Antimicrobial resistance is a serious threat to global health. Antimicrobial Stewardship Programs (ASPs) are adopted by healthcare systems worldwide. This review aims to evaluate the published practices of ASPs in Middle East countries. We searched in PubMed/ MEDLINE, EMBASE, EBSCO, Cochrane library, Google, and Google Scholar electronic databases for studies published from January 2005 to December 2020, assessing ASP practices in Middle Eastern countries following PRISMA guidelines. Out of the 422 titles identified, 20 studies met the inclusion criteria. Eight studies were conducted in the Kingdom of Saudi Arabia. Five studies were conducted in Qatar, and two studies were conducted in Lebanon and Jordan, one study in Palestine and UAE, and one multinational study. Different ASP practices, including prospective auditing and feedback, pre-authorization, tracking, antibiotic restriction, education, de-escalation, and intravenous to-oral switch, were reported. ASP practices correlated with improved susceptibility rate and decrease in antimicrobial use. Outcomes of this review reveal the scarcity of ASP practices data. The impact of introducing ASPs in hospitals in Middle Eastern countries demonstrate favorable clinical effects. Policymakers and stakeholders should promote and invest in implementing these programs as an essential component of the healthcare systems.

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers’ knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians n = 409, dentists n = 204). Respondents’ knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers’ behaviors and improving antibiotic prescribing practices.

Most acute respiratory infections (ARIs) in children are due to viral etiology; however, over-prescribing of antibiotics for ARIs is common. The aim of this investigation was to identify antibiotic prescribing prevalence for children with ARIs and to identify predictors of broad-spectrum antibiotic prescribing. This was a prospective cross sectional study in a sample of ambulatory care settings in Jordan. Children (<18 years) presenting with ARIs were assessed in terms of patient's demographics, antibiotic prescription and clinical diagnosis. Multivariable logistic regression analysis was used to identify predictors of broad-spectrum antibiotic prescription. Antibiotics were prescribed for 78.4% (4575/5829) of children with ARIs. Antibiotic prescription for ARIs for which antibiotics are not indicated was 69.2% (2688/3883). Broad-spectrum antibiotic prescription occurred in 51.1% (2337/4575) of all antibiotic-prescribed participants. Some of the predictors of broad-spectrum antibiotic prescription were: otitis media (OR 4.93 [95% CI 3.44–7.14]), tonsillitis (OR 6.03 [95% CI 4.39–8.33]), age 0–5 years (OR 1.17 [95% CI 1.02–1.38]) compared to age 6–12 years, fever (OR 2.14 [95% CI 1.78–2.59]), outpatient setting (OR 73 [95% CI 2.17–3.42]) and military sector (OR 2.29 [95% CI 1.82–2.90]). Antibiotic prescribing is high and often inappropriate. Predictors of broad-spectrum antibiotic prescribing were identified. Health policy initiatives should involve all stakeholders to minimize inappropriate antibiotic prescription and to prevent poor outcomes associated with such practice.

Objectives: The current study aimed to evaluate knowledge, attitudes, and practice patterns of health-care providers (HCPs) toward probiotics. Methods: This was a face-to-face interview in a random sample (n = 205) of physicians and clinical pharmacist in different Jordanian health-care institutions during the period of 1, June 2017–31, August 2017. A structured validated questionnaire was used to achieve study objectives. Results: Half of HCPs (51.5%) had fair knowledge about probiotics, and pediatricians were the most knowledgeable group of HCPs. Around Fifty-nine percent of HCPs had positive attitudes toward probiotics. However, less than half of HCPs (41.0%) had ever recommended or prescribed probiotics to patients. Conclusion: The results of this study reveal that HCPs have limited knowledge of probiotics although they have positive attitudes toward them. This is not reflected in their own clinical practice. Additional training and education about probiotics among HCPs are very imperative to enhance patient’s care.

Objectives: The current study aimed to evaluate the prevalence, level of knowledge and attitudes to seasonal influenza vaccination among older adults in Jordan. Methods: This was a cross-sectional study in which a close-ended questionnaire was administered to older adults (65 years or older) in two major cities in Jordan between May 2018 and July 2018. A p-value of less than 0.05 was considered the cutoff level for statistical significance. Results: Among 500 participants, only 1.2% (n = 6) received a seasonal influenza vaccine during the previous year. In assessing influenza disease and influenza vaccine knowledge, 47.8% had good knowledge. Around 61% of older adults reported influenza vaccine is effective against preventing influenza however, 49.8% reported that influenza could be treated with the influenza vaccine. Moreover, 27% thought the influenza vaccine is important for older adults. In terms of attitudes toward the vaccine, 24.6% had positive attitudes and 40.6% strongly agreed/agreed that influenza is a serious disease in older adults and they should take the influenza vaccine to prevent influenza. Conclusion: The results of this study showed an extremely poor influenza vaccination rate among older adults and a low level of influenza vaccination knowledge and attitudes.