Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study

Abstract

Introduction Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies. Aims Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan. Methodology A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit. Results Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history. Conclusion Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.

Rapid Assessment of the Potential Paucity and Price Increases for Suggested Medicines and Protection Equipment for COVID-19 Across Developing Countries With a Particular Focus on Africa and the Implications

“…Other strategies may though be needed to reduce inappropriate dispensing of antimicrobials. These include greater education in pharmacy school to address information gaps regarding antimicrobials and antimicrobial resistance (AMR), developing and implementing national guidelines for the management of infectious diseases typically seen in ambulatory care acknowledging the WHO AWaRe list of antibiotics, as well as monitoring community pharmacists’ activities through for instance mobile technologies ( Markovic-Pekovic et al, 2017 ; Hoxha et al, 2018 ; Kalungia and Godman, 2019 ; Saleem et al, 2019 ; Saleem et al, 2020 ). Community pharmacists should be mindful though that it can be difficult in practice to differentiate respiratory tract infections from COVID-19 among patients presenting with coughs and fever ( Ongole et al, 2020 ), and they should encourage testing and referrals where there are concerns.…”

Understanding of Pharmacy Students towards Antibiotic Use, Antibiotic Resistance and Antibiotic Stewardship Programs: A Cross-Sectional Study from Punjab, Pakistan

“…According to the Drug Act 1967 of Pakistan, dispensing antibiotics without a valid prescription is prohibited; however, the irrational dispensing of antibiotics is widespread [ 6 , 31 ]. Many studies from Pakistan have reported that pharmacists and pharmacy technicians routinely dispense antibiotics without inquiring about a prescription [ 32 , 33 , 34 ]. The respondents of our study righty pointed out that non-compliance to regulations often permits the purchase of antibiotics without a prescription from community pharmacies.…”

Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications

“… 107 , 108 In addition, the development and dissemination of the WHO AWaRe list of antibiotics to improve future antibiotic prescribing and dispensing. 109 , 110 Engineering includes organizational or managerial interventions such as instigating and monitoring prescribing targets and quality targets. 99 , 100 Quality targets could include the percentage of antibiotics prescribed according to agreed guidance, the percentage of antibiotics prescribed within a specified time and for an agreed length to prevent SSIs, as well as monitoring drug and therapeutic committee (DTC) activities against agreed performance indicators.…”