Pathways for Inappropriate Dispensing of Antibiotics for Rhinosinusitis: A Randomized Trial

Abstract

We evaluated the extent of and factors that determine the inappropriate use of antibiotics that are obtained without a physician's prescription. Ninety-eight Greek pharmacists were visited by actress-researchers who played clients requesting antibiotics without a physician's prescription. Pharmacists were randomly challenged in a scenario that involved simulated cases of acute uncomplicated rhinosinusitis with either low fever (38.5 degrees C) or high fever (40 degrees C). Antibiotics were offered by 34 (69%) of 49 pharmacists who were presented with the high-fever scenario and by 42 (86%) of 49 pharmacists who were presented with the low-fever scenario (risk difference, 16.3%; P = .05). Thirty-two (65%) and 35 (71%) pharmacists in the high- and low-fever study arms, respectively, agreed to sell the actress-researchers broad-spectrum antibiotics. Only 28 (57%) and 17 (35%) pharmacists, respectively, recommended that the patient visit a physician (P = .03). Inappropriate recommendations regarding antibiotic use were very common in the studied setting. Antibiotics were more likely to be offered to persons who did not have a prescription when they were less likely to be clinically indicated.

Self-medication with antibiotics in the ambulatory care setting within the Euro-Mediterranean region; results from the ARMed project

“…In a Greek study, 98 pharmacists were visited by actress-researchers who played clients requesting antibiotics without a physician's prescription. Antibiotics were more likely to be offered when they were less likely to be clinically indicated; 69% of these pharmacists gave antibiotics for highgrade fever rhinosinusitis when compared with 86% for low-grade fever [17].…”

“…Such self-medication practices are a reality in both Europe and the United States [11][12][13][14]. The Mediterranean region appears to be an area of concern, as confirmed by reports from Spain, Greece, Malta and Italy [15][16][17][18][19][20]. However information on similar practices in the southern and eastern countries of this region remains particularly sparse despite the documented high levels of resistance within these same countries.…”

Self-Medication with Antibiotics in Jordanian Population

“…This practice is a worldwide problem, not only in the developing countries (Sudan [1], Trinidad and Tobago [2], Pakistan [3], Brazil [4,5]) but also in the developed countries (Spain [6], Greece [7,8], Russia [9], USA [10], Israel [11], and Malta [12]). Furthermore, some European countries, namely Romania and Lithuania, were found to have high rates of self-medication [13].…”

Self-medication with Antimicrobial Drugs in Europe

“…For example, in an Hispanic neighborhood of New York City, antimicrobial drugs are available without a prescription ( 13 ). In Europe, studies describing self-medication and storage of antimicrobial drugs in Spain ( 14 , 15 ), Greece ( 16 , 17 ), Russia ( 18 ), and Malta ( 19 ) also suggest considerable use of the drugs without consulting a physician. However, these studies were small or used selected samples and were not carried out in northern and western Europe.…”