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Review Article | DOI: https://doi.org/10.31579/2693-4779/308
Surgeon/Specialist In Occupational Hygiene - Geriatrics, Ma In Geriatrics, Venezuela.
*Corresponding Author: Víctor José Ramón Banco López, Surgeon/Specialist in Occupational Hygiene - Geriatrics, Ma in Geriatrics, Venezuela.
Citation: Banco López VJR, (2026), Dynamics of Antibiotic Prescription, Self-Medication and Bacterial Resistance in the Pediatric Population: A Multidimensional Study of Public and Private Health Centers in the Province of Chincha, Clinical Research and Clinical Trials, 15(2); DOI:10.31579/2693-4779/308
Copyright: © 2026, Víctor José Ramón Banco López. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 12 January 2026 | Accepted: 28 January 2026 | Published: 06 February 2026
Keywords: blood transfusion safety; electronic identification systems; barcoding; radiofrequency identification (rfid); cost effectiveness; patient safety; blood transfusion errors
This comprehensive technical report presents an in-depth analysis of the pharmacological management of Acute Respiratory Infections (ARIs) in the pediatric population of Chincha Province, Ica Department, Peru. The research examines the operational and clinical dichotomy between public sector facilities (Ministry of Health - MINSA and Social Security Health Insurance - EsSalud) and private healthcare infrastructure (clinics, polyclinics, and medical centers), evaluating prescribing patterns, adherence to national and international Clinical Practice Guidelines (CPGs), and the impact of self-medication facilitated by pharmacies.
The findings reveal a silent but growing public health crisis. While the public sector struggles with adherence to protocols due to overcrowded healthcare facilities and limitations in rapid microbiological diagnostic tools, the private sector shows a trend toward overprescribing broad-spectrum antibiotics (third-generation cephalosporins and macrolides), driven by implicit economic incentives and the cultural demand for a "quick cure" from parents. We documented alarming rates of self-medication in districts such as Sunampe and Grocio Prado, exceeding 88%, and a sustained increase in bacterial resistance, particularly in Escherichia strains. Extended-Spectrum Beta-lactamase (ESBL) -producing coli and Staphylococcus methicillin -resistant aureus (MRSA), exacerbated after the COVID-19 pandemic. This report proposes a roadmap for regulatory and educational intervention, essential to preserving therapeutic efficacy in the region.
1.1. Antimicrobial Resistance: A Global Threat with Local Repercussions
Antimicrobial resistance (AMR) has ceased to be an apocalyptic prediction and has become a tangible clinical reality that threatens the foundations of modern medicine. The World Health Organization (WHO) has listed AMR as one of the top ten threats to global public health, projecting that by 2050 it could cause more deaths than cancer if immediate corrective measures are not taken. 1 In the Latin American context, and specifically in Peru, this phenomenon has reached critical dimensions, exacerbated by fragmented health systems, lax regulations on drug dispensing, and sociocultural factors that favor the indiscriminate use of medications. 2. The "post-antibiotic era," where common infections and minor injuries can once again become fatal, is a scenario already emerging in intensive care units and outpatient clinics in the Ica region. The loss of efficacy of first-line antibiotics, such as amoxicillin and cotrimoxazole , is forcing healthcare professionals to resort to second- and third-line therapies, which are more expensive, have greater adverse effects, and often require hospitalization. 4 This report focuses on the province of Chincha, a microcosm representative of the Peruvian healthcare system, where the interaction between public and private healthcare providers creates a complex ecosystem of antimicrobial use.
1.2. Problem Statement in Chincha: The Link between Prescription and Resistance
In the province of Chincha, the management of infectious diseases in childhood faces structural challenges. Inappropriate antibiotic prescription for acute respiratory infections (ARIs) of viral etiology is an endemic practice. Despite compelling scientific evidence indicating that more than 80-90% of pharyngitis, bronchitis, and rhinopharyngitis in children under five years of age are caused by viruses (rhinovirus, respiratory syncytial virus, influenza, adenovirus), the antibiotic prescription rate in local clinics remains disproportionately high. 5.
This prescribing behavior is not uniform; it varies significantly depending on the setting in which care is provided. The central hypothesis of this analysis suggests that divergent incentives exist between the public and private sectors in Chincha that perpetuate the misuse of antibiotics. While public sector physicians often prescribe defensively due to a lack of follow-up and diagnostic resources, private sector physicians face pressure to satisfy clients and the perception of immediate effectiveness [7]. Added to this is the role of pharmacies and drugstores, which in districts such as Chincha Alta, Sunampe, and Pueblo Nuevo act as the first point of contact for healthcare, dispensing antibiotics without a prescription based on the recommendations of unqualified technical personnel [9].
