Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client’s study

Abstract

Antibiotics dispensing without a prescription is an irrational practice and can increase the risk of antibiotic resistance, which is a significant public health concern around the globe. This study was aimed to determine the extent to which antibiotics are supplied without prescription in the community pharmacies (CPs) at Hazara Division from November 2020 to February 2021. The simulated client method (SCM) was used, and the data were gathered, recorded, and analyzed through different statistical methods with descriptive and inferential techniques. The antibiotic dispensing was observed in CPs (90.5%), the most dispensed antibiotics were azithromycin (29.4%) and ciprofloxacin (46.5%) respectively. Furthermore, visited medical stores/ drug outlets, 9.5% of the visited stores denied dispensing of antibiotics because they preferred a referral to visit physicians (23. 9%) and (12.8%) did not had the antibiotics at the time of visits. Antibiotics were more obtainable in retail medical stores (AOR = 8.6, 95 percent Cl: 3.0–24.7; p = 0.001) than in pharmacies. In rural areas antibiotics dispensing was more (p = 0.004) as compared to urban areas. Staff members also had asked about patient’s (17.7%) symptoms and drug allergies (12.3% and 3.9%), and (1.5%) they consoled them about their medications. The findings of this study indicate that nonprescription antibiotic sales are very common, despite national rules prohibiting this activity. When the simulated Client requested for any medication to relieve his or her discomfort, many antibiotics were given out without a prescription. Pharmacies/medical stores in Hazara Division selling antibiotics without a prescription are worrying and need immediate action by regulators.

Assessment of antibiotic storage practices, knowledge, and awareness related to antibiotic uses and antibiotic resistance among household members in post-conflict areas of Pakistan: Bi-central study

“…Knowledge gaps in antibiotics use can lead to ABR, and we observed such a lack of knowledge among HHs in the present study. We found that antibiotic identification was relatively poor (39.6%) and similar results have been reported by Atif and his colleagues, and Tawseef et al, in their studies ( 34 , 35 ). This problem is not limited to Pakistan alone; researchers from other countries have undertaken similar studies, particularly among rural low and low middle-income countries (LMIC) communities with varying levels of knowledge ranging from moderate to poor, touch comparisons are difficult ( 32 , 36 – 38 ).…”

Knowledge, Attitude and Practice of Pharmacy Professionals Against Dispensing Antibiotics Without Prescription in Ethiopia

“…5 Similarly, a Pakistani study found that two of the most frequently DAWP were ciprofloxacin and azithromycin. 20 The observed discrepancy may be caused by variations in the sample size, methodological approach and available and reasonably priced of medications for the larger community.…”

“…3,6,13,[15][16][17][18] Self-medication and DAWP in drug retail outlets is inappropriate practice that can accelerate the emergence and spread of antibiotic resistance. 19,20 According to the World Health Organization latest estimate, the annual worldwide death toll due to antimicrobial resistance can be as high as 50,000. 21 Although, DAWP in the developed world is minimal, 19,20 the problem is much higher in Africa and other low-income countries.…”

“…19,20 According to the World Health Organization latest estimate, the annual worldwide death toll due to antimicrobial resistance can be as high as 50,000. 21 Although, DAWP in the developed world is minimal, 19,20 the problem is much higher in Africa and other low-income countries. 17,[22][23][24] Accessibility and availability are commonly involved in public health issues, particularly in circumstances with limited resources.…”

Exploring Knowledge of Antibiotic Use, Resistance, and Stewardship Programs among Pharmacy Technicians Serving in Ambulatory Care Settings in Pakistan and the Implications

“…Moreover, pharmacy personnel can establish effective ASPs in ambulatory care settings [ 51 , 52 , 53 ]. There are also high rates of antibiotic dispensing without a prescription in Pakistan despite current regulations [ 54 , 55 ]. This also needs to be addressed going forward.…”