Antibiotic resistance (ABR) is an emerging global threat to public health. Substantial evidence has indicated that community pharmacists (CPs) can play a critical role in managing the ever-increasing threat of antibiotic resistance. This study aimed to determine the knowledge, attitude, and practices of CPs (n = 180) towards antibiotics and antibiotic resistance as well as to improve the rational use of antibiotics. A two-phase mixed-methods (quantitative and qualitative) online study was conducted in Pakistan from August 2019 to March 2020 by using validated questionnaires and semi-structured interview data. Different statistical methods were used to tabulate the quantitative data, whereas inductive thematic analysis was conducted to categorize themes from the qualitative data and to draw conclusions. Approximately 64.4% of the CPs were male (mean: 29–33 years old). Overall, CPs had good knowledge of and were familiar with multidrug-resistant organisms and their roles in ABR (65.6%, median = 1, and IQR = 1), although their knowledge was poor in differentiating some antibiotic groups with their respective ABR patterns (31.1%, median = 1, and IQR = 1). Most CPs have a positive attitude towards antibiotics, with most (90.0%) identifying ABR as a critical issue in public health (median = 1 and IQR = 0). Overall, CPs’ practices towards antibiotics were somewhat acceptable, where they leaned towards educating patients about the rational use of antibiotics (52.8%, median = 1, and IQR = 1). The two main themes discovered (antibiotics and counseling of patients) were related to self-medication, while educational intervention is the main subtheme. ABR is multifactorial, with subthemes related to budget, time constraints, incompetent staff, the absence of CPs, the lack of training, and the enforcement of laws and regulations being the needs of the hour in Pakistan. Effective antibiotic stewardship programs, patient education, and awareness campaigns about antibiotics and ABR along with training of the CPs are important factors that have to be addressed in a timely manner.

Antibiotics dispensing without a prescription is an irrational practice and can increase the risk of antibiotic resistance, which is a significant public health concern around the globe. This study was aimed to determine the extent to which antibiotics are supplied without prescription in the community pharmacies (CPs) at Hazara Division from November 2020 to February 2021. The simulated client method (SCM) was used, and the data were gathered, recorded, and analyzed through different statistical methods with descriptive and inferential techniques. The antibiotic dispensing was observed in CPs (90.5%), the most dispensed antibiotics were azithromycin (29.4%) and ciprofloxacin (46.5%) respectively. Furthermore, visited medical stores/ drug outlets, 9.5% of the visited stores denied dispensing of antibiotics because they preferred a referral to visit physicians (23. 9%) and (12.8%) did not had the antibiotics at the time of visits. Antibiotics were more obtainable in retail medical stores (AOR = 8.6, 95 percent Cl: 3.0–24.7;p= 0.001) than in pharmacies. In rural areas antibiotics dispensing was more (p = 0.004) as compared to urban areas. Staff members also had asked about patient’s (17.7%) symptoms and drug allergies (12.3% and 3.9%), and (1.5%) they consoled them about their medications. The findings of this study indicate that nonprescription antibiotic sales are very common, despite national rules prohibiting this activity. When the simulated Client requested for any medication to relieve his or her discomfort, many antibiotics were given out without a prescription. Pharmacies/medical stores in Hazara Division selling antibiotics without a prescription are worrying and need immediate action by regulators.

The traditional use of Mirabilis jalapa L. roots to enhance male sexual performance prompted us to assess the in silico, in vitro, and in vivo aphrodisiac activities of its hydroethanolic extract using normal male rats. Spectroscopic characterization indicated the presence of ß-D-glucopyranoside, methyl-1,9-benzyl-2,6-dichloro-9H-purine, and Bis-(2-ethylhexyl)-phthalate; these compounds have a significant inhibitory effect on the phosphodiesterase-5 (PDE-5) enzyme in silico evaluation and minerals (including zinc, cadmium, and magnesium). Other phytochemical analyses revealed the presence of phenolic compounds and flavonoids. These phytochemicals and minerals may contribute to the aphrodisiac activities of the extract. Additionally, the in vivo study revealed that the administration of M. jalapa root extract (300 mg/kg) significantly enhanced (p < 0.01, p < 0.03) mount, intromission, and ejaculation frequencies while significantly (p < 0.05) decreasing the mount and intromission latencies, as well as the post-ejaculatory interval time, in comparison with the standard drugs sildenafil and ginseng, resulting in enhanced erection and sexual performance in the rats. Furthermore, the extract significantly (p < 0.05) increased penile reflexes and also elevated the levels of testosterone and luteinizing hormones. Extract (300 mg/kg) significantly (p < 0.05) inhibited the PDE-5 enzyme in an in vitro study. Concludingly, the comprehensive findings of this study suggest that a standardized herbal extract derived from M. jalapa roots alleviates erectile dysfunction and premature ejaculation in male rats. M. jalapa root extract proved to be an alternative treatment for erectile dysfunction and premature ejaculation.

