\u201cYou could lose when you misuse\u201d \u2013 factors affecting over-the-counter sale of antibiotics in community pharmacies in Saudi Arabia: a qualitative study

Faten Alhomoud,Reem Almahasnah,Farah Kais Alhomoud

doi:10.1186/s12913-018-3753-y

Faten Alhomoud, Reem Almahasnah + Show 1 more

Open Access

https://doi.org/10.1186/s12913-018-3753-y

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Abstract

BackgroundThe sale of antibiotics without a prescription poses a global public health concern. Antibiotics dispensed without a prescription are largely recognised as a cause of antibiotic misuse and overuse which may result in antibiotic resistance, recurrent infection, increased cost and adverse effects of treatment. There have been no qualitative studies to explore the reasons for over-the-counter (OTC) sale of antibiotics, despite the fact that non-prescription sale of antibiotics are increasing in Saudi Arabia.MethodsQualitative interviews were conducted with community pharmacists living in the Eastern Province of Saudi Arabia using face-to-face, open-ended questions. Interviews were audio-recorded and transcribed verbatim. The interview transcripts were analysed using thematic analysis and NVivo 10 software.ResultsAll participants declared that antibiotics were frequently sold without a medical prescription on an OTC basis. The main reasons for OTC sale of antibiotics were found to be related to the ease of access to community pharmacies compared to other healthcare services, expertise and knowledge of pharmacists and patients’ trust, misconceptions and inappropriate practices of the public towards antibiotic use, customer pressure, pharmacists’ need to ensure business survival and weak regulatory enforcement mechanism. These are presented in more detail below by using illustrative quotes from participants’ transcripts.ConclusionsThe non-prescribed sale of antibiotics is still a common practice in Saudi Arabia, despite being a problem. The results of this study highlight the need to design interventions to promote rational use of antibiotics.

Highlights

The sale of antibiotics without a prescription poses a global public health concern
It was estimated that 23,000 deaths and more than 2 million illnesses were caused by antibiotic resistance [5]
Interviews revealed that various reasons contribute to the rise of OTC sale of antibiotics, ranging from the ease of access to community pharmacies compared to other healthcare services, expertise and knowledge of pharmacists and patients’ trust, misconceptions and inappropriate practices of the public towards antibiotic use, customer pressure, pharmacists’ need to ensure business survival and weak regulatory enforcement mechanism

Summary

Introduction

Antibiotics dispensed without a prescription are largely recognised as a cause of antibiotic misuse and overuse which may result in antibiotic resistance, recurrent infection, increased cost and adverse effects of treatment. There have been no qualitative studies to explore the reasons for over-the-counter (OTC) sale of antibiotics, despite the fact that non-prescription sale of antibiotics are increasing in Saudi Arabia. Even though antibiotics represent a vital public health achievement, their overuse and misuse, as a result of irrational prescribing and dispensing and self-medication, may cause serious adverse events, recurrent infections, antibiotic resistance, and increased treatment cost and poor health outcomes [1,2,3,4,5]. Studies in Saudi Arabia reported that non-prescribed sale of antibiotics was high in community pharmacies and ranged from 63 to 82% [9,10,11,12]. Dispensing antibiotics without a prescription has been illegal for pharmacists for more than three decades

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