Edinburgh Global access to antibiotics without prescription in community pharmacies

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 nonprescription 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 nonprescription 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 nonprescription supply of antibiotics was 62% (95% CI 53 – 72). The pooled proportion of nonprescription 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. This is the first study to provide pooled estimates of the extent of the supply of antibiotics without prescription. Despite regional variations, supplying antibiotics without prescription remains high globally. About three in four (78%) antibiotic requests and three in five (60%) consultations (in relation to symptoms of infectious diseases) in community pharmacies resulted in the supply of antibiotics without prescription. The majority of these antibiotics were supplied for the treatment of disease conditions that were largely acute and self-limiting including upper respiratory tract infections and gastroenteritis.