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This study has been aimed at evaluating knowledge, attitudes and behaviour of university students regarding the usage of antibiotics focusing on differences between medical and nonmedical students. This cross-sectional questionnaire-based study was performed on 800 students of the University of Novi Sad, Serbia. The identified predictors of adequate antibiotic knowledge were enrolled in medical program, higher grade average and appropriate use of antibiotics during last infection. Multivariate regression identified following predictors of self-medication: being medical student (B = 0.715; p

Introduction: Hypertension is a significant risk factor for stroke, myocardial infarction, and heart failure. Maintaining adequate blood pressure helps preventing cardiovascular complications. Aim: The aim of this study was to investigate the knowledge about hypertension and associated factors in controlling high blood pressure among hypertensive outpatients in the municipality of Bačka Topola, Republic of Serbia. Methods: The outpatients who visited their doctors and agreed to fill out an anonymous questionnaire were included in the survey conducted in March 2019 at the Primary Health Care Center of the municipality of Bačka Topola. The questions were related to the sociodemographic characteristics and medication-associated factors of significance for assessment of the outpatients' knowledge about antihypertensive drugs. Results: The mean age of patients was 62.9±10.7 years. Most frequently prescribed antihypertensive drugs were ACE inhibitors (80.8%) followed by beta blockers (46.8%), calcium channel blockers (22.6%) and diuretics (21%), fixed dose antihypertensive drugs were used by 4.8% patients. Majority of adequate knowledge participants had well controlled blood pressure (91.4%), while only 37.1% of average knowledge participants had well controlled blood pressure. The other factors related to poor blood pressure control and lower level of knowledge about hypertension were older age, female gender, lower level of education, less frequent visits to the GP, patients with more than one antihypertensive drug, patients with longer duration of hypertension treatment and patients who were not paying copayment for their antihypertensive drugs. Conclusions: The results of our study indicate that the patients' knowledge about hypertension and associated factors regarding the treatment of hypertension play an important role in maintaining blood pressure at the safe level. Therefore, educational campaigns are the key factors for the quality and satisfactory knowledge about use of antihypertensive drugs and management of hypertension.

Graphical abstract, Resveratrol was recognized as the major factor responsible for the beneficial properties of red wine. Several resveratrol-based dietary supplements are available, but their efficacy has not been sufficiently tested. This study was designed to examine the effect of resveratrol supplementation, using a commercially available product, on the metabolic status of experimental animals with induced hyperlipidemia or type 2 diabetes mellitus (T2DM). Hyperlipidemia was induced by feeding the rats a standard pellet diet supplemented with cholesterol. T2DM was induced by adding 10% fructose to drinking water and streptozotocin. Treatment with resveratrol-based supplement improved glycemic control in diabetic animals and significantly decreased serum low-density-lipoprotein (LDL) and triglyceride levels, concurrently increasing the high-density-lipoprotein (HDL) levels in animals with hyperlipidemia. Resveratrol-treated animals had improved tolerance to glucose loading. Supplementation did not induce alterations in parameters of liver and renal function. Findings indicate that commercial resveratrol supplement improves metabolic control in rats with induced hyperlipidemia and T2DM.

