Antibiotics stewardship: prevalence, nature, and factors associated with dispensing of antibiotics without prescription among community pharmacists in Nigeria.

Abstract

Background: Dispensing antibiotics without a prescription is common among community pharmacists in low- and middle-income countries despite its association with antibiotic resistance. This study describes the prevalence and nature of dispensing antibiotics without prescription among community pharmacists in Nigeria and its associated factors.

Method: A cross-sectional study was conducted among community pharmacists in Nigeria with a validated, online, self-administered questionnaire. Reliability was assessed with Cronbach's alpha. Descriptive and inferential statistics were performed with SPSS Version 2023 at a 0.05% significance level.

Result: A total of 420 community pharmacists participated in the study. The Reliability result was 0.860, implying the data collection tool's perfect internal consistency. Independent pharmacies represented 87.4% of the respondents, and most were in urban areas (71.4%). Most respondents (98.1%) dispensed antibiotics without prescription, with (84.2%) sometimes requesting laboratory investigations before dispensing antibiotics. Cephalosporin (74.8%), penicillin (70.2%), and quinolones (68.3%) were the major classes of antibiotics dispensed. The pharmacists' confidence in their clinical skills (78.8%), ability of the antibiotics to cover a broader range of microorganisms (78.0%), inability of patients to access healthcare services in other places (67.3%), emergencies (58.3%), affordability (49.0%), patients' demand (38.2%), absence of sanctions (34%), not getting prescriptions (33.1%), were the key deciding factors for the pharmacists to dispense antibiotics without prescription or substitute class of antibiotics. Factors like financial incentives, fear of losing clients, fear of expiry, competition from other pharmacies, and trust in patients' self-diagnosis were low in driving decisions to dispense antibiotics without prescriptions.

Conclusion: Non-prescription dispensing of antibiotics is high among community pharmacists in Nigeria, and is related to various factors. A strategic approach, including mandatory health insurance schemes, prescription and dispensing policies, and enforcement of antimicrobial stewardship regulations by the Nigerian government, is necessary to improve ethical practice and address the irrational dispensing and use of antibiotics in Nigeria.