.8%)
The shorter the length of treatment, the more compliant I am	Monthly Income Number (percentage)	< 500$	46 (55.4%)	0.04
		500–1000$	16 (19.3%)
		> 1000$	21 (25.3%)
I stop medication in case of symptoms improvement	Age Number (percentage)	18–24	30 (36.6%)	0.07
		25–34	31 (37.8%)
		35+	21 (25.6%)

Results are presented as numbers (percentage).

^a Chi-square test.

Table 7. Association between leftover users and behaviors toward antibiotic use to treat community-acquired pneumonia and urinary tract infection among Lebanese population.

Statements	Responses	Leftover users Number (percentage)	p^a
I consult a physician	Yes	85 (77.9%)	0.3
I consult a pharmacist	Yes	72 (66%)	0.1
I substitute the prescribed antibiotic by different available one	Yes	29 (26.6%)	0.2
The price of the prescribed antibiotic affects my compliance with the treatment	Yes	35 (32.1%)	0.5
The antibiotic package size affects my compliance with the treatment	Yes	47 (43.1%)	0.1
The shorter the length of treatment, the more compliant I am	Yes	56 (51.3%)	0.03
If I miss a pill on its time, I take a double dose instead	Yes	8 (7.3%)	0.3
I stop medication in case of symptoms improvement	Yes	64 (58.7%)	0.00

Results are presented as numbers (percentage).

^a Chi-square test.