Journal of Global Antimicrobial Resistance (Dec 2024)
Community pharmacist non-prescription dispensing of antimicrobials in the Eastern Mediterranean: regulations, implementation, and interventions
Abstract
AIM: This study aims to critically analyze the existence and implementation of country regulations from the Eastern Mediterranean region (EMR) that aim to improve community pharmacist nonprescription dispensing of antimicrobials (CP-NPDA). BACKGROUND: Antimicrobial resistance (AMR) is a global health threat that requires concerted health system improvements. CP-NPDA is a major factor that contributes to AMR in human health. Over two-thirds of the EMR faces conflict and fragmented health systems with variable healthcare access and increasing AMR. Balancing NPDA regulation and access is difficult as many depend on informal health structures of community pharmacists. METHODOLOGY: EMR-NPDA regulations were identified from grey literature and critically analyzed. A literature review in a systematic approach was conducted to identify EMR-NPDA practices. Published interventions aiming to regulate NPDA were critically analyzed. RESULTS: Medicine dispensing regulations, which reflect NPDA, were identified for 19 of 22 EMR countries. Fifteen regulations explicitly mentioned prescription requirements. Variation was identified in regulation wording, publication date, mention of antimicrobial dispensing regulation, OTC lists, and non-compliance penalties. Of the thirty-seven reviewed studies, all countries exhibited NPDA except Djibouti for which no literature was identified. Only 5 interventions from 3 countries were identified. Varied socioeconomic contexts that may impact regulation implementation were recognized. CONCLUSIONS: NPDA in EMR is prevalent even in the presence of regulations. Strengthening regulation wording and implementation in certain EMR countries may be feasible. However, in LMIC or conflict settings, implementation of restrictive regulations may reduce access to antimicrobials. In these contexts, innovative approaches and policy research is required.