The dispensing of non-prescription antibiotics is a worldwide concern, and antibiotics should only be dispensed with a legitimate prescription. A cross-sectional study was conducted using the simulated client methodology, with data collected, recorded, and analyzed using SPSS. The simulated client visited 210 pharmacies, of which 70 dispensed antibiotics without a prescription. Outcomes The most often suggested antibiotics for upper respiratory tract infections (URTIs) were Amoxicillin (n = 17, 8.1%), Clarithromycin (n = 20, 9.5%), and Moxifloxacin (n = 13, 6.2%), with 33.3% of medications dispensed without a prescription for URTIs. Cefixime (n = 20, 9.5%) and ceftriaxone (n = 17, 8.1%) were the most often administered medications for urinary tract infections (UTIs). The non-prescribed dispensing of upper respiratory tract infections (URTIs) and urinary tract infections (UTIs) was markedly elevated (p < 0.05). Antibiotics were dispensed without a prescription for diarrheal diseases in over 50% of pharmacies, with Metronidazole (n = 23, 11%), Azithromycin (n = 16, 7.6%), and Rifaximin (n = 15, 7.1%) being the most often prescribed. In all bivariate and multivariate models, male gender was associated with reduced likelihood (COR: 0.30, 95% CI: 0.12–0.72; p = 0.0079 and AOR: 0.03, 95% CI: 0.005–0.15; p = 0.0001). Individuals aged 30 years and older exhibited increased odds of dispensing in both bivariate (COR: 3.67, 95% CI: 1.69–8.87; p = 0.0018) and multivariate analyses (AOR: 9.44, 95% CI: 2.55–61.70; p = 0.001). The presence of a pharmacist on duty markedly diminished the likelihood of administering antibiotics without a prescription (COR: 0.13, 95% CI: 0.06–0.25; p = < 0.001; AOR: 0.06, 95% CI: 0.03–0.16; p = < 0.001). These findings highlight the imperative of enforcing existing laws and implementing rigorous rules, alongside pharmacy-centered antimicrobial stewardship programs that focus on accurate dispensing practices to mitigate antimicrobial resistance.

Inadequate infection control in healthcare settings can increase healthcare-associated infections and worsen morbidity and mortality rates. Standard precautions, applicable to all patients with suspected or confirmed infections, safeguard both healthcare personnel and patients. This study aimed to evaluate knowledge, attitudes and practices regarding standard precautions among healthcare personnel in tertiary care hospitals across Punjab, Pakistan. This multi-centre cross-sectional study, conducted from May to July 2019, included 600 healthcare personnel recruited via convenience sampling from tertiary care hospitals in six cities selected at random. Out of 533 healthcare personnel, the response rate was 88.8%. Most respondents were female (N=341, 64.2%), mean ± standard deviation (SD) age was 28.85 ±7.08 years, and mean ± SD length of service was 5.58 ± 5.78 years. Knowledge, attitudes and practices regarding standard precautions were poor, and only 37.5%, 46.7% and 46.3% of respondents had good knowledge, positive attitudes and safe practices, respectively. Healthcare personnel with >10 years of experience [adjusted odds ratio (AOR) 2.98, 95% confidence interval (CI) 1.60–5.55], previous infection control training (AOR 1.96, 95% CI 1.30–2.94), professional degrees (AOR 2.04, 95% CI 1.16–3.60), and availability of infection control guidelines in their work department were more likely to have good knowledge regarding standard precautions. The availability of infection control guidelines in the work department was also significantly associated with positive attitudes (AOR 2.83, 95% CI 1.76–4.56) and safe practices (AOR 3.46, 95% CI 1.94–6.14). Knowledge, attitudes and practices of healthcare personnel regarding standard precautions were inadequate. Continuous education and certified training for healthcare personnel can improve infection control measures substantially in public healthcare settings.