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Keywords
PPIsCommunity pharmacyPerceptionAttitude

1. Introduction
   Proton pump inhibitors (PPIs) effectively suppress acid secretion and play an important role in peptic ulcer disease and gastroesophageal reflux disease (Wolfe and Sachs, 2000). PPIs also used as protectant agent in stress ulcer disease and along with the use of NSAID (Wolfe and Sachs, 2000). It is estimated that over $13 million sales of PPI prescriptions occurred worldwide (Katz, 2010). This rise a concern about the overutilization of PPIs, which will lead to significant high cost and undesirable outcomes such as clostridium difficile, acute interstitial nephritis and microscopic colitis (Katz, 2010). In addition, they may lead to minerals and vitamins malabsorption such as calcium, magnesium and vitamin B12 (Abraham, 2012).

The introduction of a standardized guideline on prescribing PPI helped in decreasing inpatient use of PPI prescriptions, only among patients not receiving PPIs at the time of hospital admission (Yachimski et al., 2010). This support that the majority of prescriptions are among outpatient sittings and are taking care by community pharmacists (Yachimski et al., 2010). Community pharmacists’ knowledge and attitude toward PPIs play an important role in optimizing the use of PPI and to prevent any adverse event, drug-drug interaction or inappropriate use PPIs.

In view of this, we carried out a questionnaire-based study to evaluate the knowledge and attitude of community pharmacists (CPs) in Riyadh city, towards the use of gastric acid suppressants particularly, proton pump inhibitors (PPIs). Despite that these medications are prescribed medications, many community pharmacies in Saudi Arabia still dispense them without prescription. Therefore, we have used the term “prescribed’ instead of “dispensed’ throughout this study. The aim of this study is to evaluate the knowledge of community pharmacists about this class of medications and to demonstrate their attitude toward despising them to patients in Saudi Arabia.

2. Methods
   This is a cross-sectional survey-based study that was carried out between September and December 2017. The survey intended to evaluate the knowledge and attitude of CPs towards use of proton pump inhibitors and was built as an online survey. The survey link was emailed to manager of pharmacy chains. The survey was involved to a cover letter. It clarified the nature and objectives of the study. The questionnaire was composed of two sections: questions to describe demographics of CPs; and questions to assess knowledge and attitude of CPs towards use of PPIs. The knowledge and attitude questions were adapted and modified from a previous study (Padhy et al., 2014). It comprised of questions with respect to number of patient encounters, decision of acid suppressive medications, duration of treatment, favored route of administration and knowledge of adverse effect reactions. The adapted version of the original survey was validated by 30 community pharmacists before delivering it to respondents. Reliability test was done and the Cronbach’s alpha coefficient was 0.78.

All collected data were entered into Microsoft Excel 2007 and then transferred into the SPSS version 24 for Windows for analysis. Fisher’s exact test was conducted to find any significant association between respondents’ demographic characteristics and knowledge items at a significance level of 0.05.

3. Results
   A total of 1219 respondents completed the survey. The majority of the pharmacists (87.2%) were between 25 and 35 years of age. Most of the participants (75.4%) have less than 10 years of practice in community pharmacy setting. Table 1 summarizes all demographic data collected.