Surgical-site infections (SSIs) represent a significant healthcare burden, often complicating wound healing and recovery. To overcome the limitations of systemic antibiotic administration, such as toxicity and poor localization, this study aimed to develop a bioactive dressing utilizing bacterial nanocellulose (BNC) impregnated with gentamicin-loaded chitosan nanoparticles (GNP). Chitosan nanoparticles were synthesized via ionic gelation with sodium tripolyphosphate (TPP) and optimized using a one-factor-at-a-time (OFAT) approach to control particle size, polydispersity index (PDI) and zeta potential. The optimized nanoparticles were impregnated into BNC disks, and the resulting composite was characterized using FTIR and Raman spectroscopy, XRD and SEM. Antimicrobial efficacy was evaluated against Klebsiella pneumoniae, while biocompatibility was assessed using MTT assays and cell-adhesion studies on human fibroblasts. The optimization process yielded stable, monodisperse nanoparticles with a mean size of 80.07 nm and a PDI of 0.192. SEM imaging confirmed the successful integration of nanoparticles into the BNC nanofibrillar network without compromising the membrane’s structural integrity. The BNC-GNP composite demonstrated significant antimicrobial activity against K. pneumoniae, comparable to free gentamicin solution. Furthermore, in vitro studies revealed good biocompatibility, with cell viability exceeding 70% and sustained fibroblast adhesion, although cell-attachment density decreased with higher nanoparticle concentrations. The developed BNC dressing containing gentamicin-loaded chitosan nanoparticles presents a promising multifunctional biomaterial. It effectively combines local infection control with a biocompatible environment suitable for tissue regeneration, offering a novel approach for the postoperative treatment of surgical-site infections.

Chronic obstructive pulmonary disease (COPD) requires ongoing care, and community pharmacists (CPs) play a key role in its management. This study assessed CPs’ knowledge, confidence, and practices related to COPD in Kosovo. A cross-sectional survey of registered CPs evaluated their knowledge and practices concerning COPD, covering general, pharmacological, and non-pharmacological aspects. Data analysis involved cross-tabulations and chi-square tests ( p < 0.05). The sample represented 9.5% of Kosovo’s CPs (mean age = 39.1 years; 63.2% female). Most participants (88.8%) lacked formal COPD training. While 84% dispensed COPD medications, only 57.6% felt confident managing the condition. Knowledge scores revealed gaps: general knowledge (mean = 3.3/8), pharmacological (1.42/5), and non-pharmacological (2.59/5). Pharmacological knowledge was weakest, with 60% scoring low. Education level correlated with general knowledge ( p = 0.011), and confidence was linked to knowledge ( p = 0.0004) and dispensing ( p = 0.0003). Substantial COPD knowledge gaps among CPs in Kosovo underscore the need for targeted education and system-level support to optimize patient care.

Background: Antibiotic-associated diarrhea (AAD) is a common consequence of gut microbiota disruption following broad-spectrum antibiotic use. Certain probiotics may reduce the incidence of AAD. However, their effectiveness also depends on appropriate counseling by community pharmacy professionals and implementation of evidence-based practice. Objectives: To assess the knowledge, attitudes, and practices (KAP) of community pharmacy professionals in North Macedonia regarding concomitant antibiotic–probiotic use and to identify factors associated with these domains. Methods: An anonymous content-validated online questionnaire was distributed to a convenience sample of community pharmacists and pharmacy technicians in North Macedonia (April–May 2026). Data were analyzed using descriptive statistics, chi-square tests, factor analysis, and regression models in Jamovi (version 2.6) and R software (version 4.4). A p-value <0.05 was considered statistically significant. Results: Among 285 respondents (mean age 41.8 ± 9.6 years), 54.7% were classified in the high category of the survey-based knowledge index according to the prespecified survey key. Recognition of probiotic efficacy was high (95.8%), but alignment with the prespecified survey key regarding proper administration with food and risk identification was lower (34.6% and 66.8%, respectively). Attitudes toward probiotic use were highly positive, and recommendation practices were frequently reported (84.5%), although counseling practices varied. More positive attitudes were associated with higher recommendation behavior (β = 0.512, p < 0.001) and female gender was also associated with higher scores (p = 0.008). Recent continuous professional education was associated with higher counseling-related practice scores (p < 0.001), while greater variability in counseling behavior was observed across community pharmacy professionals. Conclusions: Community pharmacy professionals in North Macedonia demonstrated favorable attitudes and frequent self-reported recommendation practices regarding probiotic use alongside antibiotics. However, important gaps remain in clinical knowledge and counseling consistency. Targeted continuing professional education and development of standardized national guidelines may be considered, but their effects on observed practice and patient outcomes require prospective evaluation.

Background: Inappropriate antibiotic use contributes to antimicrobial resistance and adverse drug reactions (ADR), including antibiotic-associated diarrhea (AAD), underscoring the importance of WHO AWaRe recommendations for rational prescribing. Clinical evidence supports the use of specific probiotic strains to reduce AAD risk, with strain-specific recommendations that should be adapted to regional contexts. Objectives: To assess oral antibiotic consumption in the Republic of North Macedonia (2011–2022), evaluate prescribing patterns according to the WHO AWaRe classification, identify antibiotics associated with a higher burden of AAD, and determine the availability of evidence-supported probiotics for AAD prevention. Design: Observational pharmaco-epidemiological study integrating antibiotic utilization data, pharmacovigilance signals, and evidence synthesis from systematic reviews and market analysis. Methods: Reimbursed oral antibiotic data (ATC J01) were obtained from the National Health Insurance Fund. Gastrointestinal ADR reports were extracted from EudraVigilance and FAERS. Diarrhea risk was estimated using SmPC frequency categories and normalized pharmacovigilance indicators. Systematic reviews and meta-analyses were used to identify probiotic strains with evidence for AAD prevention, and online pharmacy surveys assessed market availability. Results: Penicillins and cephalosporins predominated in antibiotic use. Amoxicillin/clavulanic acid, cefixime, and clindamycin ranked highest for diarrhea risk based on combined utilization and pharmacovigilance indicators. Saccharomyces boulardii and Lactobacillus rhamnosus GG showed the strongest evidence for AAD prevention. Considerable variability was observed in probiotic product composition and reporting across the market. Conclusion: Findings highlight antibiotics with higher AAD-related public health burden and support antimicrobial stewardship strategies, including evidence-based probiotic co-administration.