Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study

Sivakumar Velusamy; Shiv Sundar ShyamSundar; Virgin Jerry Regi

doi:10.18203/2394-6040.ijcmph20251716

Authors

Sivakumar Velusamy Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India
Shiv Sundar ShyamSundar Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India
Virgin Jerry Regi Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20251716

Keywords:

Antimicrobial resistance, Community pharmacies, Diarrhea, Patient simulation, Upper respiratory tract infection

Abstract

Background: Antibiotics are widely used, but using them without a prescription remains problematic. In India, Despite Schedule H regulations, antibiotics are available in community pharmacies without a prescription, leading to inappropriate use and contributing to the rise of antibiotic resistance. This study aimed to evaluate antibiotic dispensing practices and influencing factors in community pharmacies for Adult Upper Respiratory Tract Infections (URI) and Uncomplicated Acute Diarrhea (UAD) using a simulated patient (SP) approach.

Methods: A cross-sectional observational study was conducted at 200 community pharmacies across Coimbatore city, Tamil Nadu, using SPs presenting symptoms of URI and UAD. Chi-square test, unpaired T-test, and binary logistic regression were employed to analyze factors like scenario, location, pharmacy type, and interaction time on antibiotic dispensing.

Results: Antibiotics were dispensed without prescription in 76% of pharmacies, with a higher rate for URI (82%) than UAD (70%, p=0.047). Dispensing was more common in pharmacies within a 1–10 km radius (92%) than those farther away (60%, p=0.032). Interaction time averaged 3.8 minutes when antibiotics were dispensed versus 2.3 minutes when not. Erythromycin (33%) and norfloxacin (32%) were the most commonly dispensed antibiotics. Scenario (OR=8) and locality (OR=5) significantly influenced dispensing practices, while pharmacy type had minimal impact.

Conclusions: Antibiotic dispensing without prescription is high with higher rates for URI compared to UAD. Factors like locality, symptom enquiry, and interaction time influenced dispensing. Targeted interventions like training, audits, and public awareness are essential to promote rational use and mitigate antimicrobial resistance.

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References

World Health Organization. Global Action Plan on Antimicrobial Resistance, 2015. Available at: https://www.who.int/publications/i/item/9789241509763. Accessed 01 January 2025.

Collaborators AR. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55. DOI: https://doi.org/10.1016/S0140-6736(21)02724-0

Chang J, Ye D, Lv B, Jiang M, Zhu S, Yan K, et al. Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey. J Antimicro Chemother. 2017;72(4):1235-42. DOI: https://doi.org/10.1093/jac/dkw519

Dandona L, Dandona R, Kumar GA, Shukla DK, Paul VK, Balakrishnan K, et al. India state-level disease burden initiative collaborators. Nations within a nation: Variations in epidemiological transition across the states of India 1990-2016 in the global burden of disease study. Lancet. 2017;390(10111):2437-60. DOI: https://doi.org/10.1016/S0140-6736(17)32804-0

Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proceed Nat Acad Sci. 2018;115(15):E3463-70. DOI: https://doi.org/10.1073/pnas.1717295115

Gandra S, Tseng KK, Arora A, Bhowmik B, Robinson ML, Panigrahi B, et al. The mortality burden of multidrug-resistant pathogens in India: a retrospective, observational study. Clin Infect Dis. 2019;69(4):563-70. DOI: https://doi.org/10.1093/cid/ciy955

Kotwani A, Joshi J, Lamkang AS. Over-the-counter sale of antibiotics in India: A qualitative study of providers’ perspectives across two states. Antibiotics. 2021;10(9):1123. DOI: https://doi.org/10.3390/antibiotics10091123

Sulis G, Daniels B, Kwan A, Gandra S, Daftary A, Das J, et al. Antibiotic overuse in the primary health care setting: a secondary data analysis of standardised patient studies from India, China and Kenya. BMJ Global Health. 2020;5(9):e003393. DOI: https://doi.org/10.1136/bmjgh-2020-003393

Lim K, Broom A, Olsen A, Seale H. Community pharmacists as antimicrobial guardians and gatekeepers-A qualitative study of the perspectives of pharmacy sector stakeholders. Explorat Res Clin Soci Pharm. 2023;9:100212. DOI: https://doi.org/10.1016/j.rcsop.2022.100212

Raju R, Srinivas SC, Siddalingegowda SM, Vaidya R, Gharat M, Kumar TP. Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low-and middle-income countries. J Pharm Pharmac Sci. 2024;27:12721. DOI: https://doi.org/10.3389/jpps.2024.12721

Coimbatore: Coimbatore District Administration. Coimbatore District. Statistical Reports. Available at: https://coimbatore.nic.in/document-category/statistical-report/. Accessed 07 October 2024.

Coimbatore District Administration. Coimbatore Corporation Map. Available at: https://coimbatore.nic.in/document-category/statistical-report/. Accessed 07 October 2024.

Collins JC, Chong WW, de Almeida Neto AC, Moles RJ, Schneider CR. The simulated patient method: design and application in health services research. Res Soci Administrat Pharm. 2021;17(12):2108-15. DOI: https://doi.org/10.1016/j.sapharm.2021.04.021

Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, et al. The association of standardized patient educators (ASPE) standards of best practice (SOBP). Advances in Simulation. 2017;2:1-8. DOI: https://doi.org/10.1186/s41077-017-0043-4

Centers for Disease Control and Prevention (CDC). Common cold: Prevention, treatment, and complications. Available at: https://www.cdc.gov/antibiotic-use/colds.html. Accessed 07 October 2024.

World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers, 2005. Available at: https://www.who.int/publications/i/item/9241593180. Accessed 07 October 2024.

Nepal G, Bhatta S. Self-medication with antibiotics in WHO Southeast Asian Region: a systematic review. Cureus. 2018;10(4). DOI: https://doi.org/10.7759/cureus.2428

Basak SC, Dondeti Sathyanarayana DS. Evaluating medicines dispensing patterns at private community pharmacies in Tamilnadu, India. Southern Med Revi. 2010;3:27-31.

Nga DT, Chuc NT, Hoa NP, Hoa NQ, Nguyen NT, Loan HT, et al. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study. BMC Pharmacol Toxicol 2014;15:1-0. DOI: https://doi.org/10.1186/2050-6511-15-6

Nafisah SB, Nafesa SB, Alamery AH, Alhumaid MA, AlMuhaidib HM, Al-Eidan FA. Over-the-counter antibiotics in Saudi Arabia, an urgent call for policy makers. J Infect Pub Heal. 2017;10(5):522-6. DOI: https://doi.org/10.1016/j.jiph.2016.09.016

Zhang Z, Hu Y, Zou G, Lin M, Zeng J, Deng S, et al. Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions. Global Health Action. 2017;10(1):1287334. DOI: https://doi.org/10.1080/16549716.2017.1287334