Effectiveness of an educational intervention to improve antibiotic dispensing practices for acute respiratory illness among drug sellers in pharmacies, a pilot study in Bangladesh

Abstract

BackgroundInappropriate dispensing of antibiotics for acute respiratory illness (ARI) is common among drug sellers in Bangladesh. In this study, we evaluated the impact of an educational intervention to promote guidelines for better ARI management among drug sellers.MethodsFrom June 2012 to December 2013, we conducted baseline and post-intervention surveys on dispensing practices in 100 pharmacies within Dhaka city. In these surveys, drug sellers participated in 6 standardized role-playing scenarios led by study staffs acting as caregivers of ARI patients and drug sellers were blinded to these surveys. After the baseline survey, we developed ARI guidelines and facilitated a one-day educational intervention about ARI management for drug sellers. Our guidelines only recommended antibiotics for children with complicated ARI. Finally, we conducted the six month post-intervention survey using the same scenarios to record changes in drug dispensing practices.ResultsOnly 2/3 of participating pharmacies were licensed and few (11%) of drug sellers had pharmacy training. All the drug sellers were male, had a median age of 34 years (IQR 28–41). For children, dispensing of antibiotics for uncomplicated ARI decreased (30% baseline vs. 21% post-intervention; p = 0.04), but drug sellers were equally likely to dispense antibiotics for complicated ARI (15% baseline vs. 17% post-intervention; p = 0.6) and referrals to physicians for complicated ARIs decreased (70% baseline vs. 58% post-intervention; p = 0.03). For adults, antibiotic dispensing remained similar for uncomplicated ARI (48% baseline vs. 40% post-intervention; p = 0.1) but increased among those with complicated ARI (44% baseline vs. 78% post-intervention; p < 0.001). Although our evidence-based guidelines recommended against prescribing antihistamines for children, drug sellers continued to sell similar amounts for uncomplicated ARI (33% baseline vs. 32% post-intervention; p = 0.9).ConclusionsDespite the intervention, drug sellers continued to frequently dispense antibiotics for ARI, except for children with uncomplicated ARI. Pairing educational interventions among drug sellers with raising awareness about proper antibiotic use among general population should be further explored. In addition, annual licensing and an reaccreditation system with comprehensive monitoring should be enforced, using penalties for non-compliant pharmacies as possible incentives for appropriate dispensing practices.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3486-y) contains supplementary material, which is available to authorized users.

Pathways to antibiotics in Bangladesh: A qualitative study investigating how and when households access medicine including antibiotics for humans or animals when they are ill

“…The alternative to restricting access to antibiotics through drug shop, is to improve their practice. This has been tried in Bangladesh, although drug shop sellers’ habits have proved difficult to shift [33]. Internationally, there is limited evidence so far about interventions to improve drug shop practice [15].…”

Tackling antimicrobial resistance in Bangladesh: A scoping review of policy and practice in human, animal and environment sectors

“…Health sector (combined by 'OR') (b) Geographic location (combined by 'OR') (c) and/or its indiscriminate use [17]. Studies reveal two or more antimicrobials to be commonly prescribed at a time in Bangladesh [14,15,18,19,20,22,30,31], and more antimicrobials to be prescribed in hospital settings compared to community settings [21].…”

Knowledge, Attitudes, and Practices of Antimicrobial Uses and Resistance Among Public University Students in Bangladesh

“…7 Availability of antibiotics from pharmacies without authorized prescription and overuse or misuse of antibiotics such as self-medication practice, non-adherence to the prescription, inappropriate prescribing, and lack of antibiotic susceptibility testing can play a vital role in the evolvement of antibiotic resistance. [8][9][10] Moreover, the uncontrolled antibiotics applications in animal husbandry as therapeutic, prophylactic, and growth enhancers can contribute to the emergence of resistant bacteria that enter humans through the food chain. 11 A study indicated that South East Asia is at the highest risk of developing and spreading antibiotic resistance, and it suggested One Health approach to address this problem.…”