The Dispensing of Non-Prescribed Antibiotics to Pediatrics in Community Pharmacies: A Simulated Client Study

Deema Al-Huwaidi; Rana K. Abu-Farha; Rama ALkhawaldeh; Rajaa Daghash; Anan Jarab; Tareq L. Mukattash

doi:10.35516/jjps.v18i3.2907

Authors

Deema Al-Huwaidi Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
Rana K. Abu-Farha Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University, Amman-Jordan.
Rama ALkhawaldeh Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University, Amman-Jordan.
Rajaa Daghash Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Science Private University, Amman-Jordan.
Anan Jarab Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; Collage of Pharmacy, Al-Ain University, Abu Dhabi, United Arab of Emirates
Tareq L. Mukattash Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan

DOI:

https://doi.org/10.35516/jjps.v18i3.2907

Keywords:

Antibiotics, non-prescription, simulated client, pharmacists, Jordan

Abstract

Objective: This study aims to explore the practice of dispensing non-prescribe antibiotics to pediatrics in the community pharmacies in Jordan.

Method: This study was a cross-sectional study, performed between August 2021 and March 2022. Five different clinical case scenarios were simulated including pharyngitis, bronchitis, otitis media, gastroenteritis, and urinary tract infection (UTI). Three levels of demand were used to conceive the pharmacy staff to sell antibiotics.

Results: A total of 207 community pharmacies in Jordan were visited. The majority of pharmacies (n= 163, 78.7%) dispensed antibiotics without a prescription using three levels of demands. Most of the antibiotics dispensed for the pharyngitis case scenarios (95.3%), followed by UTI (89.2%). Among the pharmacists who dispensed antibiotics, 92.0% explained how to take the antibiotic, 41.1% provide the duration of treatment for the dispensed antibiotic, and 27.0% inquired about any type of drug allergy. On the other hand, only 21.3% (n= 44/207) of the pharmacy staff had refused to dispense any type of antibiotics, of those (n= 17/44, 38.6%) recommended consulting a physician, in which health issues were the only reason behind that refusal.

Conclusions: The results of the current study strongly demonstrate that dispensing of non-prescribed antibiotic in pediatric patients is prevalent in Jordan despite the current legislations. The ease of access and the inappropriate overuse of antibiotics confirms the need for stringent enforcement of the existing laws and the establishment of a new regulation regarding the dispensing of antibiotics without a valid prescription in the near future.

References

Etebu E, Arikekpar I. Antibiotics: Classification and mechanisms of action with emphasis on molecular perspectives. Int J Appl Microbiol Biotechnol Res. 2016;4:90-101.

Rogawski ET, Platts-Mills JA, Seidman JC, John S, Mahfuz M, Ulak M, et al. Use of antibiotics in children younger than two years in eight countries: a prospective cohort study. Bull World Health Organ. 2017;95(1):49-61. DOI: https://doi.org/10.2471/BLT.16.176123

Bishop C, Yacoob Z, Knobloch MJ, Safdar N. Community pharmacy interventions to improve antibiotic stewardship and implications for pharmacy education: a narrative overview. Res Social Adm Pharm. 2019;15(6):627-31. DOI: https://doi.org/10.1016/j.sapharm.2018.09.017

Eck A, Rutten NB, Singendonk MM, Rijkers GT, Savelkoul PH, Meijssen CB, et al. Neonatal microbiota development and the effect of early life antibiotics are determined by two distinct settler types. PLoS One. 2020;15(2):e0228133. DOI: https://doi.org/10.1371/journal.pone.0228133

O'Neill JIM. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Rev Antimicrob Resist. 2014.

Gebretekle GB, Serbessa MK. Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals’ perspective. Antimicrobial resistance and infection control. 2016;5(1):1-7. DOI: https://doi.org/10.1186/s13756-016-0101-z

Zahreddine L, Hallit S, Shakaroun S, Al-Hajje A, Awada S, Lahoud N. Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon. Pharm Pract (Granada). 2018;16(3):1194. DOI: https://doi.org/10.18549/PharmPract.2018.03.1194

Nusair MB, Al-Azzam S, Alhamad H, Momani MY. The prevalence and patterns of self-medication with antibiotics in Jordan: A community-based study. Int J Clin Pract. 2021;75(1):e13665. DOI: https://doi.org/10.1111/ijcp.13665

Hejaz HA. Knowledge and Attitudes towards Antibiotic Usage. Jordan Journal of Pharmaceutical Sciences. 2023;16(2):447-. DOI: https://doi.org/10.35516/jjps.v16i2.1486

Bin Abdulhak AA, Al Tannir MA, Almansor MA, Almohaya MS, Onazi AS, Marei MA, et al. Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross Sectional Study. BMC Public Health. 2011;11(1):538.

