A Simulated Client Exploration of Nonprescription Dispensing of Antibiotics at Drugstores for Pediatric Acute Diarrhea and Upper Respiratory Infection in Lahore, Pakistan

Abstract

Usman Rashid Malik,1– 3 Jie Chang,1– 3 Furqan Hashmi,4 Naveel Atif,1– 3 Hareem Basir,5 Khezar Hayat,1– 3,6 Faiz Ullah Khan,1– 3 John Alimamy Kabba,1– 3 Krizzia Lambojon,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China; 2Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China; 3Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technology Innovation Harbour, Xi’an, 710000, People’s Republic of China; 4University College of Pharmacy, University of the Punjab, Lahore, 54000, Pakistan; 5Royal Albert Edward Infirmary, Wigan, WN1 2NN, UK; 6Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, 54000, PakistanCorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: The excessive consumption of antibiotics is a significant contributor to antimicrobial resistance, especially in children. Children are often advised antibiotics for viral infections. In developing countries, drugstores are a prime source of easy access to nonprescription antibiotics. Moreover, in Pakistan, their irrational use is an “everyday routine”. The study, therefore, aimed to evaluate the dispensing of nonprescription antibiotics to children.Methods: Using pediatric acute diarrhea and acute upper respiratory infection as disease scenarios, a simulated client, cross-sectional study was conducted in Lahore, Pakistan, to explore the antibiotics’ ease of availability at both categories of drugstores (pharmacies and medical stores) from November 1st, 2019 to January 31st, 2020. Chi-square (χ2) test was used to compare the differences in practices of different categorical variables. Multivariable logistic regression was applied to analyze the association of various factors with antibiotics dispensing.Results: Antibiotics were dispensed without prescription in 456 (59%) of 773 simulated visits out of which 425 (93.2%) were dispensed on the advice of the drugstore staff. A qualified pharmacist was available in only 164 (21.2%) cases. Of the 386 visits for acute diarrhea and 387 for acute upper respiratory infection, nonprescription antibiotic dispensing occurred in 259 (67.1%) and 197 (50.9%) visits, respectively. There were considerable differences (p-value < 0.05) in the practices and antibiotics dispensing between each disease scenario presented. Moreover, antibiotics were less commonly dispensed at pharmacist-supervised drugstores compared to unsupervised ones.Conclusion: Overall, inappropriate dispensing practices were prevalent to a large extent at the drugstores, and antibiotics were effortlessly obtainable without prescription. The quality of the services provided, especially by the non-pharmacist staff, was also not satisfactory. Therefore, the Drug Regulating Authority of Pakistan must enforce strict implementation of drug laws at the drugstores without delay, especially in major cities to help curb the felonious use of antibiotics.Keywords: antibiotics, nonprescription, drugstores, community pharmacies, simulated client, Pakistan

Keywords

• antibiotics
• non-prescription
• drugstores
• community pharmacies
• simulated client
• pakistan