1,4,5,6Department of pharmacy practice, Arunai college of pharmacy, Tiruvannamalai- 606603, Tamil Nadu, India
2,3Department of pharmaceutics, Arunai college of pharmacy, Tiruvannamalai- 606603, Tamil Nadu, India
Objectives: Creating awareness among community pharmacist on knowledge and practices related to antibiotic dispensing. Materials and Methodology: It is an observational study conducted among the community pharmacist in the Tiruvannamalai, Kallakkurichi, Cuddalore districts and its surrounding areas. The study was conducted for a period of 5 months. The study was divided into 2 phases. In the first phase (Nov 2024 to Dec 2024), a random sampling was employed and relevant information’s were collected from the subject. By using self-administered Questionnaire and provide information about antibiotics. In phase 2 (Dec 2024 to Jan 2025), simulated client study was performed. Result and Discussion: The study identified important factors contributing towards the dispensing of ABs without prescriptions by the community pharmacist of Tiruvannamalai, Kallakkurichi, Cuddalore districts and its surrounding areas. The proportion of dispensing antibiotic without a prescription for minor bacterial and viral infections was studied. At the community level the knowledge of pharmacists was found to be poor, contributing towards the irrational dispensing of ABs without prescription. Among the socio demographic factors; gender, age, experience and employment status are associated with the dispensing pattern of ABs for minor infections. Similarly, the qualification of pharmacists was found to be associated with the knowledge on antibiotics. Conclusion: Development of educational and behavioural interventions, dispensing guidelines and strengthening the policies are to be emphasized to combat the irrational practice of dispensing ABs without physician prescription.
Community pharmacy is defined as the place where the medicines are stocked and dispensed to the patient. Community pharmacies are integral to healthcare systems playing significant roles in medicine provision, primary prevention, patient education & lifestyle advices. Antibiotic resistance (ABR) is defined as microorganism that are not inhibited by usually achievable systemic concentration often antimicrobial agent with normal dosage schedule and/ or fall in the minimum inhibitory concentration (MIC). Antibiotics are chemical substance from a biological source or produced by microorganism that inhibits the growth or kills other microorganisms. Antibiotics have revolutionized medicine, saving countless lives since their discovery in the early 20th century. The consumption of drugs such as antibiotics by individuals based on their own experience and knowledge without consulting a doctor or having proper prescription. A recent multi-country survey conducted by WHO showed that 93% of people self-medicated themselves with antibiotics from a community pharmacy. Antibiotic resistance (ABR) is the ability of bacteria to resist the effect of antibiotics. Resistance bacteria survive exposure to the antibiotics and continue to multiply in the body, potentially causing more harm and spreading to other animal or people. ABR is a critical of concern both in developing & developed countries, making it a global issue. A Community pharmacy is a health care facility that provides pharmaceutical and cognitive services to a specific community. It includes checking and dispensing of prescription drugs, providing advice on drug selection and usage to doctors and others health professionals and counselling patient in health promotion, disease prevention and the proper use of medicines. It should aim the welfare of the patient as its prime concern, rather than aiming at maximum sales and profit. The consumption of antibiotics to treat infection remained stable high-income countries between 2000 and 2015; however, significant increases were observed in developing countries during this period. The top three countries with fluoroquinolone resistance of Gram -negative bacteria in urine cultures found in a global 2010 study were: India 75%, Panama 70%, and Mexico 49%. Inappropriate use of antibiotics means use of antibiotics for self-medication and / or medications of family members (family medication) without prescription from health professional, receiving antibiotics from anybody else and or use of left over drugs and use of prescribed antibiotics for any purpose other than prescribed. Inappropriate use of antibiotics can potentially lead to AMR and increase the necessity to use more expensive antibiotics to treat common and life-threatening infections annually, multi-drug resistance bacteria are estimated to claim the life of more than 20,000 patients in North America, 25,000 patients in Europe and more than 90,000 patients in Southern Asia. Practices of self-medication, as a form of self-care, have always triggered controversy. Yet they are common worldwide. Self-medication often involves a combination of therapeutic resources and the use of both over-the-counter (OTC) and prescription-only medicines, including antibiotics.This includes tackling the use of Ams without a prescription, which is considered a form of AM ‘misuse’ that can potentially accelerate the emergence of resistant microorganisms (WHO, 2015b). Some of the factors contributing self-medication are
Convenience: it may be difficult to find time to consult a doctor, or self-medication may be more convenient.
Minor illness: the illness may not seem serious enough to warrant a doctor visit.
Previous experience: people may have had success with antibiotics in the past for similar symptoms.
Quick relief: people may want quick relief or to use antibiotics in an emergency.
Easy access: antibiotics maybe easy to find and affordable.
Lack of knowledge: people may not know how to properly administer antibiotics or other medications.
Others: other reasons may include cost saving, doctor prescribing the same antibiotic, or recommendation from health professional.
