Community pharmacy sales of non-prescribed antibiotics in Riyadh, Saudi Arabia: a simulated patient study

Background The increased dispensing of non-prescribed antibiotics increases the public health problem of antimicrobial resistance. In April 2018, the Saudi Ministry of Health reinforced the disciplinary regulations of banning pharmacies from selling antibiotics without a medical prescription. Objective To assess the rate of non-prescribed antibiotic sales by community pharmacies and compare it with the findings from our 2011 study. Setting Community pharmacies, Riyadh City, Saudi Arabia. Methods A cross-sectional, simulated patient study was conducted between August and November 2018. Six simulated clinical scenarios were presented at stratified samples of community pharmacies. Main outcome measure The primary study outcome was the proportion of community pharmacies dispensing non-prescribed antibiotics. Results Of 327 pharmacies, 41 (12.5%) dispensed antibiotics without a prescription upon explicit request for antibiotics. Antibiotics sales decreased significantly in 2018 compared to 2011 (77.6%), (p value < 0.05) after the implementation of disciplinary regulations. Only 6.25% of pharmacists enquired about drug allergies, pregnancy status (urinary tract infection scenario), and drug-drug interactions. Conclusion Given the recent implementation of disciplinary regulations, the findings of this study demonstrate a significant decline in the proportion of pharmacies dispensing non-prescribed antibiotics. Measures to augment the enforcement of regulations and to ensure community pharmacy adherence and compliance are warranted.