Dispensing of antibiotics without prescription and associated factors in drug retail outlets of Eritrea: A simulated client method

Autoři: Merhawi Bahta aff001;  Sirak Tesfamariam aff002;  Dawit G. Weldemariam aff003;  Hermella Yemane aff004;  Eyasu H. Tesfamariam aff005;  Tesfamariam Alem aff001;  Mulugeta Russom aff006
Působiště autorů: Department of Medical Sciences, Pharmacy Unit, Orotta College of Medicine and Health Sciences, Asmara, Eritrea aff001;  Pharmacy, Nakfa Hospital, Nakfa, Eritrea aff002;  Pharmacy, Hazhaz Zonal Referral Hospital, Asmara, Eritrea aff003;  Southern Red Sea Zonal Medical Store, Assab, Eritrea aff004;  Department of Statistics, Biostatistics and Epidemiology Unit, College of Science, Eritrean Institute of Technology, Mai Nefhi, Eritrea aff005;  Eritrean Pharmacovigilance Center, National Medicines and Food Administration, Asmara, Eritrea aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0228013


Dispensing antibiotics without prescription is irrational and can hasten the emergence and spread of antibiotic resistance. This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea. A cross-sectional simulated client method was used to conduct the study. Data was collected between July and August 2019, entered and analyzed using Statistical Package for Social Science version 22. Descriptive analysis was performed using mean (standard deviation), median (interquartile range), frequency, percentage, as appropriate, for independent variables. Logistic regression, at bivariate and multivariate levels, along with odds ratio (95% confidence interval) was used to determine the association between the dispensing of antibiotics without prescription and independent variables. P-values less than 0.05 were considered as statistically significant. The extent of dispensing antibiotics without prescription was found to be 87.6% with the most frequently dispensed antibiotics being ciprofloxacin (47.8%) and co-trimoxazole (37.5%). Furthermore, 12.4% of the drug retail outlet attendants did not dispense antibiotics because they preferred a referral to health facilities (52.6%), were following administrative restrictions not to sell antibiotics (42.1%), or did not have the necessary antibiotics (31.6%). Private community pharmacies (AOR = 7.68, 95% CI: 1.67, 35.37; p = 0.009) and private drug shops (AOR = 10.65, 95% CI: 1.96, 57.93; p = 0.006) were more likely to dispense antibiotics compared to the governmental community pharmacies. Dispensing antibiotics without prescription was more likely to occur in the Maekel (central) region (AOR = 3.76, 95% CI: 1.19, 11.92; p = 0.024) compared to the remaining regions combined. In conclusion, the sales of antibiotics without prescription in the drug retail outlets of Eritrea is alarming which requires immediate attention from policymakers.

Klíčová slova:

Antibiotic resistance – Antibiotics – Drug administration – Drug licensing – Drugs – Eritrea – Pharmacists – Shops


1. Bronzwaer S. European Antimicrobial Resistance Surveillance System. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis. 2002;8:278–82. doi: 10.3201/eid0803.010192 11927025

2. Goossens H, Ferech M, Vander Stichele R, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. The Lancet. 2005;365:579–87.

3. WHO. Global action plan on antimicrobial resistance. 2015. 2017.

4. Bisht R, Katiyar A, Singh R, Mittal P. Antibiotic resistance-A global issue of concern. Asian journal of pharmaceutical and clinical research. 2009;2:34–9.

5. Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS, Monnet DL, et al. Attitudes, beliefs and knowledge concerning antibiotic use and self‐medication: a comparative European study. Pharmacoepidemiology and drug safety. 2007;16:1234–43. doi: 10.1002/pds.1479 17879325

6. Roque F, Soares S, Breitenfeld L, López-Durán A, Figueiras A, Herdeiro MT. Attitudes of community pharmacists to antibiotic dispensing and microbial resistance: a qualitative study in Portugal. International journal of clinical pharmacy. 2013;35:417–24. doi: 10.1007/s11096-013-9753-4 23397322

7. WHO. WHO report on surveillance of antibiotic consumption: 2016–2018 early implementation. 2018.

8. Haddadin RN, Alsous M, Wazaify M, Tahaineh L. Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A cross sectional study. PloS one. 2019;14:e0216115. doi: 10.1371/journal.pone.0216115 31034528

9. Cars O, Nordberg P. Antibiotic resistance–The faceless threat. International Journal of Risk & Safety in Medicine. 2005;17:103–10.