Globally, 63.4% of antibiotics dispensed in community pharmacy do not have a prescription. The major factors contributing to irrational use of antibiotics and increasing the rate of antimicrobial resistance is dispensing them without a proper prescription. The dispense of antibiotics at community pharmacies may be influenced by pharmacists, attitudes, lack of knowledge & awareness about ABR (Antibiotic Resistance). Dispensing of antibiotics without a prescription is one of the major factors contributing to irrational use of antibiotics and increasing the rate of resistance. Outpatient use of antibiotics accounts for approximately two-thirds of antibiotic sales in the world. Mexico, Brazil, South Africa, Greece, Turkey, South Korea, Russia countries demonstrated the common practice of dispensing antibiotics without prescription. Community pharmacists generally have a knowledge of antibiotics. Experience ranging between three to four years had better knowledge towards appropriate use of drugs compared to those with a nine to ten- year experience. Limited knowledge about antibiotics, ABR could be a large factor influencing illegal and inappropriate supply of antibiotics to antibiotics to patients with minor infections at community pharmacies. Creating awareness about antibiotics and ABR in society will be another fine step in promoting the rational use of antibiotics.
Objective: To evaluate community pharmacy staff knowledge about antibiotics and dispensing behaviour of antibiotics without a prescription. To identify possible factors impacting antibiotics dispensing behaviour. Creating awareness among community pharmacist on knowledge and practices related to antibiotic dispensing.
Material and methodology:
Study Design: The study was designed and conducted as an observational study
Study population: Community pharmacist in Tiruvannamalai, Kallakurichi, districts and its surrounding areas.
Selection of subjects: The subject was selected for the study based upon the inclusion and exclusion criteria. It is explained in detail in below
Inclusion Criteria: All type of community pharmacy pharmacist in a Tiruvannamalai, Kallakurichi, districts and its surrounding areas. Both male and female pharmacist who can give consent was selected for the study.
Exclusion Criteria: Pharmacist who are not willing to participate in this study.
Methods: Community approval
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Subject enrolment → Enrolment
Based on criteria
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Obtaining consent
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Subject interview
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Outcome measures & analysis
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Perform simulated client study (Among 50 pharmacists, only N= 50 gave consent for simulated client study)
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Results and Discussion
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Conclusion
Visit the community pharmacy (N =50)
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Describe the Symptoms
? ?
Antibiotic given (40) Refuse to dispense (10)
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Failure Demanding antibiotics
? ?
Refuse to dispense (NIL)
Antibiotic given (10)
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Success of study
How to Overcome:
Results and Discussion:
A total of 50 subjects were interviewed and their details were noted in a specially designed data collection form. The data collection form contains information about socio demographics characteristics, questionnaire about community pharmacists on knowledge and practices on antibiotics. The study identified important factors contributing towards the dispensing of ABs without prescriptions by the community pharmacist of Tiruvannamalai, Kallakkurichi districts and its surrounding areas. The proportion of dispensing antibiotic without a prescription for minor bacterial and viral infections was studied. At the community level the knowledge of pharmacists was found to be poor, contributing towards the irrational dispensing of ABs without prescription. Similarly, the qualification of pharmacists was found to be associated with the knowledge on antibiotics. The study, demonstrated that pharmacists have poor knowledge about antibiotics, its use and resistance. Only 28% (n=14) pharmacist correctly defined the term antibiotics and 18% (n=9) of pharmacist had a good knowledge about ABs. Antibiotics without prescriptions were more readily dispensed to the patients who were known to the pharmacist. Findings from simulated client study concluded that majority of the pharmacy dispense antibiotics without prescription. Around 78% of the pharmacist dispense Amoxicillin tablet without prescription.
Figure 4: Employment wise distribution
Figure 6: Employment status wise distribution
Figure 7: Pharm & Non-Pharm wise distribution
CONCLUSION: The government should consider ABR as a major public health issue. Policies and regulations should be put in place to enforce appropriate access, minimize the public’s demand from health professionals and reduce inappropriate use of antibiotics. The empirical evidence may facilitate the development of educational and behavioural interventions, dispensing guides, and strengthening the policies which can be undertaken to combat against this public health issue. It is important that the government strictly enforces the law regarding antibiotics supply. Furthermore, standards should be implemented and adopted on the appropriate provision and supply of antibiotics.
ACKNOWLEDGEMENT:
Declared none.
Author contributions:
All authors have contributed equally.
ABBREVIATIONS:
ABs – Antibiotics, ABR – Antibiotic Resistance, AMR – Anti-Microbial Resistance, OTC -Over the Counter, MIC – Minimum Inhibitory Concentration, WHO – World Health Organisation, AMS – Anti-Microbial Stewardship.
REFERENCES
R. Kalidasan*, Dr. Jayaprakash Shanmugam, Dr. S. K. Senthil kumar Kulanthaivel, S. Arunkumar, S. Bhuvaneshwari, K. Durgadevi, Community Pharmacist Knowledge and Practices on Antibiotics (Otc): An Observational Study, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 2, 1869-1875. https://doi.org/10.5281/zenodo.14913369
10.5281/zenodo.14913369
