Abstract
Antibiotic dispensing without a prescription poses a threat to public health as it leads to excessive antibiotic consumption. Inappropriate antibiotic availability to the community has been documented to be amongst drivers of antimicrobial resistance emergence. Community pharmacies are a source of antibiotics in low and middle-income countries (LMICs). We aimed at assessing antibiotic dispensing practices by community pharmacy retailers in Moshi urban, Kilimanjaro, Tanzania and recommend interventions to improve practice. Using a Simulated Client (SC) Method, an observational cross-sectional survey of antibiotic dispensing practices was conducted from 10th June to 10th July 2017. Data analysis was done using Stata 13 (StataCorp, College Station, TX, USA). A total of 82 pharmacies were visited. Part I pharmacies were 26 (31.71%) and 56 (68.29%) were part II. Overall 92.3% (95% CI 77.8–97.6) of retailers dispensed antibiotics without prescriptions. The antibiotics most commonly dispensed without a prescription were ampiclox for cough (3 encounters) and azithromycin for painful urination (3 encounters). An oral third generation cephalosporin (cefixime) was dispensed once for painful urination without prescription by a part I pharmacy retailer. Out of 21, 15(71.43%) prescriptions with incomplete doses were accepted and had antibiotics dispensed. Out of 68, 4(5.9%) retailers gave instructions for medicine use voluntarily. None of the retailers voluntarily explained drug side-effects. In Moshi pharmacies, a high proportion of antibiotics are sold and dispensed without prescriptions. Instructions for medicine use are rarely given and none of the retailers explain side effects. These findings support the need for a legislative enforcement of prescription-only antibiotic dispensing rules and regulations. Initiation of clinician and community antibiotic stewardship and educational programs on proper antibiotic use to both pharmacists and public by the regulatory bodies are highly needed.
Highlights
The ability to acquire antibiotics from a community pharmacy without a prescription poses a challenge in the control of irrational antibiotic consumption
Moshi urban with a population of 184,292 inhabitants, is the administrative center of the Kilimanjaro Region with a total population of 1,640,087 million inhabitants.[24]. These community pharmacies were categorized as part I and II according to Tanzania Food and drug Authority (TFDA) classification system
We have identified a widespread antibiotic dispensing practice from community pharmacies and drug stores without prescription in Moshi, Tanzania
Summary
The ability to acquire antibiotics from a community pharmacy without a prescription poses a challenge in the control of irrational antibiotic consumption. There is a relationship between irrational antibiotic consumption and development of antibiotic resistance.[1,2,3] Excessive antibiotic consumption leads to antimicrobial resistance through a postulated mechanism of antibiotic selection pressure.[4] Other factors responsible for development of antibiotic resistance include acquisition of resistance genes from the environment (plasmids) and bacterial mutations.[5] As mutation is a natural phenomenon we cannot control or influence its occurrence. We can mitigate the rapid development of antibiotic resistance by employing a regulated and a prudent use of antibiotics.[6] Antibiotic resistance is escalating and has recently been declared by WHO as a world crisis.[7] Amongst the consequences of antibiotic resistance include severe infections, longer hospital stays, disease complications and increased morbidity and mortality.[8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
