Empirical treatment of uncomplicated urinary tract infection by community pharmacist in the Eastern province of Saudi Arabia

Objectives: It is a well known phenomenon in the Kingdom of Saudi Arabia that prescription drugs are dispensed over the counter in the community pharmacies. The aim of this study is to document the attitude of community pharmacists to fulfill the concept of pharmaceutical care and to evaluate how they manage a case of acute uncomplicated lower urinary tract infection. Method: Eighty-eight community pharmacists in the Eastern province of Saudi Arabia were presented with a patient claiming urinary tract infection and seeking medical treatment. Results: Only one attendant pharmacist refused to dispense medications without prescription. Fifteen others (17%) dispensed urinary antiseptic only and 72 (82%) gave antibacterial agents. Fluoroquinolones were the most commonly dispensed (69%) as first choice and 87% as an alternative) followed by co-trimoxazole, penicillins, cephalosporins and tetracyclines. The number of drugs dispensed ranged from a single agent at 52 (59%), 2 drugs at 31 (35%) and 3 drugs at 4 (4.5%) pharmacies. The average cost was Saudi Riyal (SR) 45.8 ($12.2) for first choice drugs and SR 31.5 ($8.4) for the alternatives. Conclusion: The heavy dispensing of fluoroquinolones over the counter could eventually lead to increased resistance of the pathogenic bacteria to these drugs. However, despite the lack of pharmacist's adherence to the pharmaceutical law, this study does not indicate that they had abused their patients. It is rather demonstrating the urgent needs for successful implementation of the pharmaceutical law taking into consideration better integration between governmental health providers and the private retail pharmacies. In addition, it supports calls to educate pharmacists to perform basic clinical assessment in the community pharmacy, as a vital tool to effectively manage their patients' health status. The Ministry of health should credit such educational activity for the renewal of pharmacist's license in the Kingdom.