The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia

ABSTRACT

Background: Dispensing of antibiotics without a prescription (DAwP) has been widely practised among community pharmacies in Saudi Arabia despite being illegal. However, in May 2018, the law and regulations were enforced alongside fines. Consequently, we wanted to evaluate the impact of these changes.

Methods: A study was conducted among 116 community pharmacies in two phases. A pre-law enforcement phase between December 2017 and March 2018 and a post-law enforcement phase one year later. Each phase consisted of a cross-sectional questionnaire-based survey and a simulated client method (SCM) approach. In the SCM, clients presented with either pharyngitis or urinary tract infections (UTI). In SCM, for each phase, all 116 pharmacies were visited with one of the scenarios.

Results: Before the law enforcement, 70.7% of community pharmacists reported that DAwP was common with 96.6% and 87.7% of participating pharmacies dispensed antibiotics without a prescription for pharyngitis and UTI respectively. After the law enforcement, only 12.9% reported that DAwP is still a common practice, with only 12.1% and 5.2% dispensing antibiotics without prescriptions for pharyngitis and UTI respectively.

Conclusion: law enforcement was effective. However, there is still further scope for improvement. This could include further educational activities with pharmacists, physicians and the public.

KEYWORDS:

• Dispensing antibiotics without prescriptions
• community pharmacy
• law enforcement
• health policy
• Saudi Arabia

Article highlights

• There was considerable dispensing of antibiotics without a prescription among community pharmacists in Saudi Arabia despite legislation banning this

• In May 2018, greater enforcement of the dispensing of antibiotics without a prescription (DAwP) took place with imposing of fines up to 100,000 SR (equivalent to US$26,666) and cancellation of the licence in case of violations

• This resulted in a considerable reduction on DAwP with only 12.9% of community pharmacists reporting that DAwP is still a common practice, with only 12.1% and 5.2% of pharmacists dispensing antibiotics without prescriptions for pharyngitis and UTI respectively; with this typically only occurring following specific requests

• However, there is still a need for greater educational activities among all key stakeholder groups including patients to reduce expectations of being prescribed or dispensed an antibiotic for essentially self-limiting conditions

• Multiple ongoing activities are in line with the goals of the national action plan of Saudi Arabia on combating AMR

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.