1.3. Epidemiological and Social Justification
Acute respiratory infections are the leading cause of morbidity in children under five years of age in the department of Ica. 11 Epidemiological bulletins from the Regional Health Directorate (DIRESA) of Ica confirm that the districts of Chincha Alta and Grocio Prado consistently present high incidence rates of ARI, associated with climatic factors (high humidity), environmental pollution, and housing conditions. 12
The social cost of bacterial resistance in this population is incalculable. A child colonized by multidrug-resistant bacteria (such as ESBL-producing E. coli or MRSA) due to prior and unnecessary antibiotic use has a significantly higher risk of treatment failure if they develop a subsequent serious bacterial infection, such as pyelonephritis or complicated pneumonia. 14 Furthermore, the economic impact on families in Chincha is considerable, given that out-of-pocket expenses for brand-name medications and private consultations increase due to the ineffectiveness of initial treatments. 16
The healthcare system in Chincha is dual and fragmented, which directly impacts the quality of prescriptions and access to accurate diagnoses. Analyzing this infrastructure is vital for understanding patient flows and treatment decisions.
2.1. The Public Sector: MINSA and EsSalud
The public sector in Chincha is primarily represented by the network of facilities belonging to the Ministry of Health (MINSA) and the Social Health Insurance (EsSalud). These centers form the backbone of healthcare for the low- and middle-income population.
• Infrastructure and Resources: Primary healthcare facilities (health posts and centers in districts such as El Carmen, Alto Larán, or Sunampe) often have limited capacity. They frequently lack microbiology laboratories capable of performing cultures or rapid antigen detection tests (for example, for Streptococcus). pyogenes), which forces the physician to base their diagnosis exclusively on clinical observation [17].
• Protocols and Restrictions: Prescribing in these centers is strictly governed by the National List of Essential Medicines (PNUME). This, in theory, promotes rational use by limiting the availability of broad-spectrum antibiotics not indicated for primary care. However, the lack of therapeutic options and the pressure to "resolve" the condition in a 15-minute consultation often led to the empirical prescription of amoxicillin or cotrimoxazole, even when viral suspicion is high [19].
• Overcrowding: The high demand for care at hospitals such as Hospital San José (a MINSA referral hospital) and Hospital René Toche Groppo (EsSalud) generates long waiting times, which encourages parents to seek faster alternatives in the private sector or at pharmacies [21].
2.2. The Private Sector: Clinics and Medical Centers
The private sector in Chincha has experienced remarkable growth, offering an alternative for those who can afford it or have private insurance. Key institutions identified in the region include:
In this sector, the prescribing dynamic is different. There is greater availability of brand-name and latest-generation drugs. Physicians, often specialists or general practitioners with experience in the private sector, may feel pressure to prescribe "stronger" treatments to ensure the satisfaction of the parent, who often associates the prescription of an expensive antibiotic with quality care [9].
2.3. The "Gray Sector": Pharmacies and Drugstores
The network of pharmacies and drugstores in Chincha is extensive and widespread, reaching areas where medical services are scarce. In districts like Sunampe and Pueblo Nuevo, these pharmacies effectively serve as primary care centers.
• The Pharmacist as Prescriber: Local studies indicate that a large proportion of the population goes directly to the pharmacy at the first sign of an acute respiratory infection (ARI). Pharmacy staff, often technicians rather than licensed pharmacists, recommend and dispense antibiotics without a prescription, contravening national regulations. 9
• Perverse Incentives: There is evidence of economic incentives (the " push" therapy " by laboratories and pharmaceutical chains so that pharmacy employees recommend certain brands of antibiotics, prioritizing sales over clinical indication. 28
To understand the use of antibiotics, we must first understand the burden of disease that motivates the consultation.
3.1. Respiratory Morbidity Profile (2023-2024)
According to epidemiological surveillance reports, ARIs consistently represent the number one cause of outpatient and emergency visits in pediatrics in the Ica region.
• Rhinopharyngitis (Common Cold): This is the most frequent pathology, responsible for approximately 40-50% of consultations for acute respiratory infections (ARIs). Its etiology is viral in almost 100% of cases (Rhinovirus, seasonal Coronaviruses).
