Dispensing of Antimicrobial Agents Without a Prescription in Iraq: A Call for Upholding the Legislations to Change Long-Standing Practices

Abstract

Background: Antimicrobial prescribing patterns have an important role in the emergence of resistance, and community pharmacists have a substantial influence on this issue. Objective: To assess community pharmacists' behaviors and attitudes toward antimicrobial dispensing, determine their proportions and categories, and examine the underlying rationales for this practice. Methods: A descriptive cross-sectional survey of community pharmacists in Iraq was conducted from June to August 2023, using a self-administered validated questionnaire. The attitudes, practices, and motivations driving the distribution of antimicrobials without a prescription (AWP) were explored in three areas. Results: A sizable proportion (61.6%) of respondents rejected dispensing AWP at community pharmacies. Patients primarily seek antibacterials from community pharmacies owing to budget constraints, according to 82.7% of respondents, rather than for consultation and diagnostic services. The most powerful element in a pharmacist's decision to administer AWP is that patients will seek antimicrobials from another pharmacy if they are not dispensed by the pharmacist, owing to the pharmacist's experience in infection management. The study found that 50%–74% of patients who visited community pharmacies sought AWP. Antimicrobials are most commonly provided without a prescription for cold and flu and urinary tract infections (37.3% and 27.7%, respectively). Conclusions: The majority of pharmacists regularly dispense AWP. To guarantee compliance with Iraqi legislation and laws governing AWP distribution, ongoing training programs should be created to educate the public on the most effective methods.