Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross Sectional Study

Abstract

BackgroundAntibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios.MethodsA cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women).ResultsA total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases.ConclusionsWe observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted.

Evaluation of rational antibiotic dispensing in the community pharmacy setting: a simulated patient study

“…[5][6][7][8] A simulated patient demanded medication for pain located in the region of the frontal sinuses. The other information regarding the simulated patient was listed as following; he was purchasing this medication for his wife, who was 24 years old; she had a fever of 38-38.5 o C, she also had running nose; she had a history of rhinosinusitis and she had used antibiotics in the past, but she could not remember the name of the antibiotic; she was currently only using oral contraception and had no history of allergies.…”

“…5 However, in many simulated patient studies, it has been observed that antibiotics which were suggested without prescription were common in cases with acute uncomplicated rhinosinusitis or other acute infections. [5][6][7][8] According to the report by the Turkish Ministry of Health based on records of Prescription Information System in 2011 and 2012, it was determined that the rate of prescribing antibiotics by general practitioners were approximately 35.0% and 34.0%, respectively. 9 The elevated utilization of antibiotics is not unique to Turkey and other developing countries; it is also common in Europe.…”

“…7 In another study conducted in the United Arab Emirates, the percentage of antibiotics dispensed without prescription was 68.4% in the community pharmacy setting. 10 In this study, the antibiotics suggested by community pharmacies was a combination of penicillin including β-lactamase inhibitors, penicillin with extended spectrum and second-generation cephalosporin.…”

Assessing Knowledge, Perception and Attitudes About Antibiotics Among Final Year Pharmacy Undergraduates in Sri Lanka

“…This may be compounded by irrational practices of prescribing antibiotics mainly for upper respiratory infections [13][14][15][16], and immature antibiotics stewardship policies. This may be complicated by the availability of antibiotics without prescription (regulated but not controlled) [17][18][19] and lack of laboratories for antibiotics susceptibility testing and surveillance. Factors such as; lack of access to health care services, services are not affordable, limited regulatory control of the use of prescription medicines including antibiotics, limited understanding of the role of antibiotics, the opportunity to self-medicate, the concern of doctors for the risk of secondary bacterial infections after viral illnesses in poor environments, prohibitive cost sensitivity testing and pharmaceutical promotional tactics all compound the problem [20][21][22].…”

Adherence of Community Pharmacies in Riyadh, Saudi Arabia, to Optimal Conditions for Keeping and Selling Good-Quality Medicines

“…For example, one can easily buy prescription-only medicines, such as antibiotics, without a prescription despite the strict regulations [12].…”