Pharmacy World & Science

, Volume 29, Issue 6, pp 655–660 | Cite as

Utilization of antimicrobial agents with and without prescription by out-patients in selected pharmacies in South-eastern Nigeria

  • Charles Okey Esimone
  • Chukwuemeka Sylvester NworuEmail author
  • Obinna Patrick Udeogaranya
Research Article



We conducted a study in out-patient pharmacies in South-eastern Nigeria in order to determine the extent of self-medication of antimicrobial agents in this area, assess the dosing error associated with this practice and to ascertain the extent of involvement of community pharmacies.


A survey was carried out daily in selected community pharmacies for a period of 90 days. Data were collected on the number of patients visiting these shops for antimicrobial agents, the number getting their medication with a prescription, the number getting their order without prescription and on the type and dose of antimicrobial agents received.

Main out-come measure

The percentage of patients with prescription and without prescription was compared. The percentage under-dosages or over-dosages associated with how each antimicrobial agent was obtained were compared. The total DDDs of antimicrobial agents dispensed within this period with and without prescription were compared.


A total of 4,128 outpatients visited the shops for antimicrobial agents within the period and were involved in the study. Of this number, 1,742 (42.2%) came with a prescription from qualified medical personnel and 2,386 (57.8%) came without a prescription. A total of 13,693.13 DDDs of antimicrobial agents was dispensed, of which 56.38% was dispensed with prescription and 43.62% was dispensed without prescription. The degrees of under-dosing were significantly (P < 0.05) higher in regimen filled without prescription when compared to those filled with prescription.


Majority of the patients in this region still obtains their antimicrobial agents without a proper prescription, which is associated with sub-therapeutic dosing of these agents. There is a need for better regulation of antimicrobial agents dispensing and utilization in the region.


Antimicrobial agents Antibiotics Antimicrobial agents resistance Dispensing Prescription Nigeria 



We acknowledge the cooperation and contributions of some members of The Association of Community Pharmacy Practice of Nigeria (ACPN).


This research was funded through personal contributions of the authors only.


  1. 1.
    Rang HP, Dale MM, Ritter JM. Basic principles of chemotherapy. In Pharmacology, Churchill Livingstone: London, 1995. 681–695 ISBN 0 443 05086 4.Google Scholar
  2. 2.
    Levy SB, Burke JP, Wallace CK. Antibiotics use and antibiotic resistance worldwide. Rev Infect Dis 1987;3:745.Google Scholar
  3. 3.
    Silver LS, Bostian KA. Discovery and development of new antibiotics: the problem of antibiotics resistance. Antimicrob Agents Chemother 1993;37:377–383.PubMedGoogle Scholar
  4. 4.
    O’Brien TF. Global surveillance of antimicrobial resistance. N Engl J Med 1992;326:339–340.PubMedCrossRefGoogle Scholar
  5. 5.
    Goossens H, Ferech M, Stichele RV et al. Outpatient antibiotic use in Europe and association with resistance; a cross-national database study, 2005; 365:579–587. Scholar
  6. 6.
    Vuckovic N, Nichter M. Changing patterns of pharmaceutical practice in the United States. Soc Sci Med 1997;44:1285–1302.PubMedCrossRefGoogle Scholar
  7. 7.
    Haak H. Pharmaceuticals in two Brazilian villages: lay practices and perceptions. Soc Sci Med 1988;27:1415–1427.PubMedCrossRefGoogle Scholar
  8. 8.
    Guillemot D et al. Low dosage and long treatment duration of beta-lactam: risk factors for carriage of penicillin-resistant Streptococcus pneumoniae. JAMA 1998;279:365–370.PubMedCrossRefGoogle Scholar
  9. 9.
    Kunin CM et al. Social, behavioral, and practical factors affecting antibiotic use worldwide: report of Task Force 4. Rev Infect Dis 1987;993:S270–S285.Google Scholar
  10. 10.
    Obaseiki-Ebor EE, Akarele Jo, Ebea PO. A survey of antibiotic outpatient prescribing and antibiotic-medication. J Antimicrob Chemother 1987;20:759–763.PubMedCrossRefGoogle Scholar
  11. 11.
    Goel P, Ross-Degnan D, Berman P, Soumerai S. Retail pharmacies in developing countries: a behaviour and intervention framework. Soc Sci Med 1996; 42:1155–1161.PubMedCrossRefGoogle Scholar
  12. 12.
    British National Formulary. BMA and RPSGB: London, 2005; BNF-Vol 50, ISBN 0 85369 4621.Google Scholar
  13. 13.
    World Health Organisation. The anatomical therapeutical chemical classification system with defined daily doses (ATC/DDD). Norway: WHO, 2004. (accessed January 6, 2007) .
  14. 14.
    Abosede OA. Self-medication: an important aspect of primary health-care. Soc Sci Med 1984;19:699–703.PubMedCrossRefGoogle Scholar
  15. 15.
    Okeke IN, Lamikanra A, Edelman R. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis 1999;5 (1):18–27.PubMedCrossRefGoogle Scholar
  16. 16.
    Saradamma RD, Higginbotham N, Nichter M. Social factors influencing the acquisition of antibiotics without prescription in kerala State, South India. Soc Sci Med 2000;50 (6):891–903.PubMedCrossRefGoogle Scholar
  17. 17.
    World Health Organisation. Global Strategy for Containment of Antimicrobial Resistance, 2001;WHO/CDS/CSR/DRS/2001.2.Google Scholar
  18. 18.
    World Health Organization. World Health Assembly (fifty-first). Emerging and other communicable diseases: antimicrobial resistance. 1998;WHA51.17.Google Scholar
  19. 19.
    Lansang MA, Lucas-Aquino R, Tupasi TE et al. Purchase of antibiotics without without prescription in Manila, the Philippines. Inappropriate choice and doses. J Clin Epidemiol 1990;43 (1):61–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Mainous AG, Cheng AY, Garr RC, Tilley BC, Everett CJ, McKee MD. Nonprescribed antimicrobial drugs in Latino community, South Carolina. Emerg Infect Dis 2005;11 (6):883–8.PubMedGoogle Scholar
  21. 21.
    Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JGM et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis 2006;12 (3):452–9.PubMedGoogle Scholar
  22. 22.
    t’Hoen E. Direct-to-consumer advertising: for better profits or for better health? Am J Health Syst Pharm 1998;55:594–7.Google Scholar
  23. 23.
    World Health Organization. Public education in rational drug use. Report of an informal consultation, Geneva, 23–26 November 1993.1994; WHO/DAP/94.1.Google Scholar
  24. 24.
    Shapiro MF. Regulating pharmaceutical advertising: what will work? CMAJ 1997;156:359–361.PubMedGoogle Scholar
  25. 25.
    World Health Organization. Rational drug use: consumer education and information, Geneva, 1996; DAP/MAC/(8)96.6.Google Scholar
  26. 26.
    Radyowijati A, Haak H. Improving antibiotic use in low- income countries: an overview of evidence on determinants. Soc Sci Med 2003;57 (4):733–44.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Charles Okey Esimone
    • 1
  • Chukwuemeka Sylvester Nworu
    • 2
    Email author
  • Obinna Patrick Udeogaranya
    • 3
  1. 1.Department of Pharmaceutics, Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaNigeria
  2. 2.Department of Pharmacology & Toxicology, Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaNigeria
  3. 3.Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaNigeria

Personalised recommendations