Diarrhea is one of the medical problems frequently found in the community. Pharmacists should determine the conditions treatable with over-the-counter medications and those that need urgent referral to a doctor, such as bloody diarrhea. Therefore, this study aimed to determine the appropriateness of the pharmacists' recommendations when responding to self-medication requests in the case of adult bloody diarrhea. This cross-sectional study was conducted from October to December 2019 using a questionnaire consisting of participants' characteristics and newly developed acute bloody diarrhea scenarios in adults. The quality and content of the questionnaire was validated by the experts in clinical pharmacy, public health, and pharmacists. The data obtained from 84 pharmacists with the response rate of 38.71% were analyzed descriptively. About 89.29 % of the pharmacists were female between 24 to 34 years. Referral to a doctor was the most suitable recommendation; however, only 23 pharmacists (34.52%) recommended this method. Some recommended antibiotics, such as metronidazole, cotrimoxazole, or thiamphenicol. Most pharmacists have not provided appropriate recommendations for a scenario related to bloody diarrhea in adults. Therefore, further research should be conducted to identify the required variables by the community pharmacists to make an appropriate recommendation as a response towards minor ailments in the community, especially medical referrals.

Appropriate recommendations given by pharmacists play a critical role in determining the efficacy and safety of self-medication practices in pharmacies, including in the case of diarrhea with alarm symptoms. This observational study with a cross-sectional design aims to determine the profile and appropriateness of recommendations given by pharmacists in Surabaya when they faced self-medication requests for diarrhea with alarm symptoms. Data were collected using a questionnaire consisting of two parts, i.e., participants’ characteristics and one case of adult diarrhea with alarm symptoms. The case used was newly developed and the content had been validated. The content validation and the determination of appropriate recommendations given by pharmacists involved experts in clinical pharmacy, community pharmacy, and public health. The final data were analyzed and presented descriptively. A total of 160 pharmacists were involved in this study, the majority of whom were managing pharmacists (82.50%), female (85.50%), and have been working as pharmacists for 1 to 7 years (48.75%). Most pharmacists (56.87%) gave more than one type of recommendation, the majority of whom recommended dispensing of pharmaceutical products accompanied by a referral to physicians (21.88%). Only 42 pharmacists (26.25%) gave appropriate recommendations including referral to physicians (18.13%) or referral accompanied by pharmaceutical product (6.88%) and non-pharmacology recommendations (1.25%). Need assessment is required to identify interventions preferred by pharmacists to optimize their role in promoting responsible self-medication practices.