Dispensing of antibiotics without prescription and associated factors in drug retail outlets of Eritrea: A simulated client method

Abstract

Dispensing antibiotics without prescription is irrational and can hasten the emergence and spread of antibiotic resistance. This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea. A cross-sectional simulated client method was used to conduct the study. Data was collected between July and August 2019, entered and analyzed using Statistical Package for Social Science version 22. Descriptive analysis was performed using mean (standard deviation), median (interquartile range), frequency, percentage, as appropriate, for independent variables. Logistic regression, at bivariate and multivariate levels, along with odds ratio (95% confidence interval) was used to determine the association between the dispensing of antibiotics without prescription and independent variables. P-values less than 0.05 were considered as statistically significant. The extent of dispensing antibiotics without prescription was found to be 87.6% with the most frequently dispensed antibiotics being ciprofloxacin (47.8%) and co-trimoxazole (37.5%). Furthermore, 12.4% of the drug retail outlet attendants did not dispense antibiotics because they preferred a referral to health facilities (52.6%), were following administrative restrictions not to sell antibiotics (42.1%), or did not have the necessary antibiotics (31.6%). Private community pharmacies (AOR = 7.68, 95% CI: 1.67, 35.37; p = 0.009) and private drug shops (AOR = 10.65, 95% CI: 1.96, 57.93; p = 0.006) were more likely to dispense antibiotics compared to the governmental community pharmacies. Dispensing antibiotics without prescription was more likely to occur in the Maekel (central) region (AOR = 3.76, 95% CI: 1.19, 11.92; p = 0.024) compared to the remaining regions combined. In conclusion, the sales of antibiotics without prescription in the drug retail outlets of Eritrea is alarming which requires immediate attention from policymakers.

Antibiotic Dispensing Practices in Community Pharmacies: A Major Health Concern in the Eastern Democratic Republic of Congo

“…The efficacy of antibiotics depends partly on its rational use in clinical as well as pharmacy settings [22]. This study shows [10]. In Sub Saharan Africa, the ratios pharmacist and community pharmacies to population are found very low.…”

“…Over-prescription and self-medication are common forms of antibiotic misuses leading to antimicrobial resistance. Self-medication is very common in Sub Saharan Africa countries and antibiotic dispensing practices may contribute to self-medication [10]. According to the US 2016 Centers for Disease Control and Prevention report, at least 30% of antibiotics prescribed in outpatient settings are unnecessary [11].…”

“…In developing countries, the ratios pharmacists and pharmacies to population are low so that he can be helped by a pharmacy technician. Unfortunately, access to a better pharmaceutical care is impeded by the huge presence of no trained healthcare workers [10,15,16].…”

Knowledge, Attitude, and Practices of Community Pharmacists on Antibiotic Resistance and Antimicrobial Stewardship in Lusaka, Zambia

“…Dispensing antibiotics without prescription is very common in most countries in the world [83, [103][104][105][106][107]. This practice contributes greatly to the emergence of antibiotic-resistant bacteria [108][109][110][111][112][113][114].…”

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Usage and co-prescription with other potentially interacting drugs in elderly: A cross-sectional study

“…In Eritrea, to the authors knowledge, there no studies conducted so far to evaluate the appropriateness of the use of NSAIDs in elderlies. Due to shortage of physicians, lower health cadres are authorized to prescribe medicines and recent studies show that self-medication and dispensing non-over-the-counter medicines without prescription is a common practice [18,19].…”