The beneficial medical properties of cannabis in treatment of variety of diseases have been widely recognized across many cultures (Zuardi, 2006, Aggarwal et al., 2009, Birdsall et al., 2016). At the end of the 19th century in Europe, cannabis was considered effective for the treatment of chronic pain, asthma, sleep disorders, depression, and loss of appetite (Guy et al., 2004, Manzanares et al., 2006, Sabo et al., 2013). Medical use of cannabis continued until the first half of the 20th century, when legal restrictions were introduced due to the psychoactive constituent - delta-9-tetrahydrocannabinol (THC), which is one of at least 113 cannabinoids identified in cannabis (Ben Amar, 2006, Horvat et al., 2007). In Serbia, cannabis is classified under narcotic drugs, and the production, sale and possession of cannabis for recreational use or any form of medical marijuana products is illegal (Law on Psychoactive Controlled Substances). Recently, a number of countries in Europe have introduced specific laws and programs to allow patients to use cannabis preparations to effectively relieve the symptoms of chronic pain, muscle cramps and spasticity in patients with multiple sclerosis, to alleviate nausea and vomiting and to improve weight gain and appetite in patients with AIDS (European Monitoring Centre for Drugs and Drug Addiction, 2017). Besides Netherlands, a country with more than 10 years of experience in medical cannabis use, medical cannabis has also been legalized in Italy, Spain, France, Romania and Czech Republic. As for the countries surrounding Serbia, Croatia and Macedonia are the most recent countries which have allowed the use of cannabis in medical purposes (Bifulco and Pisanti, 2015). As more countries in Europe and worldwide continue to change laws for medical marijuana use, public interest in medical cannabis legalization in Serbia is growing. When medical cannabis is legalized in Serbia, doctors will be the ones who will prescribe the products and answer to patients’ questions about its use, benefits and side effects. It is of immense importance to bear in mind specific harmful effects of cannabis, especially in young people. Cannabis is indicated as a possible risk factor for cardiovascular disease in young adults due to increased reporting of cardiovascular complications related to cannabis and their extreme seriousness (Jouanjus et al., 2014). Furthermore, exposure to cannabis during adolescence has been connected to deviations in the normal neurodevelopment, producing a brain particularly at risk of psychiatric disorders such as schizophrenia (Iannitelli et al., 2017, Quartini et al., 2017). Yet, prospective doctors may receive minimal education on this issue throughout the curriculum. A paucity of studies exist evaluating future health care professionals’ knowledge and attitude towards medical cannabis (Sabo et al., 2013, Ben Amar, 2006). In Serbia, one study evaluated beliefs about medical cannabis among fourth-year medical students, while another included only the final year students of pharmacy (Vujcic et al., 2017, Stojanovic et al., 2017). The aim of this study was to determine the frequency of recreational cannabis use among medical students and to explore their knowledge about therapeutic use/abuse, side effects and current legislation status of medical cannabis, as well as attitudes toward its legalization.

The aim of this study was to determine and describe trends in antibiotics utilization in Serbia over a ten-year period. Data were retrieved from publicly available annual reports (2010–2019). The results were expressed as Defined Daily Dose (DDD) per 1000 inhabitants per day (DID). All calculations were performed using the DDD values for the 2020 Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) version for each year of the study, to account for the DDD changes during the study period. Antibiotics were classified using the WHO Access, Watch, Reserve (AWaRe) classification. Total utilization of antibacterials for systemic use increased from 17.25 DID in 2010 to 28.65 DID in 2019. A statistically significant increasing trend in the use of the Watch category antibiotics was observed. A tendency towards use of broad-spectrum antibiotics, apparent by a statistically significant increase in the rate of utilization of broad-spectrum macrolides, quinolones and third-generation cephalosporins vs. narrow-spectrum ones, as well as a significant increasing trend in the use of quinolones was identified. Total antibiotic utilization was found to be well above the European average. Several specific problem areas were identified, which requires further efforts to improve antibiotic prescribing. The present study provides the information needed to facilitate antibiotic stewardship in Serbia further and proposes specific interventions to optimize antibiotic use in Serbia.

© 2020 Edizioni Scientifi che per l'Informazione su Farmaci e Terapia. A surveillance study was performed in an intensive care unit in the largest tertiary health care center in Vojvodina, Serbia from 2014 to 2018. Antibiotic prescription data were collated in the WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) format, while antibiotic resistance was expressed as incidence density adjusted for total inpatient-days. Individual trends were determined by linear regression, while possible associations between antibiotic prescription and resistance were evaluated using cross-correlation analysis. An overall decrease in antibiotic utilization was observed. The prescription rates of piperacillin-tazobactam increased significantly, while consumption of 3rd and 4th generation cephalosporins and fluoroquinolones decreased. There were rising incidence densities of doripenem resistant Acinetobacter spp., piperacillin-tazobactam resistant Pseudomonas aeruginosa and carbapenem and colistin resistant Klebsiella pneumoniae. These results can serve as a basis for the development of antimicrobial stewardship strategies in the current setting.

