Highlights
- •We estimated the extent of non-prescription supply of antibiotics in community pharmacies.
- •The pooled proportion of non-prescription supply of antibiotics was 62%.
- •Non-prescription supply of antibiotics was highest in South America.
- •Antibiotics were commonly supplied for acute and self-limiting conditions.
Summary
Objective
To estimate the proportion of over-the-counter antibiotic requests or consultations
that resulted in non-prescription supply of antibiotics in community pharmacies globally.
Methods
We systematically searched EMBASE, Medline and CINAHL databases for studies published
from January 2000 to September 2017 reporting the frequency of non-prescription sale
and supply of antibiotics in community pharmacies across the world. Additional articles
were identified by checking reference lists and a Google Scholar search. A random
effects meta-analysis was conducted to calculate pooled estimates of non-prescription
supply of antibiotics.
Results
Of the 3302 articles identified, 38 studies from 24 countries met the inclusion criteria
and were included in the review. All the included countries with the exception of
one, classified antibiotics as prescription-only medicines. The overall pooled proportion
of non-prescription supply of antibiotics was 62% (95% CI 53–72). The pooled proportion
of non-prescription supply of antibiotics following a patient request was 78% (95%
CI 59–97) and based on community pharmacy staff recommendation was 58% (95% CI 48–68).
The regional supply of non-prescription antibiotics was highest in South America,
78% (95% CI 72–84). Antibiotics were commonly supplied without a prescription to patients
with symptoms of urinary tract infections (68%, 95% CI 42–93) and upper respiratory
tract infections (67%, 95% CI 55–79). Fluoroquinolones and Penicillins respectively
were the most commonly supplied antibiotic classes for these indications.
Conclusion
Antibiotics are frequently supplied without prescription in many countries. This overuse
of antibiotics could facilitate the development and spread of antibiotic resistance.
Keywords
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Article info
Publication history
Published online: July 05, 2018
Accepted:
July 1,
2018
Received in revised form:
June 28,
2018
Received:
December 18,
2017
Identification
Copyright
© 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