Nafisah SB, Nafesa SB, Alamery AH, Alhumaid MA, AlMuhaidib HM, Al-Eidan FAJJoi, et al. Over-the-counter antibiotics in Saudi Arabia, an urgent call for policy makers. 2017;10(5):522-6. DOI: https://doi.org/10.1016/j.jiph.2016.09.016

Dweib M. Community Pharmacists’ Knowledge, Attitude, and Practices Towards Dispensing Antibiotics without Prescription (DAwP) in the West Bank, Palestine. Jordan Journal of Pharmaceutical Sciences. 2023;16(2):468-. DOI: https://doi.org/10.35516/jjps.v16i2.1516

Mason T, Trochez C, Thomas R, Babar M, Hesso I, Kayyali R. Knowledge and awareness of the general public and perception of pharmacists about antibiotic resistance. BMC Public Health. 2018;18(1):711. DOI: https://doi.org/10.1186/s12889-018-5614-3

Almaaytah A, Mukattash TL, Hajaj J. Dispensing of non-prescribed antibiotics in Jordan. Patient Prefer and Adher. 2015;9:1389-95. DOI: https://doi.org/10.2147/PPA.S91649

Ayyash M, Abu-Farha R, Jaber K, Ateih S, Akour A. Patterns of Antibiotic Use, Knowledge, and Perceptions among Jordanian Population: A Cross-sectional Study. Jordan Journal of Pharmaceutical Sciences. 2024;17(1):131-43. DOI: https://doi.org/10.35516/jjps.v17i1.1744

Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Med Res. 2005;36(6):697-705. DOI: https://doi.org/10.1016/j.arcmed.2005.06.009

Zawahir S, Lekamwasam S, Aslani P. Antibiotic dispensing practice in community pharmacies: A simulated client study. Res Social Adm Pharm. 2019;15(5):584-90. DOI: https://doi.org/10.1016/j.sapharm.2018.07.019

Halboup A, Abdi A, Ahmed M, Al-Qadasi F, Othman GQ. Access to antibiotics without prescription in community pharmacies in Yemen during the political conflict. Public health. 2020;183:30-5. DOI: https://doi.org/10.1016/j.puhe.2020.03.003

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. J Pharm (Cairo). 2019;2019:3510659. DOI: https://doi.org/10.1155/2019/3510659

Ahmad T, Khan FU, Ali S, Rahman AU, Ali Khan S. Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study. PLoS One. 2022;17(2):e0263756. DOI: https://doi.org/10.1371/journal.pone.0263756

Saleem Z, Hassali MA, Godman B, Fatima M, Ahmad Z, Sajid A, et al. Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study. Journal of pharmaceutical policy and practice. 2020;13:26. DOI: https://doi.org/10.1186/s40545-020-00233-3

Hallit S, Zahreddine L, Saleh N, Shakaroun S, Lahoud N. Practice of parents and pharmacists regarding antibiotics use in pediatrics: A 2017 cross-sectional study in Lebanese community pharmacies. J Eval Clin Pract. 2020;26(1):181-9. DOI: https://doi.org/10.1111/jep.13165

Norton AE, Konvinse K, Phillips EJ, Broyles AD. Antibiotic Allergy in Pediatrics. Pediatrics. 2018;141(5). DOI: https://doi.org/10.1542/peds.2017-2497

Bin Abdulhak AA, Altannir MA, Almansor MA, Almohaya MS, Onazi AS, Marei MA, et al. Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: a cross sectional study. BMC Public Health. 2011;11:538. DOI: https://doi.org/10.1186/1471-2458-11-538

Zhu Y, Tang X, Yan R, Shao Z, Zhou Y, Deng X, et al. Non-prescription antibiotic use for cough among Chinese children under 5 years of age: a community-based cross-sectional study. BMJ Open. 2021;11(12):e051372. DOI: https://doi.org/10.1136/bmjopen-2021-051372

Shet A, Sundaresan S, Forsberg BC. Pharmacy-based dispensing of antimicrobial agents without prescription in India: appropriateness and cost burden in the private sector. Antimicrob Resist Infect Control. 2015;4:55. DOI: https://doi.org/10.1186/s13756-015-0098-8

Bianco A, Licata F, Trovato A, Napolitano F, Pavia M. Antibiotic-Dispensing Practice in Community Pharmacies: Results of a Cross-Sectional Study in Italy. Antimicrob Agents Chemother. 2021;65(6). DOI: https://doi.org/10.1128/AAC.02729-20

Battikhi MN. Epidemiological study on Jordanian patients suffering from diarrhoea. New Microbiol. 2002;25(4):405-12.

Llor C, Cots JM. The sale of antibiotics without prescription in pharmacies in Catalonia, Spain. Clin Infect Dis. 2009;48(10):1345-9. DOI: https://doi.org/10.1086/598183

Al Baz M, Law MR, Saadeh R. Antibiotics use among Palestine refugees attending UNRWA primary health care centers in Jordan - A cross-sectional study. Travel Med Infect Dis. 2018;22:25-9. DOI: https://doi.org/10.1016/j.tmaid.2018.02.004