An ongoing issue of expired medications accumulating in some households is a universal problem around the world. The aim of the study was to investigate the extent and structure of expired medications in Serbian households, and to determine which therapeutic groups generated the most waste.This was an observational, cross-sectional study conducted in households in the city of Novi Sad, Serbia. The study had been performed over 8 month period (December 2011 - July 2012) and it consisted of personal insights into the medication inventory in households.Of 1008 families, 383 agreed to participate and complete the questionnaire (38.3% response rate). In almost a half of households (44.4%), expired medications were maintained. The amount of expired medications was 402 items, corresponding to 9.2% of total medications presented in surveyed households. The majority of expired medications (64.7%) was in solid dosage (tablets, capsules, granules, lozenges), following semisolid (ointments, creams, gel, suppositories) and liquid dosage forms (drops, syrups). Expired medications in the households belonged mostly to 3 categories: antimicrobials for systemic use (16.7%), dermatological preparation (15.9%) and medications for alimentary tract and metabolism (14.2%).This study revealed that there were relatively large quantities of expired medications in Serbian households, with a high prevalence of antibiotics for systemic use, anti-inflammatory and antirheumatic products, and medications for alimentary tract and metabolism.Težava s kopičenjem zdravil s pretečenim rokom trajanja v gospodinjstvih je velik problem po vsem svetu. Cilj te študije je bil raziskati obseg in sestavo zdravil s pretečenim rokom trajanja v srbskih gospodinjstvih in določiti, katere terapevtske vrste zdravil predstavljajo največji odpad.Opazovalna, presečna raziskava je bila izvedena v srbskih gospodinjstvih v Novem Sadu. Trajala je osem mesecev (od decembra 2011 do julija 2012). Sestavljena je bila iz osebnega vpogleda v zalogo zdravil v gospodinjstvih.Od 1008 družin se jih je 383 odločilo za sodelovanje in izpolnilo vprašalnik (38,3-odstotna odzivnost). V skoraj polovici gospodinjstev (44%) so imeli zdravila s pretečenim rokom trajanja. Skupno sta bili najdeni 402 zdravili s pretečenim rokom trajanja, kar predstavlja 9,2% vseh zdravil v anketiranih gospodinjstvih. Večina zdravil s pretečenim rokom trajanja (64,7%) je bila v trdi obliki (tablete, kapsule, granule, lozenge), sledila so zdravila v poltrdni obliki (masti, kreme, geli, suspenzije) in tekočine (kapljice, sirupi). Večina zdravil s pretečenim rokom trajanja v gospodinjstvih pripada eni od naslednjih treh skupin: antimikrobna zdravila za sistemsko rabo (16,7%), dermatološki preparati (15,9%) in zdravila za bolezni prebavil in presnove (14,2%).Raziskava je pokazala, da je v srbskih gospodinjstvih shranjenih relativno veliko zdravil s pretečenim rokom trajanja. Najpogosteje se pojavljajo antibiotiki za sistemsko uporabo, protivnetni in antirevmatski pripravki ter zdravila za bolezni prebavil in presnove.

Background/Aim. Hypertension is one of the leading causes of cardiovascular morbidity and mortality and more than a half of all health insurance expenditures for reimbursed medicines are allocated to antihypertensive drugs in Serbia. The aim of this study was to identify the antihypertensive drug utilization patterns among hypertensive outpatients in the city of Novi Sad, Serbia, determine the adherence to clinical guidelines and address the economic aspects of current prescribing practices. Methods. This retrospective observational study was conducted in Novi Sad over a period of six months. The data on the number of packages, size of packages, and retail price of antihypertensives issued on prescription in outpatients with the diagnosis of essential arterial hypertension was collected from all state-owned pharmacies in Novi Sad. Drug consumption was analyzed using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. Results. Total consumption of antihypertensives issued on prescription over 6 month period in the city of Novi sad, Serbia was 283,48 DDD per 1,000 inhabitans per day (DID). Angiotensin converting enzyme inhibitors (ACEi) were most commonly prescribed drugs, and were used 3 times more often than calcium channel blockers and 5 times more than betablockers. The consumption of diuretics and angiotensin receptor antagonists was low within all groups of outpatients. Both national and international guidelines state superiority and effectiveness of diuretics in treatment of hypertension in the elderly, but their consumption was unreasonable low despite the fact that over 70% of all antihypertensive drugs in the city of Novi Sad were dispensed in people aged > 60. The use of more expensive ACEi was observed, despite the guidelines deeming all the drugs of these class equally effective in treatment of hypertension. Conclusion. Large differences in utilization of different groups of antihypertensive agents were noted in this study. Underutilization of valuable, efficacious, and cost-effective thiazide diuretics and over use of expensive ACE inhibitors is unjustifiable. There is a potential for large savings with switching to low-price ACEi, modeling the practice of Scandinavian countries. [Projekat Ministarstva nauke Republike Srbije, br. III 41012]

