Abstract
Antibiotic resistance still remains a major global public health problem and the dispensing of antibiotics without a prescription at community pharmacies is an important driver of this. MEDLINE, Pubmed and EMBASE databases were used to search and identify studies reporting the dispensing of non-prescribed antibiotics in community pharmacies or drugstores that sell drugs for human use, by applying pharmacy interviews/questionnaires methods and/or simulated patient methods. Of the 4683 studies retrieved, 85 were included, of which 59 (69.4%) were published in low-and middle-income countries. Most of the papers (83.3%) presented a percentage of antibiotic dispensing without a prescription above 60.0%. Sixty-one studies evaluated the active substance and the most sold antibiotics without a prescription were amoxicillin (86.9%), azithromycin (39.3%), ciprofloxacin (39.3%), and amoxicillin-clavulanic acid (39.3%). Among the 65 articles referencing the diseases/symptoms, this practice was shown to be mostly associated with respiratory system problems (100.0%), diarrhea (40.0%), and Urinary Tract Infections (30.8%). In sum, antibiotics are frequently dispensed without a prescription in many countries and can thus have an important impact on the development of resistance at a global level. Our results indicate the high need to implement educational and/or regulatory/administrative strategies in most countries, aiming to reduce this practice.
Highlights
Antibiotic resistance remains one of the major global public health problems, due to its impact on morbidity, mortality, and healthcare costs
This self-medication is associated with an inadequate use of antibiotics, inadequate dosages, and duration of treatments that increase the risk of resistant bacteria selection [9]
Sample size: PH, Pharmacies; Ph, Pharmacists; PS, Pharmacy Staff; INT, Interactions; Frequency of antibiotic dispensation without a prescription: PD: Percentage corresponding to pharmacists who report dispensing antibiotics without a prescription calculated using the strategy: 100% less than the percentage of pharmacists who report never dispensing antibiotics without a prescription; PSD: Percentage corresponding to pharmacists who report dispensing antibiotics without a prescription sometimes/occasionally.; PD: Percentage corresponding to pharmacists who report dispensing antibiotics without a prescription calculated using the strategy: 100% less than the percentage of pharmacists who report never/rarely dispensing antibiotics without a prescription; Types of disease/symptoms most commonly associated with dispensation without a prescription: urinary tract infections (UTI), Urinary Tract Infection; upper respiratory tract infections (URTI), Upper Respiratory
Summary
Antibiotic resistance remains one of the major global public health problems, due to its impact on morbidity, mortality, and healthcare costs. It is estimated that over-the-counter dispensing may account for half of the antibiotic sales worldwide [8], even though in North America, Northern Europe, and Australia this pratically doe not exist [7]. This self-medication is associated with an inadequate use of antibiotics, inadequate dosages, and duration of treatments that increase the risk of resistant bacteria selection [9]
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