Factors Related to Antibiotic Supply without a Prescription for Common Infections: A Cross-Sectional National Survey in Sri Lanka

Abstract

Inappropriate antibiotic use is a problem in Sri Lanka. We investigated pharmacy staff’s attitudes towards antibiotic supply for common infections in Sri Lanka. A self-reported cross-sectional survey was conducted among a random sample (n = 369) of pharmacies. We assessed staff’s beliefs and attitudes to antibiotic supplying for common infections (common cold and cough, sore throat, diarrhoea, wound and urinary tract infections (UTI)). Pharmacists (n = 210; 79%) and pharmacy assistants (n = 55: 21%) responded. About 30% (80/265) had supplied antibiotics without a prescription for common infections, including common cold (15.8%), sore throat (13.6%) and diarrhoea (10.2%). Overall, pharmacists were less likely to supply than non-pharmacists. Pharmacy staff with more positive beliefs about their professional competency to supply and monitor antibiotic use were more likely to supply antibiotics without a prescription for common cold (Adj.OR = 1.08; 95% CI: 1.01–1.15; p = 0.032), wound infections (Adj. OR = 1.06; 95% CI: 1.00–1.13; p = 0.059), and UTI (Adj.OR = 1.07; 95% CI: 0.99–1.15; p = 0.097). Pharmacy staff who believed in the effectiveness of antibiotics against common infections were more likely to supply antibiotics for common infections. Supply of antibiotics without a prescription was associated with staff’s beliefs about antibiotics’ effectiveness and their professional competency. Our findings could be used to strengthen regulatory strategies to improve practice.

A National Survey of Dispensing Practice and Customer Knowledge on Antibiotic Use in Vietnam and the Implications

“…The results demonstrate that the purchase of antibiotics without a prescription is still common practice across Vietnam despite current regulations (81.7% of participants stated they would still purchase antibiotics without a prescription). These findings were similar or higher than recent results in China (45.5–88.4%) [ 17 , 45 ], Cameroon (47%) [ 46 ] and earlier in Saudi Arabia (48.4–70.7%) before greater enforcement of the laws and fines [ 28 , 47 ] as well as Sri Lanka (30.2%) [ 29 ]. However, our results show appreciably greater dispensing of antibiotics without a prescription in Vietnam than seen in Saudi Arabia following enforcement of their regulations coupled with appreciable fines for abuse [ 28 ], and in the Republic of Srpska [ 43 ] ( Table 1 ).…”

“…Antibiotics were mainly purchased to treat RTIs (61.4%), similar to findings across countries including China (45.5%), Saudi Arabia in 2018 prior to recent initiatives and Sri Lanka [ 11 , 29 , 45 , 47 ]. As seen, the main respiratory-related symptoms for which antibiotics were dispensed were flu-like symptoms, coughs and colds.…”

“…In addition, the timing of the research and whether there had been recent tightening of the regulations as seen, for instance, in Brazil, Mexico, Saudi Arabia and the Republic of Srpska [ 28 , 43 ] ( Table 1 ), may also have been factors. Alongside this are the qualifications of the pharmacy personnel interviewed, since the presence of trained pharmacists has reduced self-purchasing of antibiotics, especially for viral infections, in some countries ( Table 1 ) [ 29 , 41 , 48 ].…”

“…In order to reduce inappropriate practices among community pharmacies and drug stores, and any potential risks for patients, effective interventions are needed. These include increased education of both patients and pharmacists as well as monitoring of community pharmacies, sanctions and realistic fines [ 11 , 12 , 28 , 29 ]. This is especially true in the case of Vietnam, where there has been an appreciable increase in the number of pharmacists in recent years alongside high alert regarding AMR across both community and hospital settings, which is causing concern among the medical authorities.…”

Inappropriate supply of antibiotics for common viral infections by community pharmacies in Vietnam: A standardised patient survey

“…Previous self-reported surveys and qualitative studies have shown that self-medication with antibiotics is common, and that antibiotic supply by private pharmacies in Vietnam is frequently inappropriate. 25 , 26 , 27 Limitations of previous research include a lack of blinding of the pharmacists – potentially contributing to social desirability bias 28 – as well as possible recall bias. 29 Standardised patient surveys (SPS) can overcome these forms of bias, by evaluating the performance of pharmacy staff in real life scenario.…”