10. Chang J, Ye D, Lv B, Jiang M, Zhu S, Yan K, et al. Sale of antibiotics without a prescription at community pharmacies in urban China: a multicentre cross-sectional survey. Journal of Antimicrobial Chemotherapy. 2017;72:1235–42. doi: 10.1093/jac/dkw519 28062684

11. Gastelurrutia MA, Larrañaga B, Garay A, de Asis Echeveste F, Fernandez-Llimos F. Impact of a program to reduce the dispensing of antibiotics without a prescription in Spain. Pharmacy practice. 2013;11:185. doi: 10.4321/s1886-36552013000400002 24367457

12. Horumpende PG, Sonda TB, van Zwetselaar M, Antony ML, Tenu FF, Mwanziva CE, et al. Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach. PloS one. 2018;13:e0207465. doi: 10.1371/journal.pone.0207465 30462700

13. Kalungia AC, Burger J, Godman B, Costa JdO, Simuwelu C. Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia. Expert review of anti-infective therapy. 2016;14:1215–23. doi: 10.1080/14787210.2016.1227702 27548801

14. Hoxha I, Malaj A, Tako R, Malaj L. Survey on how antibiotics are dispensed in community pharmacies in Albania. Lancet. 2005;365:579–87. doi: 10.1016/S0140-6736(05)17907-0

15. Ateshim Y, Bereket B, Major F, Emun Y, Woldai B, Pasha I, et al. Prevalence of self-medication with antibiotics and associated factors in the community of Asmara, Eritrea: a descriptive cross sectional survey. BMC public health. 2019;19:726. doi: 10.1186/s12889-019-7020-x 31182071

16. Schneider CR, Everett AW, Geelhoed E, Kendall PA, Clifford RM. Measuring the assessment and counseling provided with the supply of nonprescription asthma reliever medication: a simulated patient study. Annals of Pharmacotherapy. 2009;43:1512–8. doi: 10.1345/aph.1M086 19690228

17. Berger K, Eickhoff C, Schulz M. Counselling quality in community pharmacies: implementation of the pseudo customer methodology in Germany. Journal of clinical pharmacy and therapeutics. 2005;30:45–57. doi: 10.1111/j.1365-2710.2004.00611.x 15659003

18. Chua SS, Ramachandran CD, Paraidathathu TT. Response of community pharmacists to the presentation of back pain: a simulated patient study. International Journal of Pharmacy Practice. 2006;14:171–8.

19. Madden JM, Quick JD, Ross-Degnan D, Kafle KK. Undercover careseekers: simulated clients in the study of health provider behavior in developing countries. Social science & medicine. 1997;45:1465–82.

20. Xu T, de Almeida Neto AC, Moles RJ. A systematic review of simulated‐patient methods used in community pharmacy to assess the provision of non‐prescription medicines. International Journal of Pharmacy Practice. 2012;20:307–19. doi: 10.1111/j.2042-7174.2012.00201.x 22953770

21. WHO. World Health Organization model list of essential medicines: 21st list 2019. World Health Organization, 2019.

22. Marković-Peković V, Grubiša N, Burger J, Bojanić L, Godman B. Initiatives to reduce nonprescription sales and dispensing of antibiotics: findings and implications. Journal of research in pharmacy practice. 2017;6:120. doi: 10.4103/jrpp.JRPP_17_12 28616436

23. Zapata-Cachafeiro M, Piñeiro-Lamas M, Guinovart MC, López-Vázquez P, Vázquez-Lago JM, Figueiras A. Magnitude and determinants of antibiotic dispensing without prescription in Spain: a simulated patient study. Journal of Antimicrobial Chemotherapy. 2018;74:511–4.

24. Farah R, Lahoud N, Salameh P, Saleh N. Antibiotic dispensation by Lebanese pharmacists: a comparison of higher and lower socio-economic levels. Journal of infection and public health. 2015;8:37–46. doi: 10.1016/j.jiph.2014.07.003 25139454

25. Zawahir S, Lekamwasam S, Aslani P. Community pharmacy staff’s response to symptoms of common infections: A pseudo-patient study. Antimicrobial Resistance & Infection Control. 2019;8:60.

26. Llor C, Monnet D, Cots J. Small pharmacies are more likely to dispense antibiotics without a medical prescription than large pharmacies in Catalonia, Spain. Eurosurveillance. 2010;15:19635. 20738994

27. Damisie G, Hambisa S, Yimam M. Over the Counter Sale of Antibiotics at Drug Stores Found in Mizan-Aman Town, Southwest Ethiopia: A Cross-Sectional Simulated Client Visit Study. Journal of pharmaceutics. 2019;2019.

28. Economist Intelligence Unit. The Future of Healthcare in Africa. Geneva, Switzerland: The Economist Intelligence Unit; 2011. 2014.

29. Andrea Von Groll Anandi Martin, Jureen Pontus, Hoffner Sven, Vandamme Peter, Portaels Françoise, et al. Fluoroquinolone Resistance in Mycobacterium tuberculosis and Mutations in gyrA and gyrB Antimicrobial Agents and Chemotherapy 2009;53:4498–500. doi: 10.1128/AAC.00287-09 19687244

Článek vyšel v časopise


2020 Číslo 1
Nejčtenější tento týden