Adherence to antibacterial therapy and associated factors in lower respiratory infections in war-affected areas: a randomized controlled trial

Background: Lower respiratory tract infections (LRTIs) are one of the leading causes of mortality. Pharmacist-led interventions can enhance adherence to antibiotics; the present study aims to determine adherence to the antibiotics prescribed for LRTIs and related factors. Methods: An individual randomized control trial was conducted with 1:1 (intervention=205, control=205) participants aged >18 years recruited. The primary outcomes included adherence to therapy at weeks 1 and 2, awareness of antibiotic use, and appropriate discontinuation as prescribed. The secondary outcome measures were the overall clinical outcomes of the therapy and the effectiveness of educational interventions assessed at the final week 7 (overall assessment checked and treatment was not continued). The data were analyzed using different statistical methods, including descriptive statistics for data summarization, and inferential techniques were used. The WHO-PAS and BMQ questionnaires were scored on a 5-point (Likert Scale), with total and domain-specific scores computed and summarised as median (IQR); group comparisons were carried out by Mann–Whitney U statistics, while mean (SD) values were additionally calculated to descriptively summarise group-level differentiations. Finally, 187 patients remained in the intervention group, and a total of n=18 were lost to follow-up. The awareness was significantly increased through pharmacist-led interventions (n=106, 56.7%; p=0.01), along with the factors leading to antibiotic resistance knowledge. Overall, adherence to antibacterial therapy for the LRTIs has improved (p≤0.01), and a significant correlation exists between overall MMAS-8 mean scores and other demographic factors; interventions improved [0.441-2.151] with adherence (post-intervention). Higher adherence was found (p≤0.05) among the participants in the intervention group as compared to the control group, and with (OR: 1.050; CI: 0.150-1.024) demographics (education, p=0.05). Conclusion: Overall, the intervention group showed better awareness, understanding, and attitudes about antibiotics, and their adherence to antibiotic therapy improved significantly, along with the overall clinical outcomes.