Barriers and determinants of over-the-counter antibiotic sales de-escalation: perspectives of community pharmacists in Aseer, Saudi Arabia.

Background: Antimicrobial resistance (AMR) represents a significant global health threat, which is worsened by the inappropriate distribution of antibiotics without a prescription. Cultural conventions and the easy accessibility of pharmacies in Saudi Arabia further aggravate this situation. Community pharmacists play a crucial role in antimicrobial stewardship, yet they continue to face substantial challenges.

Objective: The objective of this study was to examine the barriers and determinants that influence community pharmacists' capability to reduce over-the-counter (OTC) antibiotic sales in the Aseer region of Saudi Arabia.

Methods: A cross-sectional survey was conducted with 269 community pharmacists, utilizing a validated, self-administered questionnaire. Data were analyzed using descriptive statistics, Chi-square tests, Kruskal-Wallis tests, and ordinal logistic regression to assess associations between demographic characteristics and pharmacists' views of obstacles and stewardship practices.

Results: The type of pharmacy was significantly associated with perceived barriers (p = 0.027), with chain pharmacists reporting more challenges than independent pharmacists. Logistic regression also showed that working in a chain pharmacy (OR = 2.01) and holding a PharmD degree (OR = 1.56) were predictors of higher perceived barriers. These findings suggest that both organizational factors and educational background shape how pharmacists perceive obstacles to reducing inappropriate antibiotic dispensing. Other demographic variables lacked statistical significance.

Conclusion: The study highlights that systemic and educational factors strongly influence pharmacists' roles in antimicrobial stewardship. This indicates that targeted interventions such as continuous professional education, digital prescription monitoring, and stronger regulatory enforcement are necessary to support pharmacists and reduce the dispensing of inappropriate antibiotics. These measures also align with Saudi Arabia's Vision 2030 healthcare priorities. To our knowledge, this is the first study to investigate these barriers within the Aseer region, offering novel evidence on how organizational and educational contexts shape stewardship practices. The findings provide insights that extend beyond Saudi Arabia, informing global antimicrobial resistance containment strategies.