• pharyngotonsillitis: Presents a diagnostic challenge. Although only 15-30% of cases in children are bacterial (caused by Streptococcus). pyogenes), the antibiotic prescription rate for this diagnosis in Chincha exceeds 70-80% in the private sector. 12
• Bronchitis and Bronchiolitis: Predominantly viral conditions (Influenza, Parainfluenza, RSV) that, nevertheless, frequently receive antibiotic coverage under suspicion of bacterial superinfection, often without radiological or laboratory evidence [29].
| Pathology | Predominant Etiological Agent | Estimated Antibiotic Prescribing Rate (Public) | Estimated Antibiotic Prescription Rate (Private) | Actual Clinical Justification |
| Acute Rhinopharyngitis | Viral (Rhinovirus, Coronavirus, Adenovirus) | 20% - 30% | 40% - 55% | None (except for complications such as otitis media) |
| Pharyngotonsillitis | Viral (70-80%) / S. pyogenes (20-30%) | 55% - 65% | > 85% | Indicated only if bacterial (Centor Criteria /Culture) |
| Acute Bronchitis | Viral (Influenza, Parainfluenza, RSV) | 35% - 45% | 65% - 80% | Generally, not indicated (self-limited) |
| Acute Otitis Media | Viral/Bacterial (S. pneumoniae, H. influenzae) | 75% - 85% | > 95% | Indicated according to severity and age (<2> |
| Pneumonia | Viral (RSV, Influenza) / Bacterial (S. pneumoniae) | > 95% | 100% | Indicated (mandatory empirical treatment) |
Table 1: Estimated Epidemiological Profile of Respiratory Infections in Children Under 5 Years Old (Chincha/Ica, 2023-2024).
Source: Prepared by the authors based on regional trends, local prescribing studies, and data from the CDC in Peru. 12
3.2. Impact of the COVID-19 Pandemic on the Virological Profile
The COVID-19 pandemic significantly altered the circulation of respiratory viruses. Following the lifting of isolation measures, Chincha, like the rest of Peru, experienced a resurgence of influenza and respiratory syncytial virus (RSV) cases in 2023 and 2024. This phenomenon, known as "immunological debt," led to more severe respiratory illnesses in children who had not previously been exposed to these pathogens. Clinically, this translated into increased parental anxiety and a greater demand for antibiotics, leading to the misdiagnosis of severe viral infections as bacterial infections. 29
Analysis
Prescribing an antibiotic is not only a clinical act, but also a social and economic one. In Chincha, the differences between the public and private sectors are stark and revealing.
4.1. Public Sector: The Protocolized but Limited Prescription
In the MINSA and EsSalud health centers in Chincha, prescription patterns are characterized by:
1. Penicillin Dominance: Amoxicillin is the most prescribed antibiotic, followed by Benzathine Penicillin G (for streptococcal pharyngotonsillitis) and Cotrimoxazole (although its use has decreased due to high rates of resistance) [11].
2. Adherence to National Guidelines: There is greater formal adherence to the MINSA Clinical Practice Guidelines, which recommend amoxicillin as first-line treatment for most uncomplicated bacterial respiratory infections [32].
3. Diagnostic Gaps: The lack of rapid tests (streptotest, viral PCR) in public primary care leads to "empirical prescribing due to uncertainty." Faced with doubt as to whether a high fever is due to influenza or a bacterial infection, and given the impossibility of close follow-up (due to access barriers), the physician opts to prescribe antibiotics to "cover up" the patient [17].
4.2. Private Sector: The Prescription of "High-End" Products and Marketing
In private clinics and private practices in Chincha, a shift in the prescriptive profile is observed:
1. Use of Cephalosporins and Macrolides: It is common to find prescriptions for Cefixime, Cefuroxime, and Azithromycin as first-line treatments for conditions that, according to guidelines, should be treated with amoxicillin or symptomatic management. The use of intramuscular Ceftriaxone for "severe flu" is a widespread and culturally accepted practice in the private sector, perceived as a more "potent" intervention [5].
2. Brand Influence: Prescriptions for brand-name medications predominate over those for generics. This reflects the perception of superior quality among physicians and patients, as well as the promotional strategies of the pharmaceutical industry, which regularly visits these offices [31].
3. Defensive Medicine and Satisfaction: Private physicians often prescribe antibiotics to meet the expectations of parents, who may feel the consultation "wasn't worth it" if they are only prescribed paracetamol and fluids. The antibiotic acts as a psychological placebo for parental anxiety [6].
Post-COVID Azithromycin Phenomenon
A critical issue in Chincha is the excessive use of azithromycin. During the COVID-19 pandemic, this drug was included in treatment kits and became extremely popular. Despite evidence ruling out its effectiveness against COVID-19, the population of Chincha incorporated azithromycin into their mental medicine cabinet as a standard remedy for any respiratory ailment. In the period 2023-2024, it was observed that many parents administered azithromycin to their children before attending a doctor's appointment, or explicitly requested it from the doctor or pharmacist. This massive and unnecessary use (given that most respiratory pathogens are viral or require beta-lactams) is exerting tremendous selective pressure on bacteria such as Streptococcus. pneumoniae in the community.5
Self-medication is not a marginal phenomenon in Chincha; it is a central practice in health-seeking behavior.
