Dispensing antibiotics without prescription in the Arab world: A narrative review of the prevalence, appropriateness, facilitators and preventive interventions.

Inappropriate antibiotic-related practices are common worldwide but feature more strongly in developing countries. An example of such practices is dispensing antibiotics without prescription [DAwP] in community pharmacies, despite being illegal in most countries around the globe. The aim of this review is to discuss in-depth all aspects related to the practice of DAwP in Arab countries. We searched SCOPUS, PubMed and Google Scholar for articles involving studies addressing the practice of DAwP, conducted in any Arab country, and published from 2000 to 2022. We found that DAwP is very common with extremely high prevalence rates that differ according to methodologies used in those studies. Malpractices associated with DAwP include poor information-gathering before dispensing, poor counseling, inappropriate choice of the antibiotic, recommending antibiotics when they are not indicated, wrong duration and wrong dosing. Common factors shown to contribute to this practice include lax enforcement of regulations, misconceptions about antibiotics by the public, accessibility of community pharmacies, trustability of pharmacists, and the business orientation of pharmacies. Enforcement of regulations, increasing the competency of pharmacists by enhancing undergraduate pharmacy plans and establishing well-planned continuing education programs, reframing regulations to account for the expanding role of competent pharmacists, and increasing the awareness of the public towards antibiotics may limit DAwP and other antibiotic-related inappropriate practices.