Dispensing and purchasing antibiotics without prescription: a cross-sectional study among pharmacists and clients

Background: Antimicrobial resistance (AMR) is a public health issue with resistance rates increasing worldwide. Major contributing causes of AMR are the behaviors of dispensing and purchasing antibiotics without a prescription (DAWP and PAWP), respectively among pharmacists and clients, especially in low- and middle-income countries. This study aims to investigate behavioral patterns related to DAWP and PAWP among pharmacists and citizens of Beirut, Lebanon.

Methods:  We conducted a cross-sectional study using questionnaires targeting a stratified random sample of pharmacy managers and a random sample of clients, recruited from public spaces in the Municipal Beirut area. Questionnaires assessed behavioral patterns, reasons for, and attitudes towards DAWP and PAWP. We compared the perceptions and self-reported behaviors related to DAWP and PAWP among the two samples.

Results: We recruited 70 pharmacists and 178 citizens. While most pharmacists recognized that AMR is a public health problem and that DAWP is a major contributing factor, about a third (37%) declared supporting DAWP; citizens confirmed this response, as 30% declared they do not usually obtain a prescription before purchasing antibiotics. However, when recalling their last purchase of antibiotics, 43% of clients did not get a prescription. The reasons for this behavior are mostly financial and convenience, coupled with low law enforcement.

Discussion: DAWP and PAWP seem to be common practices among a relatively high proportion of pharmacists and citizens of Beirut. Despite being illegal, this practice seems to take ground in a politically and economically weak country and in a semi-privatized healthcare system. National efforts including anti-AMR educational campaigns and law enforcement need to be implemented problem this problem can grow out of proportion and reduce the effectiveness of vaccination campaigns, especially considering the impact of the COVID-19 pandemic.