Abstract
Objectives The aim of this study is to investigate over-the-counter sale of antibiotics from community pharmacies in Abu Dhabi city, focusing on the extent, demographic and socioeconomic determinants of this practice. Setting The study was conducted in the capital of the United Arab Emirates, Abu Dhabi, and involved 17 randomly selected private pharmacies. Method A cross-sectional design using structured observations of 30 clients purchasing antibiotics from a pharmacy staff (either a pharmacist or pharmacy assistant) at each selected pharmacy. A total of 510 interactions were observed. Statistical analysis was performed using SPSS. Main outcome measure The extent and types of antibiotics sold over-the-counter in Abu Dhabi city as observed in the selected sample of community pharmacies, and the demographic and socioeconomic factors that contributed to this practice. Results Sixty eight percent (68.4%) of the observed antibiotic sales were sold over-the-counter without prescriptions. Injection antibiotics constituted 2.2% of the antibiotics sold, 45.5% of which were sold over-the-counter. Combination of penicillins including β-lactamase inhibitors (34.0%), penicillins with extended spectrum (22.3%) and second generation cephalosporins (11.2%) were the mostly commonly sold antibiotic groups. Respiratory conditions (63.1%) were the most frequent reason for purchasing antibiotics. Over-the-counter sales of antibiotics were related to client ethnicity and age, gender of pharmacy staff and health complaint. Conclusion Our study revealed high sales of over-the-counter antibiotics, despite this being illegal. The ineffectiveness of antibiotics in treating respiratory conditions of viral origin and effects of such practice on the emergence of bacterial resistance necessitates prompt action.
Similar content being viewed by others
References
Austin DJ, Kristinsson KG, Anderson RM. The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance. Proc Natl Acad Sci. 1999;96(3):1152–6.
Tenover FC. Development and spread of bacterial resistance to antimicrobial agents: an overview. Clin Infect Dis. 2001;33(Suppl 3):S108–15.
WHO. WHO global strategy for containment of antimicrobial resistance. Report No. WHO/CDS/CSR/DRS/2001.2. Geneva: WHO; 2001.
Rotimi VO, Jamal W, Pal T, Sonnevend A, Dimitrov TS, Albert MJ. Emergence of multidrug-resistant Salmonella spp. and isolates with reduced susceptibility to ciprofloxacin in Kuwait and the United Arab Emirates. Diagn Microbiol Infect Dis. 2008;60(1):71–7.
HA-AD. Health Authority of Abu Dhabi, Abu Dhabi Health Statistics; 2007. Available from: http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=mqZ%2f%2fS9She8%3d&tabid=349. Accessed December 2008.
WHO. United Arab Emirates National Health Accounts; May 2008. Available from: http://www.who.int/nha/country/are/en/. Accessed January 2009.
Jumaa PA, Neringer R. A survey of antimicrobial resistance in a tertiary referral hospital in the United Arab Emirates. J Chemother. 2005;17(4):376–9.
Tomson G, Sterky G. Self-prescribing by way of pharmacies in three Asian developing countries. Lancet. 1986;2(8507):620–2.
Chuc NT, Larsson M, Falkenberg T, Do NT, Binh NT, Tomson GB. Management of childhood acute respiratory infections at private pharmacies in Vietnam. Ann Pharmacother. 2001;35(10):1283–8.
Chalker J. Improving antibiotic prescribing in Hai Phong Province, Vietnam: the “antibiotic-dose” indicator. Bull World Health Organ. 2001;79(4):313–20.
Lansang MA, Lucas-Aquino R, Tupasi TE, Mina VS, Salazar LS, Juban N, et al. Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. J Clin Epidemiol. 1990;43(1):61–7.
Dua V, Kunin CM, White LV. The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country. Soc Sci Med. 1994;38(5):717–24.
Van Duong D, Binns CW, Van Le T. Availability of antibiotics as over-the-counter drugs in pharmacies: a threat to public health in Vietnam. Trop Med Int Health. 1997;2(12):1133–9.
Bi P, Tong S, Parton KA. Family self-medication and antibiotics abuse for children and juveniles in a Chinese city. Soc Sci Med. 2000;50(10):1445–50.
Sihavong A, Lundborg CS, Syhakhang L, Akkhavong K, Tomson G, Wahlstrom R. Antimicrobial self medication for reproductive tract infections in two provinces in Lao People’s Democratic Republic. Sex Transm Infect. 2006;82(2):182–6.
Benjamin H, Smith F, Motawi MA. Drugs dispensed with and without a prescription from community pharmacies in a conurbation in Egypt. East Mediterr Health J. 1996;2(3):506–14.
Awad A, Eltayeb I, Matowe L, Thalib L. Self-medication with antibiotics and antimalarials in the community of Khartoum State, Sudan. J Pharm Pharm Sci. 2005;8(2):326–31.
