Nearly two thirds of antibiotics dispensed in community pharmacies around the world are given out without a prescription, according to a paper published yesterday in The Lancet Infectious Diseases.

The mixed-methods systematic review, conducted by a team of researchers from China, analyzed 162 studies on the dispensing of non-prescription antibiotics in community and retail pharmacies covering 52 countries. The pooled prevalence of community pharmacy non-prescription antibiotic dispensing was 63.4% (95% confidence interval [CI], 59.6% to 67.1%), with the highest prevalence seen in low-income nations (75.1%; 95% CI, 65.5% to 83.7%) and the lowest in high-income nations (48.4%; 95% CI, 40.5% to 56.4%).

Broken down by disease type, dispensing of non-prescription antibiotics was highest for urinary tract infections (71.2%; 95% CI, 58.4% to 82.5%), followed by upper respiratory tract infections (63.4%; 95% CI, 55.3% to 71.1%), diarrhea (60.3%; 95% CI, 51.5% to 68.7%), and bronchitis (48.0%; 95% CI, 12.1% to 85.1%). Additionally, non-prescriptions dispensing of antibiotics was more common in adults (70.8%; 95% CI, 64.3% to 76.9%) than children (52.2%; 95% CI, 43.2% to 61.1%).

The promotion of the appropriate use of antibiotics is a complicated process.

Quantitative studies indicated that pharmacies located in poorer economic areas, those staffed by pharmacy owners, and private pharmacies were more likely to dispense non-prescription antibiotics. Analysis of qualitative studies revealed four major factors driving dispensing of antibiotics without a prescription: strong customer demand for non-prescription antibiotics combined with a lack of relevant knowledge, pharmacy staff motivated by financial or personal viewpoints, expensive or inconvenient alternative healthcare services or irregular prescribing practices, and weak social, industry, and legal regulation. 

The analysis also found that there has been no significant improvement in dispensing of non-prescription antibiotics at community pharmacies over the last 20 years, despite implementation of policies related to antibiotic sales in several countries.

"The promotion of the appropriate use of antibiotics is a complicated process," the study authors wrote. "A systematic approach, enhanced multisectoral cooperation, and mechanisms for cross-sectoral collaboration are needed."

Today in Emerging Infectious Diseases, researchers describe the epidemiologic characteristics of 118 mpox patients in Los Angeles who were homeless at the time of their diagnosis and note that 60% also had HIV. All patients were identified from July to September 2022.

Los Angeles County is home to approximately 70,000 people experiencing homelessness (PEH), and 10% identify as gay, lesbian, or bisexual. During summer 2022, mpox outbreaks among PEH became a public health concern and triggered an epidemiologic review of cases.

Researchers found the age and sex of homeless people was similar to mpox cases in the general US population, with almost all cases occurring in men, and 53% of cases occurring in people ages 30 to 39.

A total of 64 case-patients (54%) identified as gay or lesbian, 21 (18%) as bisexual or another term, 14 (12%) as heterosexual, 5 (4%) preferred not to state, and sexual orientation was unknown for 14 (12%).

Seventy-one homeless case-patients (60%) were HIV-positive; among them, 36 (51%) had unsuppressed viral loads. Those percentages were higher than those of the general population. Hospitalization was more often required for homeless case-patients (25 [21%]) because of disease severity, and a total of 42 (35%) PEH mpox case-patients received treatment with tecovirimat (Tpoxx).

No transmission in encampments

Researchers were able to locate and interview 101 (86%) homeless patients; of them, 21% reported exposure to a known or symptomatic mpox case-patient, 24% attended a large event 3 weeks before symptoms appeared, 73% reported sexual activity in the weeks before symptom onset, and 23% denied sexual activity.

"No transmission in encampments, considered congregate settings by Los Angeles County, was identified despite potential sharing of sleeping bags, clothes, and utensils in settings with poor access to cleaning and laundry services" the authors said. "One PEH mpox case-patient did report exposure without sexual contact through wearing found clothing.

No transmission in encampments, considered congregate settings by Los Angeles County, was identified.

"Additional research is needed to identify nonsexual transmission among PEH, especially among encampment residents where follow-up and contact tracing are challenging."

Tanzania, battling its first Marburg virus outbreak, has reported another case and another death, according to the latest weekly health emergencies report from the World Health Organization (WHO) African regional office.

The latest case raises the country's outbreak total to nine cases, and the death lifts the fatality count to six, for a case-fatality rate of 66.7%. All of the country's cases are in Bukoba rural district in the Kagera region, located in northwestern corner of Tanzania. Of 212 contacts, 206 have completed their monitoring period.

In its previous weekly update, the WHO said two of the earlier cases involved healthcare workers, including one who died. Many of the contacts under monitoring were healthcare workers.

The outbreak was first reported in the middle of March, with the index patient developing symptoms after returning from an island in Lake Victoria.

Marburg virus is closely related to Ebola virus, which is thought to jump to humans from fruit bats that harbor the virus. Like Ebola, Marburg virus spreads among humans through contact with an infected person's body fluids. However, unlike Ebola, there are no approved vaccines or treatments for Marburg virus infections.