5.1. Prevalence and Local Reality
Recent studies conducted in pharmacies in the districts of Sunampe and Grocio Prado reveal alarming figures. A 2023 investigation at the "J and M" pharmacy in Sunampe found a self-medication prevalence of 88.9% among the adult population, who often purchase medications for their young children. 37 Another study in Chincha Alta corroborated this trend, reporting that more than 80% of pharmacy users acquire antibiotics without a prescription. 27
| Factor | Description of Local Impact |
| Economic | Pharmacy consultations are free. Avoid clinic co-payments or transportation costs and waiting times at public hospitals. |
| Cultural | Deep-seated belief that antibiotics "cut off the infection" or "dry up the phlegm." Previous use of old prescriptions for similar symptoms. |
| Access | High density of pharmacies and drugstores in urban and peri-urban areas of Chincha. 24/7 availability. |
| Pharmaceutical Counseling | Pharmacy technicians recommend antibiotics in more than 70% of cases of respiratory symptoms (cough, sore throat). 9 |
Table 2: Factors Associated with Self-Medication with Antibiotics in Chincha
5.2. The Role of Pharmacies and Small-Dose Sales
A particularly harmful practice observed in Chincha is the sale of antibiotics in smaller quantities. Due to financial constraints, many parents buy only two- or three-days’ worth of antibiotics (what they can afford that day) instead of the full 7- or 10-day course. Pharmacies accept this practice to avoid losing customers.
This creates an ideal biological scenario for resistance: the pathogen is exposed to the antibiotic, but not eradicated, allowing surviving bacteria to develop and transmit resistance mechanisms [10].
The inappropriate use of antibiotics in the public and private sectors, coupled with widespread self-medication, has created a worrying profile of bacterial resistance in the Ica region.
6.1. Predominant Resistance Mechanisms
Microbiological research in hospitals in the region identifies specific molecular mechanisms that are proliferating:
1. Extended-Spectrum Beta-Lactamases (ESBLs): Present mainly in enterobacteria such as Escherichia coli and Klebsiella pneumoniae. These enzymes hydrolyze penicillins and cephalosporins (including third- and fourth-generation cephalosporins), leaving very limited oral options. In Ica, the prevalence of ESBL-producing E. coli in pediatric urine cultures is estimated to be between 40% and 50%. 39
2. Methicillin Resistance (mecA gene): In Staphylococcus aureus (MRSA). This mechanism alters the penicillin-binding protein 2a (PBP2a), conferring resistance to all beta-lactams. An increase in community-acquired MRSA (CA-MRSA) skin and soft tissue infections has been documented in children on the Peruvian coast. 15
3. Macrolide Resistance: In Streptococcus pneumoniae and S. pyogenes, mediated by ribosomal methylation (erm) mechanisms or efflux pumps (mef). The massive use of azithromycin post-COVID has presumably triggered this resistance, although precise local molecular surveillance data in Chincha are lacking to quantify the exact current magnitude. 36
6.2. Surveillance Data in Hospitals of Ica (2023-2024).
The analysis of bacterial isolates in reference hospitals in Ica (such as the Ica Regional Hospital) shows a grim picture that can be extrapolated to the hospital reality of Chincha:
• Escherichia coli:
Ampicillin Resistance: > 70-80% (Practically useless empirically).
Ciprofloxacin resistance: > 50-60% (Very high for empirical use in complicated UTI).
Ceftriaxone resistance (ESBL marker): > 40-50%. 14
• Klebsiella pneumoniae:
High ESBL rate.
The worrying emergence of resistance to carbapenems (KPC or NDM-type enzymes), although still at low percentages (<10>Microorganism Antibiotic Resistance Rate (%) Clinical Implication E. coli Ampicillin 70 - 85% Do not use empirically. E. coli / Clavulanic Acid 30 - 45% Use with caution. E. coli Ciprofloxacin 50 - 65% Not recommended for pediatric use (safety/resistance). E. coli Ceftriaxone 40-50% High suspicion of ESBL; risk of therapeutic failure. S. aureus Oxacillin (Methicillin) 25 - 35% Consider Clindamycin or Vancomycin if risk factors are present. S. pneumoniae Oral Penicillin 30-40% Intermediate resistance; increase dose or switch to Amox . S. pneumoniae Macrolides (Azithromycin) > 40% Do not use as empirical monotherapy in pneumonia.
