Community Pharmacy Personnel Understanding of Antibiotic Dispensing in Eastern Nepal

Abstract

Background

Community pharmacies are easily accessible outlets providing medicines to the general public in Nepal, but it is known that irrational dispensing of antibiotics from such outlets contributes to antimicrobial resistance.

Objective

To assess the understanding of community pharmacy personnel around antibiotic-dispensing in Eastern Nepal and the relationship between this understanding and their personal characteristics.

Methods

A cross-sectional survey was conducted on 312 pharmacy personnel working in community pharmacies of three districts within Eastern Nepal using a self-administered questionnaire. Descriptive statistics were used to analyze participants’ characteristics and their understanding of antibiotic dispensing. The relationships between their understanding of antibiotic dispensing and their characteristics were determined using Chi-square tests.

Results

Most of the pharmacy personnel considered that dispensing antibiotics without a valid prescription is a problem (76.9%), and that it would not be legal to do so (86.9%). In the survey, 34.9% of participants agreed that they had dispensed antibiotics without prescription, and 26.9% disagreed with the assertion that inappropriate dispensing of antibiotics could promote antimicrobial resistance. Most (94.5%) reported that they would advise patients to follow their antibiotic dosage regimen, but 34.3% reported that they believed antibiotics to reduce pain and inflammation. Bivariate analysis showed that the level of understanding about antibiotic indication was significantly associated with age (p<0.001), work experience (p<0.001) and qualifications (p=0.017) of the pharmacy personnel. Work experience and qualifications also had significant but independent relationships with the level of understanding that irrational dispensing of antibiotics promotes antimicrobial resistance (p=0.018 and p=0.004) and is on the need for patient follow-up after dispensing antibiotics (p<0.001 and p=0.042).

Conclusion

The understanding of community pharmacy personnel about antibiotic dispensing in Eastern Nepal requires significant improvement. Degree of understanding of some aspects of antibiotic dispensing was influenced by age, work experience and qualifications.

Keywords:

• antibiotic dispensing practice
• antibiotic resistance
• community pharmacy
• irrational drug dispensing
• pharmacist
• pharmacy personnel

Acknowledgments

The authors are grateful to Dr. Rebeca Dewey (University of Nottingham, Nottingham, United Kingdom), Dr. Roger Watson (University of Hall, Hull, United Kingdom) and Dr. P Ravi Sankhar (Oceania University of Medicine, Florida, United States) for their English editing. We would like to kindly thank all the faculty members of Purbanchal University College of Medical and Allied sciences (Gothgaun, Morang, Nepal), especially, Dr. Sailesh Mani Pokhrel (Dean, Faculty of Medicine), Dr. Kajiram Adhikari (Program Head, Department of Pharmacy), Mrs. Kabita Adhikari (Campus chief) for their motivation and support in this study.

Data Sharing Statement

Raw and analyzed study data are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Reg No 82/2019 Ref: 2500), Kathmandu, Nepal. Each participant provided a verbal consent followed by a written consent prior to the data collection.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was supported by PG research grant by Nepal Health Research Council, Kathmandu, Nepal. The funder was not involved in any part of the research nor in writing the manuscript.