Introduction: Overuse of antibiotics has contributed to the development of organism resistance. The acquisition of antibiotics without prescription by the general population seems to be common practice in pharmacies of Damascus, Syria. This study aimed to determine the proportion of pharmacies dispensing antibiotics without medical prescription and without seeing the patient. Methodology: A cross-sectional study involving a sample of 224 pharmacies was conducted in Damascus. To obtain antibiotics without medical prescription, the investigators posed as individuals who had a sister with symptoms of sinusitis.. Results: From 200 pharmacies visited, 87% agreed without insistence from the investigator to sell antibiotics without prescription. This figure increased to 97% when the investigators who were at first denied antibiotics insisted on having the antibiotics. Conclusion: Dispensing of antibiotics is high in Damascus despite federal regulations. Health education programs should be directed to pharmacies and also to the population.

Syria is a major tourist attraction in the Middle East and hosts about three million tourists every year. 1 An unfortunate part of the story, however, remains the acquisition of infections by a substantial number of travelers. Q-fever, brucellosis and dirofilariasis are just three of the rare and fatal infections that have been associated with travel to Syria. [2][3][4] The Centers for Disease Control and Prevention (CDC), USA, has issued a comprehensive set of guidelines regarding travel to Syria, 5 but they fail to encompass some of the unique features that necessitate extra precautions while traveling to Syria. The economic burden and the human population pressure could have very likely led to the emergence of novel and drug-resistant infectious strains in Syria. 6 Owing to a lack of surveillance and the habit of local physicians of not reporting notifiable diseases, the situation remains hidden from the rest of the world. 7 A popular form of Arab cultural experience for tourists is dining at traditional restaurants and water-pipe smoking. Guidelines might not draw sufficient attention to the infectious hazards associated with these practices. The food and water served in traditional Arab restaurants usually lack adequate hygienic processing. Traveler's diarrhea hence remains one of the biggest risks associated with travel to the Middle East. 8 Narghile (water-pipe) smoking is a common and widely accepted form of tobacco use in Syria. The ambiance of the water-pipe cafes and the colorful presentation of the Narghile attract tourists year round. Apart from the usual tobacco-related adverse effects on health, Narghile smoking is also an unexpected means of transmission of infections. A wide range of infections, including tuberculosis, herpes gingivitis, hepatitis and Helicobacter pylori gastritis, have been associated with water-pipe smoking. 9 More alarming is the notion that this hazard of water-pipe smoking is not even known to the literate Syrian population, including medical students. 10 We strongly urge that the potential risk of infection associated with water-pipe smoking and with dining in traditional restaurants in Syria be communicated to tourists. In addition, wide-scale epidemiological surveys of endemic, as well as emerging and re-emerging, infections in the region should be undertaken and the implications incorporated into the CDC guidelines.

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