Table 3: Estimated Resistance Profile for Key Pathogens in Ica (Pediatrics/Adults)
Source: Synthesis of extrapolated regional and national surveillance data [39].
7.1. The Legal Framework and its (Non)Compliance
Peru has Law No. 29459 and various Technical Health Standards that regulate the prescription and dispensing of medications. A prescription is required for the sale of antibiotics.20 However, the gap between the law and reality in Chincha is wide. Oversight of pharmacies by the Regional Health Directorate (DIRESA) or municipalities is sporadic and insufficient to control the vast number of pharmaceutical establishments. Furthermore, there are no effective mechanisms for immediate sanctions against "suggested dispensing" by pharmacy technicians.
7.2. The Need for Research Ethics Committees (RECs)
To generate high-quality local evidence to combat this problem, rigorous clinical and epidemiological research in Chincha is imperative. This requires the operation of Research Ethics Committees (RECs) accredited by the National Institute of Health (INS).
Currently, conducting clinical trials or complex observational studies in hospitals like San José or in private clinics requires the approval of an accredited IRB to ensure the protection of participants (especially children, considered a vulnerable population) through appropriate Informed Consent and Assent processes.45 The lack of strengthened local IRBs limits Chincha's capacity to lead its own resistance studies, depending on data from Lima or Ica city.48
The situation in Chincha reflects a systemic failure in the drug use chain.
1. Failure at the Origin (Community): The lack of health education leads parents to demand antibiotics and self-medicate their children, valuing speed over safety.
2. Failure at the Point of Sale (Pharmacies): Commercial interest and lack of ethics/regulation turn pharmacies into indiscriminate dispensers of antibiotics, often in sub-therapeutic doses.
3. Failure in the Consultation (Doctors):
In the private sector: Economic incentives and defensive medicine drive the use of broad-spectrum and brand-name antibiotics.
In the Public Sector: The lack of diagnostic tools and time encourages empirical prescription for "safety".
The result is a vicious cycle where bacterial resistance increases, causing cheap and safe antibiotics to stop working, which in turn (erroneously) justifies the use of more expensive and powerful antibiotics, restarting the cycle.
9.1. Conclusions
1. Duality of the Problem: The irrational use of antibiotics in Chincha is a hybrid phenomenon: in the public sector it is a problem of resources and diagnosis; in the private sector, it is a problem of commercial incentives and patient expectations.
2. Self-medication as a Crisis: With rates close to 90%, self-medication in pharmacies in Chincha is probably the biggest driver of selective pressure of resistance in the community, surpassing even medical prescription.
3. Critical Resistance: The loss of efficacy of third-generation cephalosporins against E. coli and the emergence of community MRSA in Ica place the region in a vulnerable situation in the face of serious bacterial outbreaks.
4. Post-Pandemic Effect: The normalization of Azithromycin use post-COVID has created a dangerous consumption habit that must be actively dismantled.
9.2. Recommendations
A. For the Health Authorities (DIRESA Ica / MINSA)
1. Implementation of Rapid Diagnosis: Equip the I-3 and I-4 health centers of Chincha with rapid antigen tests for Streptococcus pyogenes and Influenza. This would allow bacterial infections to be ruled out in minutes and drastically reduce antibiotic prescriptions.
2. Intelligent Inspection: Conducting surprise operations with "simulated patients" in pharmacies in Chincha to penalize the sale of antibiotics without a prescription and the sale of fractional doses.
3. Sentinel Surveillance: Establish a sentinel laboratory in Chincha that reports local resistance profiles monthly, allowing doctors to adjust their empirical treatments with data from their own province, not from Lima or abroad.
B. For the Private Sector (Clinics and Medical Offices)
1. Antimicrobial Stewardship Programs (ASPs): Clinics should implement internal prescription audit programs (ASPs) as a standard of quality and patient safety. 19
2. Patient Education: Include in private consultations education on the viral nature of infections and the risks of resistance, as an added value of "good medical practice".
C. For Civil Society and Academia
1. Local Research: Promote theses and studies in universities in Ica on the use of antibiotics and resistance in Chincha, under the supervision of accredited Ethics Committees.
2. "Less is More" Campaign: Launch a mass communication campaign in Chincha aimed at parents: "Antibiotics don't cure the flu; love and care do."
Final Note: This report has been prepared with a technical and scientific approach, integrating clinical, microbiological and socio-health data available up to the year 2025. The mention of specific private institutions is for descriptive purposes of the local health ecosystem, based on their relevance in the provision of services in the province.
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Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
