Antibiotic dispensing practice in community pharmacies: A simulated client study

Background: Dispensing antibiotics without a prescription, although forbidden by Sri Lankan law since 1986, is a common practice throughout the country. This study attempted to quantify this practice for the first time. Objectives: To evaluate the response of community pharmacy staff to an antibiotic product request without a prescription and to explore possible factors influencing such practice. Methods: A cross-sectional simulated client study was conducted from Jan to Sept 2017. A total of 242 community pharmacies were visited by trained simulated clients (SCs) and they requested for one of four antibiotics (erythromycin tablets, amoxicillin syrup, metronidazole tablets, or ciprofloxacin tablets) without a prescription. Data on the interaction between the pharmacy staff and SC was recorded using a data collection sheet immediately after each visit. Results: Nearly 50% of pharmacies had a pharmacist on duty during the visit. Attending pharmacy staff asked for a prescription for the requested antibiotic in 47% of the instances. Only 16 (7%) pharmacy staff recommended the SC to see a doctor. Overall, 61% of pharmacies dispensed antibiotics without a prescription. The highest dispensed antibiotic was ciprofloxacin (44/63 requests; 70%) and the least was amoxicillin (32/62; 52%). Patient history was obtained in only a few instances and none of the pharmacies dispensed alternative over the counter medicines. The availability of a pharmacist reduced the risk of dispensing an antibiotic without a prescription (Adj. OR = 0.54, 95% CI: 0.30-0.95; P = 0.033), however, it did not have any impact on patient history taking. Conclusions: Dispensing antibiotics without a prescription is a common practice in Sri Lankan community pharmacies. In most instances, pharmacy staff neither inquired about patient history nor requested the patient to obtain the advice of a doctor. Presence of a pharmacist may reduce dispensing antibiotics without prescription, but may not have an effect on interactions with clients requesting antibiotics.