Dietary supplements based on soybean extracts are widely used for a myriad of indications, but there is evidence that isoflavones, components of these supplements affect cytochrome activity. Alteration in pharmacodynamics of cytochrome-substrate drugs after co-administration with dietary supplements based on soybean extracts offers information on clinically significant herb-drug interactions that can cause unanticipated adverse reactions or therapeutic failures. Moreover, herbal drugs can contribute to the development and severity of drug-induced liver injury. Therefore, the aim of this study was to examine the effect of commercially available dietary supplements based on soybean extracts on liver and renal function, oxidative stress and pharmacodynamics of several conventional drugs. After quantification of isoflavones in the supplement using HPLC-DAD, pharmacological tests such as hot-plate, rotarod, pentobarbital-induced sleeping time were performed on Swiss albino mice treated with soybean extracts and several central nervous system acting drugs. Liver, renal function, and oxidative status in liver homogenates were determined in healthy and Wistar rats subjected to oxidative stress with CCl4. Dietary supplements based on soybean extracts weakened the analgesic activity of codeine, significantly potentiated diazepam-induced motor coordination impairment at 10th and 30th minute after diazepam administration, but had the opposite effect on alprazolam effect. Soybean extracts pretreated group also exhibited significantly shorter pentobarbital sleep induction and sleeping time. Soybean extracts administration did not affect the liver and renal function and ameliorated oxidative stress caused by CCl4. Despite exhibiting no negative effects on liver and renal function and demonstrated antioxidant in vivo potential, the safety of soybean extracts in addition to conventional drugs is questionable. The results of our study implicate the potential of dietary supplements based on soybean extracts for serious herb-drug interactions.

Aims The aims of this study were to assess patients’ non-adherence and associated factors to antidiabetic medication in the primary care setting in the eastern part of Bosnia and Herzegovina (BiH). Methods We conducted a retrospective chart review of 323 patients with type 2 diabetes mellitus (T2DM) attending the primary health care center of the Foca municipality in eastern part of BiH and measured adherence to antidiabetic medication. Adherence was measured using a pill count method. Results The majority of patients were treated with oral therapy (84.21%). Half of the patients (48%) treated pharmacologically were non-adherent and patients on oral and insulin combination therapy showed better adherence than those on oral therapy. Age (B = −0.749; p = 0.004), copayment (B = 0.549; p = 0.028) and oral therapy (B = 0.827; p = 0.045) were the strongest predictors of poor adherence. Conclusion About half of the patients were non-adherent to antidiabetic medication. Interventions oriented towards policy changes regarding availability of antidiabetic medication through copayment reductions, and providing healt education to younger population and patients on oral therapy could lead to better adherence among T2DM patients in eastern part of BiH.

