Adherence to Antibacterial Therapy and Associated Factors in Lower Respiratory Infections in War-Affected Areas: A Randomized Controlled Trial

<b>Background:</b> 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. <b>Methods:</b> An individual randomized controlled trial was conducted with 1:1 (intervention = 205, control = 205) participants aged >18 years. 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. <b>Results:</b> Finally, 187 patients remained in the intervention group, and a total (<i>n</i> = 18) lost to follow-up. The awareness was significantly increased through pharmacist-led interventions (<i>n</i> = 106, 56.7%; <i>p</i> = 0.01), along with the factors leading to antibiotic resistance knowledge. Overall, adherence to antibacterial therapy for the LRTIs has improved (<i>p</i> ≤ 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 (<i>p</i> ≤ 0.05) among the participants in the intervention group compared to the control group and with (OR: 1.050; CI: 0.150-1.024) demographics (education, <i>p</i> = 0.05). <b>Conclusions:</b> 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.