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A substantial amount of read-through into full-length product was observed for some macrolides and depends on the relation between the dissociation rate constants for peptidyl-tRNA and the macrolide, respectively. The dissociation rate constant for josamycin is 60 times lower than the dissociation rate constant for erythromycin, which explains why no read-through is seen for josamycin in contrast to erythromycin.

Further, we have examined the phenomenon of peptide mediated resistance to macrolides. Our results show that expression of a resistance peptide increases the dissociation rate constant for erythromycin.

According to the National Direction of Pharmacy at the MoH, as of September 2018, 451 private pharmacies were registered countrywide. Of these, 150 (33%) were based in Maputo city, which includes the KaMphumo district municipality, where the study was conducted. The registered private pharmacies in the study area were categorised according to the socioeconomic status (high, middle and low) of their location in the city. After using the Excel random number function, three pharmacies were randomly selected from each socio-economic area (n=9).

The interview guide for the pharmacists was developed after an extensive literature review of similar studies. Primary data were collected using face-to-face in-depth interviews with open-ended questions. The interview guide was based on the objectives of the study. It consisted of demographic information, questions regarding dispensing practices, reasons, perceptions of pharmacists regarding customers behaviours towards antibiotic use, compliance with the law and guidelines dispensing. The interview guide included a definition of SMA, which was defined as the circumstances wherein the customer requests, purchases and administers an antibiotic without prescription, to themselves or a child.

Overall, 30 (93.75%) out of 32 pharmacy clients acknowledged using a variety of antibiotics, such as amoxicillin, cotrimoxazole, ciprofloxacin, azithromycin, metronidazole, amoxicillin with acid clavulanic, tetracycline, doxycycline and erythromycin. As the quotes below indicate:

Since events of sickness are likely to happen, participants expressed their entitlement to health. The health-seeking behaviour of participants is determined by their explanatory models of health and their medical rationalities.29 30 The practices of SMAs were regarded as a right of self-care where self-treatment is needed. However, what participants may not understand is that using NPAs exposes them to a variety of health risks, increasing the costs of healthcare services and the burden of resistant infections within the population. Moreover, participants were also not aware that by dispensing the requested NPAs, the pharmacists were acting against the dispensing protocols and the medicines law that states antibiotics are POMs.

The narratives of the participants, concerning the commonly used antibiotics, show that amoxicillin, cotrimoxazole and amoxicillin with clavulanic acid were the most used antibiotics. We found different results in a study in Nigeria, where ampicillin/cloxacillin, metronidazole, cotrimoxazole, ciprofloxacin and amoxicillin were the most used antibiotics.37

The utilisation of other antibiotics less prescribed by physicians and more potent antibiotics such as azithromycin, doxycycline and ciprofloxacin were also noticed. This was regarded by pharmacists as a changing trend in the utilisation of antibiotics, especially within the middle and high socioeconomic area pharmacy clients. Comparable results were reported in studies from India, where the tendency to request less common and more potent antibiotics was frequent.10 43 59ce067264

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