Community Pharmacists’ Knowledge, Attitude, and Practices Towards Dispensing Antibiotics without Prescription (DAwP) in the West Bank, Palestine

Introduction: Non-prescription dispensing of antibiotics is common in the West Bank and this could contribute to the emergence of microbial resistance. Objectives: To evaluate knowledge, attitude, and practices of community pharmacists towards dispensing antibiotics without prescription (DAwP) in the West Bank, Palestine. Methods: A cross-sectional survey was conducted between April and May 2022 using a structured, validated, and pilot-tested questionnaire. Participants were community pharmacists who completed a 28-item questionnaire either in English or Arabic language based on their personal preference. The data was analyzed using descriptive and inferential analyses. Main outcome measure Knowledge, perception and practices towards dispensing antibiotics without prescription. Results: Of the 650 community pharmacists approached, 580 completed the questionnaire (response rate: 89.3%). More than half (53.5%) of the pharmacists were not aware that DAwP is illegal practice. Lack of patient willingness to consult a physician for a non-serious infection (71.2%) and an inability to afford a consultation with a physician (63.4%) were the most common reasons claimed for DAwP. A statistically significant association was found between the number of antibiotics dispensed and educating patients about the importance of adherence and completion of the full course of antibiotics (p <0.05). Conclusions: In general, community pharmacists have inadequate understanding of the regulations prohibiting the over-the-counter sale of antibiotics in the West Bank, explaining the high rate of DAwP in the region. A complicated approach consisting of educational interventions and improving the access to and affordability of healthcare facilities for the general public is required to efficiently reduce DAwP and its negative consequences on public health.