Assessing antibiotic dispensing without prescription through simulated client methodology in developing countries: A comprehensive literature review from 2009 to 2021

• Published in: Journal of public health Vol. 33; no. 4; pp. 781 - 803
• Main Authors: Ahmad, Tawseef, Khan, Shujaat Ali, Mallhi, Tauqeer Hussain, Mannan, Abdul, Rahman, Asad Ur, Salman, Muhammad, Saleem, Zikria, Khan, Hamayun, Khan, Zakir, Karataş, Yusuf, Khan, Faiz Ullah
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2025; Springer Nature B.V
• Subjects: Amoxicillin; Antibiotic resistance; Antibiotics; Azithromycin; Cotrimoxazole; Developing countries; Diarrhea; Dispensing; Drug stores; Epidemiology; Health Promotion and Disease Prevention; LDCs; Literature reviews; Medicine; Medicine & Public Health; Pharmacy; Public Health; Quinolones; Respiratory tract; Respiratory tract infection; Review Article; Urinary tract; Developing countries; Simulated client; Antimicrobial resistance; Antimicrobials; Nonprescription; Pharmacy
• ISSN: 2198-1833; 1613-2238
• DOI: 10.1007/s10389-023-02032-x

Aim The objective of this review was to assess the extent of nonprescription antibiotics obtained at community pharmacies without a valid prescription and their association with various factors using the simulated client methodology. Subject and methods A literature search of the PubMed, CINAHL, Scopus, Google Scholar, and Cochrane Database of Systematic Reviews was carried out in 2022. We also looked through the references for pertinent papers. Results The current review of 40 studies in different countries revealed that the most common case scenarios used by simulated clients for antibiotic dispensing were upper respiratory tract infections, acute diarrhea, and urinary tract infections, and the most common antibiotics prescribed to treat those symptoms were amoxicillin, azithromycin, quinolones, and co-trimoxazole. Regular dispensing of antibiotics without a prescription was observed in several countries. Antibiotic abuse and easy access both have the potential to accelerate the evolution of antibiotic resistance in these areas. Conclusion Antibiotics are still often dispensed without an inquiring physician's prescription. Our review emphasizes the need for strict enforcement of current regulations and/or the adoption of new legislative frameworks to control the supply of antibiotics, as well as training and educational support for pharmacy staff (such as pharmacists and pharmacy assistants) regarding the responsible use of antibiotics and the significance of antimicrobial stewardship.