Antibiotics Dispensing for URTIs by Community Pharmacists and General Medical Practitioners in Penang, Malaysia: A Comparative Study using Simulated Patients

Antibiotic Stewardship in Community Pharmacies: A Scoping Review

“…The attitudes of the majority of the pharmacists did not parallel with their awareness and perception and, interestingly, dispensing without medical prescription (DAwMP) is an extensive phenomenon seen in many community settings [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. There is a plethora of facilitators that seem to be involved in DAwMP and the most important ones are highlighted below:…”

“…This review also highlighted that specific antibiotics were commonly dispensed to each scenario accounting for sore throat, URTI, sinusitis, urinary tract infection, acute bronchitis, otitis media, acute gastroenteritis, and/or diarrhea. Penicillin only or combination with penicillinase inhibitor were the most common antimicrobial agents dispensed for URTI [ 20 , 21 , 23 , 26 , 27 ]; the fluoroquinolone group was commonly dispensed for UTI scenario [ 21 , 23 ]; the fluoroquinolone group and antiprotozoan agents are mostly dispensed for diarrhea, either alone or in combination [ 20 , 23 , 24 , 26 ]; while for otitis media penicillin, chloramphenicol, or macrolides were dispensed [ 20 , 23 ]. Interestingly, in all these regions legal implications existed, but most of the dispensing attitudes were attributed to customers’ demands, gratification, and satisfaction, the pharmacy owner’s pressure on pharmacists or dispensing personnel, and/or financial motives of community pharmacists.…”

“…This concept is well-established in developing countries where it is considered pertinent and economical and helps in identifying areas of improvement for providing quality services in patient care [ 33 ]. The current review included simulated patient research from Spain, Greece, India, Malaysia, Jordan, and the Kingdom of Saudi Arabia (KSA) [ 20 , 21 , 22 , 23 , 24 , 26 , 27 ]. In the KSA study, 95% of antibiotics were dispensed on the pharmacist’s own discretion and not per the demand of patients [ 23 ].…”

“…Based on the review undertaken, most of the community pharmacists presented appropriate awareness towards AMR [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ], but the majority reflected unacceptable attitudes towards dispensing and preferred to perform DAwMP in minor ailments and self-limiting conditions [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The majority of the papers included in the review identified several enablers that promote DAwMP, such as indifference on the part of pharmacists, fulfilment of the demands of patients/clients/customers, external responsibility, and insufficient knowledge of the consumer and/or patient [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The knowledge and awareness of pharmacists on disease management was predictably outstanding [ 16 , 18 ] since they are considered experts with respect to medicines.…”

“…Likewise, the problem of dispensing of antibiotics without prescription is also observed in many regions, except for US, Canada, and Northern Europe [ 13 , 15 ]. It is difficult to ascertain the comprehensive effect of antimicrobial resistance, but in the middle- and lower-income regions judicious sale of antibiotics is always a question mark [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”