Abstract
BackgroundAlthough prohibited by law and legal regulatory frameworks, non-prescribed sale of antibiotics in community medicine retail outlets (CMROs) remains a serious problem in Ethiopia. The aim of this study was to document the extent of and motivations behind non-prescribed sale of antibiotics among CMROs in Gondar town, Ethiopia.MethodsA 2 phase mixed-methods study (a simulated patient visit followed by an in-depth interview) was conducted among CMROs in Gondar town, Ethiopia. Two clinical case scenarios (acute childhood diarrhea and upper respiratory tract infection) were presented and the practice of non-prescribed sale were measured and results were reported as percentages. Pharmacy staff (pharmacists and pharmacy assistants) were interviewed to examine factors/motivations behind dispensing antibiotics without a valid prescription.ResultsOut of 100 simulated visits (50 each scenarios) presented to drug retail outlets, 86 cases (86%) were provided with one or more medications. Of these, 18 (20.9%) asked about past medical and medication history and only 7 (8.1%) enquired about the patient’s history of drug allergy. The most frequently dispensed medication for acute childhood diarrhoea simulation were oral rehydration fluid (ORS) with zinc (n = 16) and Metronidazole (n = 15). Among the dispensed antibiotics for upper respiratory infection simulation, the most common was Amoxicillin (n = 23) followed by Amoxicillin-clavulanic acid capsule (n = 19) and Azithromycin (n = 15). Perceived financial benefit, high expectation and/or demand of customers and competition among pharmacies were cited as the main drivers behind selling antibiotics without a prescription.ConclusionsA stringent law and policy enforcement regarding the sale of antibiotics without a valid prescription should be in place. This will ultimately help to shift the current pharmacy practices from commercial and business-based interests/practices to the provision of primary healthcare services to the community.
Highlights
Prohibited by law and legal regulatory frameworks, non-prescribed sale of antibiotics in community medicine retail outlets (CMROs) remains a serious problem in Ethiopia
Finding of simulated visits Out of 100 simulated visits (50 scenarios each) presented to drug retail outlets, 86 cases (86%) were provided with one or more antimicrobials
A variety of medications were dispensed for acute diarrhea including antiamoebic, antibiotics, anthelmintic, oral rehydration salts (ORS) and zinc (Table 2)
Summary
Prohibited by law and legal regulatory frameworks, non-prescribed sale of antibiotics in community medicine retail outlets (CMROs) remains a serious problem in Ethiopia. The aim of this study was to document the extent of and motivations behind non-prescribed sale of antibiotics among CMROs in Gondar town, Ethiopia. Community medicine retail outlets (CMROs) represent one of the main sources of antimicrobials globally [3]. In Ethiopia, the widespread access and availability of antibiotics without a valid prescription, coupled with the general public’s poor knowledge about antimicrobials, has increased self-medication with these drugs and augmented the risk of the inappropriate antibiotics use in the community [5,6,7]. Non-prescribed sale and dispensing of antibiotics will promote antimicrobial resistance but can be linked with adverse drug events, significantly increased cost burden and poor health outcome. By acting as antimicrobial stewardship proponents, community pharmacists can play a significant role in the containment of cost and antimicrobial resistance
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