Abstract
BackgroundAntibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios.MethodsA cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women).ResultsA total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases.ConclusionsWe observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.
Highlights
Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance
Antibiotics were dispensed without medical prescription from 244 (77.6%) of 327 with different levels of demand
Simulated cases of sore throat and diarrhea accounted for the highest percentage of antibiotic sales without medical prescription (90%) with level one of demand, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%)
Summary
Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. Most initiatives regarding antibiotic misuse are directed toward optimizing physicians’ prescriptions [11,12,13,14,15,16], while other potential sources of antibiotic misuse are neglected. It has been illegal for pharmacists in Saudi Arabia to dispense an antibiotic without a medical prescription for more than three decades [17]. A previous study from the Eastern Province of Saudi Arabia demonstrated a high rate of antibiotic sales without a prescription for presumed urinary tract infections [18] due to lack of adherence to these regulations
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