This article presents a novel formulation for preparation of Lactobacillus casei 01 encapsulated in soy protein isolate and alginate microparticles using spray drying method. A response surface methodology was used to optimise the formulation and the central composite face-centered design was applied to study the effects of critical material attributes and process parameters on viability of the probiotic after microencapsulation and in simulated gastrointestinal conditions. Spherical microparticles were produced in high yield (64%), narrow size distribution (d50=9.7 µm, span=0.47) and favourable mucoadhesive properties, with viability of the probiotic of 11.67, 10.05, 9.47 and 9.20 log CFU/g after microencapsulation, 3 h in simulated gastric and intestinal conditions and four-month cold storage, respectively. Fourier-transform infrared spectroscopy confirmed the probiotic stability after microencapsulation, while differential scanning calorimetry and thermogravimetry pointed to high thermal stability of the soy protein isolate-alginate microparticles with encapsulated probiotic. These favourable properties of the probiotic microparticles make them suitable for incorporation into functional food or pharmaceutical products.

Phosphodiesterase-5 (PDE-5) inhibitors, such as sildenafil and tadalafil, are drugs commonly used to improve erectile function. However, some erectile function-enhancing supplements with claims of being entirely natural may be adulterated with these drugs, posing health risks. This study screened supplements for erectile dysfunction from the Republic of North Macedonia using a fast, specific and sensitive HPLC-DAD method (runtime: 15 min). No interference was observed at the retention times of sildenafil and tadalafil, allowing for their unambiguous identification and quantification. Tadalafil was absent, but sildenafil was found in two of eight samples (32.78 and 13.47 mg per dosage). The results demonstrated the applicability of the method to determine whether food supplements marked for the erectile function enhancement are free of sildenafil and tadalafil.

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.

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.