Anonymous. Multicenter study on self-medication and self-prescription in six Latin American countries. Drug Utilization Research Group, Latin America. Clin Pharmacol Ther. 1997;61(4):488–93.
Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JG, Mechtler R, Deschepper R, Tambic-Andrasevic A, et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis. 2006;12(3):452–9.
Mainous AG III, 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.
Mainous AG III, Diaz VA, Carnemolla M. Factors affecting Latino adults’ use of antibiotics for self-medication. J Am Board Fam Med. 2008;21(2):128–34.
WHO. How to investigate drug use in health facilities: selected drug use indicators. Geneva: WHO; 1993.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2007. 10th ed. Oslo, Norway: WHO; 2007.
Igun UA. Reported and actual prescription of oral rehydration therapy for childhood diarrhoeas by retail pharmacists in Nigeria. Soc Sci Med. 1994;39(6):797–806.
Tumwikirize WA, Ekwaru PJ, Mohammed K, Ogwal-Okeng JW, Aupont O. Management of acute respiratory infections in drug shops and private pharmacies in Uganda: a study of counter attendants’ knowledge and reported behaviour. East Afr Med J. 2004;Suppl:S33–40.
Al-Azzam SI, Al-Husein BA, Alzoubi F, Masadeh MM, Al-Horani MA. Self-medication with antibiotics in Jordanian population. Int J Occup Med Environ Health. 2007;20(4):373–80.
Amidi S, Ajamee G, Sadeghi HR, Yourshalmi P, Gharehjeh AM. Dispensing drugs without prescription and treating patients by pharmacy attendants in Shiraz, Iran. Am J Public Health. 1978;68(5):495–7.
Wolff MJ. Use and misuse of antibiotics in Latin America. Clin Infect Dis. 1993;17(Suppl 2):S346–51.
Calva J, Bojalil R. Antibiotic use in a periurban community in Mexico: a household and drugstore survey. Soc Sci Med. 1996;42(8):1121–8.
Borg MA, Scicluna EA. Over-the-counter acquisition of antibiotics in the Maltese general population. Int J Antimicrob Agents. 2002;20(4):253–7.
Carrasco-Garrido P, Jimenez-Garcia R, Barrera VH, Gil de Miguel A. Predictive factors of self-medicated drug use among the Spanish adult population. Pharmacoepidemiol Drug Saf. 2008;17(2):193–9.
Llor C, Reig R, Hernandez S, Sugranes J. Over the counter antibacterials in southern Europe. Scand J Infect Dis. 2005;37(5):399–400.
Matuz M, Benko R, Doro P, Hajdu E, Soos G. Non-prescription antibiotic use in Hungary. Pharm World Sci. 2007;29(6):695–8.
Larson EL, Dilone J, Garcia M, Smolowitz J. Factors which influence Latino community members to self-prescribe antibiotics. Nurs Res. 2006;55(2):94–102.
Al-Ghamdi MS. Empirical treatment of uncomplicated urinary tract infection by community pharmacist in the Eastern province of Saudi Arabia. Saudi Med J. 2001;22(12):1105–8.
Awad AI, Eltayeb IB. Self-medication practices with antibiotics and antimalarials among Sudanese undergraduate university students. Ann Pharmacother. 2007;41(7):1249–55.
Schorling JB, De Souza MA, Guerrant RL. Patterns of antibiotic use among children in an urban Brazilian slum. Int J Epidemiol. 1991;20(1):293–9.
Cederlof C, Tomson G. Private pharmacies and the health sector reform in developing countries: Professional and commercial highlights. J Soc Adm Pharm. 1995;12:101–11.
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.
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.
Al-Bakri AG, Bustanji Y, Yousef AM. Community consumption of antibacterial drugs within the Jordanian population: sources, patterns and appropriateness. Int J Antimicrob Agents. 2005;26(5):389–95.
Chalker J, Ratanawijitrasin S, Chuc NT, Petzold M, Tomson G. Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand—a randomized controlled trial. Soc Sci Med. 2005;60(1):131–41.
Pechere JC, Hughes D, Kardas P, Cornaglia G. Non-compliance with antibiotic therapy for acute community infections: a global survey. Int J Antimicrob Agents. 2007;29(3):245–53.
Grigoryan L, Burgerhof JG, Degener JE, Deschepper R, Lundborg CS, Monnet DL, et al. Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system. J Antimicrob Chemother. 2008;61(5):1172–9.
Acknowledgements
Special thanks to the UAE Ministry of Health’s Department of Drug Control for their kind assistance in providing the list of pharmacies in Abu Dhabi and relevant information regarding pharmacies’ floor size etc.
Funding
No grants from any funding body were received to conduct this study.
Conflict of interest
No conflict of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dameh, M., Green, J. & Norris, P. Over-the-counter sales of antibiotics from community pharmacies in Abu Dhabi. Pharm World Sci 32, 643–650 (2010). https://doi.org/10.1007/s11096-010-9418-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-010-9418-5