Sale of Antibiotics without Prescriptions in Alexandria, Egypt

Kotb, Maryam; ElBagoury, Marwan

doi:10.22207/jpam.12.1.34

Cited by 10 publications

(12 citation statements)

References 22 publications

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“…This commercial-oriented practice and the notion of customer satisfaction is two-fold, and the relationship is one that is reciprocal and based on a win-win strategy: the CDRO owner wants to increase profit margins, and customers need access to antibiotics to treat their minor conditions although their conditions do not necessarily warrant an antibiotics. Some customers prefer and often opt to directly purchase antibiotics from CDROs as they strongly rely on their previous experience with the disease and treatment [ 39 – 41 , 45 – 47 , 49 ], that it would give them a quick relief. Moreover, customers do so for a number of other reasons including if they feel like their condition is not severe enough to visit a doctor [ 48 ], if they cannot afford to pay for consultation fee for physicians [ 39 – 42 , 44 , 45 , 47 , 49 ], or if they experience poor satisfaction with the services of health facilities in nearby areas (e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Some customers prefer and often opt to directly purchase antibiotics from CDROs as they strongly rely on their previous experience with the disease and treatment [ 39 – 41 , 45 – 47 , 49 ], that it would give them a quick relief. Moreover, customers do so for a number of other reasons including if they feel like their condition is not severe enough to visit a doctor [ 48 ], if they cannot afford to pay for consultation fee for physicians [ 39 – 42 , 44 , 45 , 47 , 49 ], or if they experience poor satisfaction with the services of health facilities in nearby areas (e.g. prolonged waiting time due to the overcrowded services, doctors unable/unwilling to have enough consultation time with patients and less quality service) [ 40 – 42 , 47 – 49 ] or if there are no health facilities in nearby areas at all [ 41 – 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, customers do so for a number of other reasons including if they feel like their condition is not severe enough to visit a doctor [ 48 ], if they cannot afford to pay for consultation fee for physicians [ 39 – 42 , 44 , 45 , 47 , 49 ], or if they experience poor satisfaction with the services of health facilities in nearby areas (e.g. prolonged waiting time due to the overcrowded services, doctors unable/unwilling to have enough consultation time with patients and less quality service) [ 40 – 42 , 47 – 49 ] or if there are no health facilities in nearby areas at all [ 41 – 43 ]. “… .most of the customers questioned the necessity of going to clinic as they expect same antibiotic will be prescribed again and hence they opted to buy the same antibiotic directly from the pharmacy” (participant/CMP004/) [ 39 ] .…”

Section: Resultsmentioning

confidence: 99%

“…More than half of the studies were conducted either in Sub-Saharan Africa (n = 4) [24,[39][40][41] or South Asia (n = 4) [42][43][44][45]. Most of the included studies instituted in depth or face to face interview (n = 10) [24,[38][39][40][41][42][44][45][46][47] while the other two employed a focus group discussion (n = 1) [44] or a focus group discussion plus in depth interview (n = 1) [48] to explore the reasons for dispensing antibiotics without prescription or drivers for inappropriate dispensing of antibiotics. A total of 442 respondents participated in the included studies, ranging from five in Ethiopia [40] to 147 in Syria [46].…”

Section: Description Of Studiesmentioning

confidence: 99%

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No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies

2021

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Background Non-prescription dispensing of antibiotics, one of the main sources of antibiotic misuse or over use, is a global challenge with detrimental public health consequences including acceleration of the development of antimicrobial resistance, and is facilitated by various intrinsic and extrinsic drivers. The current review aimed to systematically summarise and synthesise the qualitative literature regarding drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries. Methods Four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) and reference lists of the relevant articles were searched. The Joanna Briggs Institute’s Critical Appraisal Checklist for qualitative studies was used to assess the quality of included studies. The enhancing transparency in reporting the synthesis of qualitative research statement was used to guide reporting of results. Data were coded using NVivo 12 software and analysed using both inductive and deductive thematic analysis. Results A total of 23 articles underwent full text review and 12 of these met the inclusion criteria. Four main themes were identified in relation to facilitators of non-prescribed sale of antibiotics among community drug retail outlets: i) the business orientation of community drug retail outlets and tension between professionalism and commercialism; ii) customers’ demand pressure and expectation; iii); absence of or a lax enforcement of regulations; and iv) community drug retail outlet staff’s lack of knowledge and poor attitudes about antibiotics use and scope of practice regarding provision. Conclusions This review identified several potentially amendable reasons in relation to over the counter dispensing of antibiotics. To contain the rise of antibiotic misuse or over use by targeting the primary drivers, this review suggests the need for strict law enforcement or enacting new strong regulation to control antibiotic dispensing, continuous and overarching refresher training for community drug retail outlet staff about antibiotic stewardship, and holding public awareness campaigns regarding rational antibiotic use.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

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No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies

2021

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“…However, the participants in this study had varying viewpoints in this regard. Similar to pharmacists in Egypt, pharmacy staff in Pakistan considered that DoNAprovides economic benefit to patients [ 31 ]. This misconception among respondents was coupled with unawareness of applicable legislation, which is an important aspect that enhances compliance with regulations.…”

Section: Discussionmentioning

confidence: 99%

Dispensing of Non-Prescribed Antibiotics from Community Pharmacies of Pakistan: A Cross-Sectional Survey of Pharmacy Staff’s Opinion

et al. 2021

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Community pharmacies are the main channel of antibiotics distribution. We aimed to analyze the dispensing of non-prescribed antibiotics and knowledge of pharmacy staff. We conducted a cross-sectional study in Punjab, Pakistan between December 2017 and March 2018. A self-administered, structured, pretested, and validated bilingual questionnaire was used, and we used chi-square tests in the statistical analysis. A total of 573 (91.7%) pharmacy retailers responded to the survey; 44.0% were aged 31–40 years and all were men. Approximately 81.5% of participants declared that dispensing non-prescribed antibiotics is a common practice in community pharmacies, and 51.1% considered themselves to be authorized to dispense these drugs; 69.3% believed this a contributing factor to antimicrobial resistance. Most (79.1%) respondents believed that this practice promotes irrational antibiotics use, and half (52.2%) considered antimicrobial resistance to be a public health issue. Only 34.5% of respondents reported recommending that patients consult with a doctor prior to using antibiotics, and 61.8% perceived that their dispensing practices reduce patients’ economic burden. Approximately 44.9% of pharmacy retailers stated that they have proper knowledge about antibiotics use. Nitroimidazole was the main class of antibiotic dispensed without a prescription. Dispensing of injectable and broad-spectrum antibiotics can be potential threat for infection cure. Poor knowledge of staff is associated with dispensing of non-prescribed antibiotics. This inappropriate practice must be addressed immediately.

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