Ensuring medication availability in healthcare facilities (HCFs) is crucial to providing good quality healthcare and reducing avoidable patient readmissions. In addition to manufacturing in the licensed pharmaceutical industries, extemporaneous compounding is the essential source of medication availability, especially for personalized healthcare [1,2,3,4].
Since the mid-1980s, the number of patients seeking personalized healthcare has been increasing. It is due to one size medicine (strength and dosage form) does not fit all. Therefore prescribing, dispensing, and administering extemporaneously compounded medication is a good solution. Extemporaneous compounding is the art and science of combining, mixing, repackaging, and labeling a drug product. Historically, it has been a crucial part of the pharmaceutical process. It has long been a service provided by licensed pharmacists since the origin of pharmacy. Today, with the technological advancements in the pharmaceutical field and increased need, the compounding pharmacy industry is experiencing a resurgence and becoming more relevant than ever [3, 5,6,7,8,9,10,11].
The medicine compounders compound according to a licensed practitioner’s prescription, medication order, or initiative based on the practitioner-patient-pharmacist relationship in the course of professional practice [1, 12]. It includes removal of allergenic ingredients, dosage form change, especially for easy swallow, altering strength, routes of the delivery, unpleasant flavor of available drug product, and allowing access to discontinued medications [5,6,7, 9, 12,13,14]. Therefore, compounding allows specific patients such as pediatric and geriatric patients, patients requiring dermatologic disease treatment and pain management, and others with more options [1, 8].
The compounded medications should be developed to meet unique medical needs and ensure patient safety. Therefore, compounding prescriptions should be prescribed by a licensed practitioner, compounded and dispensed by the licensed pharmacist, administered and used correctly. Compounding pharmacies must also comply with good compounding practice regulations for compounding within hospitals, community pharmacies, home infusion pharmacies, and, more recently, outsourced compounding facilities [1, 8, 9].
The regulatory scrutiny of pharmaceutical compounding practices is significantly less rigorous than that required for FDA-approved medications (commercially available medications). It is exempted from regular inspections, quality control testing, and rejection of material not meeting specifications. Furthermore, they are not clinically assessed for safety or efficacy before marketing. Moreover, there is no standard labeling or prescribing information with instructions for the safe use of compounded products. They are the potential causes for poor quality medication preparation (contamination, medication with too little or too much active ingredient, or failure to meet specifications). Finally, they may pose potentially fatal health risks for the users [5, 6, 12, 15,16,17,18,19]. As evidence, FDA reported the prevalence and potential risks of poor quality compounded medications many times. These defects lead to serious patient illnesses, adverse events, and deaths linked to poor quality compounded drugs [16, 20, 21].
Poor quality of compounded medication causes administration of a low dose of active ingredients. Administration of lower-dose antimicrobials can cause microbes, including bacteria, fungi, parasites, and viruses, to adapt and become less susceptible to medical treatment. Therefore, it can play a role in the emergence and spread of antimicrobial resistance (AMR), which causes a profound threat to human health. Moreover, irrational prescribing, packaging and labeling, administering, and using compounded medicine can contribute to AMR prevalence [1, 22,23,24]. Thus, the rational use of compounded antimicrobials can be the critical action to prevent the spread of antimicrobial-resistant infections. It mostly depends on healthcare practitioners' (HCPs') knowledge, perceptions, and practices. The presented study was aimed to investigate their knowledge, perception, and practice of extemporaneous compounding and its contribution to the prevalence of AMR.