Introduction: With the growing trend for legalization of cannabis and its derivatives in Serbia, pharmacists are likely to be consulted on the safety, efficacy, and drug-drug or drug-disease interactions of medical cannabis. Thus, the aim of our study was to assess pharmacy students’ knowledge and attitude toward medical cannabis use in Serbia to determine if additional education is needed. Subjects and methods: In the study students from the final year of the study program of integrated academic studies of pharmacy at the Faculty of Medicine, University of Novi Sad were asked to complete an anonymous questionnaire regarding their knowledge and attitudes on the use of cannabis and its derivatives in medical purposes. After giving their written informed consent, they were instructed by the researchers on how to complete the questionnaire. All questionnaires were administered between August 1, 2017 and August 15, 2017. The study was approved by the Ethical Committee of the Faculty of Medicine in Novi Sad; a total of 80 questionnaires were distributed. The questionnaire consisted of 3 groups of statements on which they should mark level of their agreement related to students’ knowledge about the use of cannabis and its derivatives in therapeutical purposes, potential negative effects, dispensing in a pharmacy and legalization of cannabis and its derivatives in medical purposes. Results: Although 91.2% of the respondents agreed that cannabis and its derivatives could potentially have therapeutical effects, much lower percentage of respondents (51.3%) were familiar with possible therapeutical effects of cannabis. The same percentage of respondents learned about therapeutical effects of cannabis from sources other than school. About third (31.3%) of our respondents thought that the use of cannabis and its derivatives in therapeutical purposes could cause their abuse and the similar percentage of respondents (33.8%) thought that issuing cannabis and its derivatives in the pharmacy could expose a pharmacist to the certain dangers such as insisting on the issuing without the prescription or robbery. About 90% of the respondents agreed it is necessary to create clear guidelines for the use of cannabis and its derivatives in therapeutical purposes and 76.3% of the respondents thought that doctor’s prescription is necessary for their dispensing in a pharmacy. Most of the respondents (75%) agreed that, based on the experiences of the countries which have approved the use of cannabis and its derivatives in therapeutical purposes, its use in those purposes should be approved in Serbia. Conclusion: The majority of pharmacy students supported medical cannabis legalization but only with strict legal regulations and clear guidelines for their use implemented. Further education of the pharmacist about therapeutical effect of cannabis is necessary.

The purpose of this systematic review was to determine the practice of medication disposal around the world and get insight into possible association between environmental awareness and people’s behavior regarding this issue. A literature search (2005–2015) was performed to identify reports with quantitative data on disposal practices published in peer-reviewed literature. The most common method for disposal of unused medications in households is disposal in the garbage (Kuwait, United Kingdom, Lithuania, Qatar, Serbia, Ghana, Bangladesh, Malta and Saudi Arabia). The practice of flushing drugs into the sewage system still takes place in New Zealand, USA and Bangladesh. Only in Sweden and Germany, practice of returning drugs to pharmacy was practiced to a larger extent. The environmental impact of improper medication disposal is expected in countries with poorly functioning waste management schemes (Middle Eastern, Asian and African countries). Lack of the adequate information and clear instructions on proper manners of drug disposal was reported in many surveyed countries (USA, New Zealand, Bangladesh, Malta and Ireland). Clear and definite connection between knowledge about environmental detrimental effects of improper drug disposal and the preference towards disposal methods could not be established. Many respondents were generally concerned with issues of inadequate medicines discarding but the behavior regarding disposal of unused drugs often did not equate the awareness (Serbia, USA, Kuwait, Malta and UK). The current data emphasizes the global issue of improper medicine disposal, prevalent in environmentally-aware people.

Introduction The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population. Methods The study sample consisted of adult subjects who consulted general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%). Results The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection. Conclusions Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.

Antibacterial drugs, including fluoroquinolones, can exert their therapeutic action only with adequate penetration at the infection site. Multiple factors, such as rate of protein binding, drug liposolubility and organ blood-flow all influence ability of antibiotics to penetrate target tissues. Microdialysis is an in vivo sampling technique that has been successfully applied to measure the distribution of fluoroquinolones in the interstitial fluid of different tissues both in animal studies and clinical setting. Tissue concentrations need to be interpreted within the context of the pathogenesis and causative agents implicated in infections. Integration of microdialysis -derived tissue pharmacokinetics with pharmacodynamic data offers crucial information for correlating exposure with antibacterial effect. This review explores these concepts and provides an overview of tissue concentrations of fluoroquinolones derived from microdialysis studies and explores the therapeutic implications of fluoroquinolone distribution at various target tissues.