Pharmacists' practices, perceptions, and challenges in dispensing antibiotics without prescription: a qualitative study in Palestine.

Background and objective: Antimicrobial resistance (AMR) is a critical global health threat, fuelled by inappropriate antibiotic use. In Palestine, dispensing antibiotics without prescription remains common despite legal restrictions, but limited qualitative evidence exists on pharmacists' perspectives. The objective was to explore community pharmacists' practices, perceptions, and challenges in dispensing antibiotics without prescription in Palestine.

Methods: This qualitative descriptive study used semi-structured, in-depth interviews with 14 licensed pharmacists from urban, semi-urban, and rural districts of the West Bank, conducted between January and March 2025. Purposive sampling ensured variation in gender, experience, and setting. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Braun and Clarke's framework. Six major themes were identified.

Results: Participants were aware of the legal prohibition but cited weak enforcement. Daily non-prescription requests were common, especially during seasonal illnesses, driven by prior positive experiences, social recommendations, and inability to afford doctor visits. Symptom-based dispensing was used in perceived 'clear cases,' influenced by customer pressure and business competition. Public misconceptions-such as believing antibiotics treat viral infections-were widespread, with frequent incomplete dosing and reuse of leftovers. Pharmacists attempted patient education but faced time and receptiveness barriers, and often experienced ethical conflict. Regulatory oversight was minimal; participants recommended stricter inspections, public awareness campaigns, and collaborative practice models.

Conclusions: Non-prescription antibiotic dispensing in Palestine is shaped by patient demand, economic pressures, and weak regulation. Addressing these drivers requires strengthened enforcement, targeted public education, professional training, and integration of pharmacists into AMR stewardship to safeguard public health. These findings highlight the need for actionable reforms in pharmacy practice and national policy, including stricter regulatory oversight and pharmacist-led public education, to reduce inappropriate antibiotic use and strengthen AMR containment strategies.