The impact of law enforcement on dispensing antibiotics without prescription: a multi-methods study from Saudi Arabia
Open accessAbstract
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.
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Studies in Zimbabwe, Chile, Colombia, Brazil, Mexico, Korea and Saudi Arabia found strict enforcement of existing laws to be effective in containing non-prescribed antibiotic provision.
“A number of studies conducted in Zimbabwe, Chile, Colombia, Brazil, Mexico and Korea in addition to a study completed in Saudi Arabia found strict enforcement of existing laws to be effective in containing the non-prescribed antibiotics provision [61–65].”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [65]
The Discussion reports that enforcement and fines reduced dispensing without prescription by more than 80% in Saudi Arabia, and describes reductions in Chile and Mexico and smaller effects in Brazil and Colombia. The Introduction adds that compliance in Colombia remained poor. Our copy does not report enforcement findings for Zimbabwe or Korea, so it does not support the full country list (searched: Zimbabwe, Korea). (LLM, conf=0.87)
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- Authors
- Alrasheedy, A. A., Alsalloum, M. A., Almuqbil, F. A., Almuzaini, M. A., Aba Alkhayl, B. S., Albishri, A. S., Alharbi, F. F., Alharbi, S. R., Alodhayb, A. K., Alfadl, A. A., Godman, B., Hill, R., & Anaam, M. S.
- Affiliations
- Qassim University (SA)
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- Karolinska University Hospital (SE)
- University of Liverpool (GB)
- Corresponding author
- Alrasheedy, Alian A.
- ORCID
- Venue
- Expert Review of Anti-infective Therapy
- Publisher
- Informa UK Limited
- Published
- 2019-12-23
- Volume
- 18
- Issue
- 1
- Pages
- 87-97
- ISSN
- 1478-7210 (ISSN-L)
- 1744-8336
- OpenAlex
- W2995139871
- Cited by
- 102
- References
- 85
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 10 · 2023: 24 · 2022: 9 · 2021: 26 · 2020: 11
- FWCI
- 7.47
- Type
- journal article
- Language
- en
- Open access
- Locations
- Expert Review of Anti-infective Therapy (publishedVersion)
- PubMed (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Keywords
- antibiotic misuse, law enforcement, community pharmacy, pharmacy regulation, pharyngitis, urinary tract infection, Saudi Arabia
- MeSH terms
- Anti-Bacterial Agents, Community Pharmacy Services, Cross-Sectional Studies, Humans, Legislation, Pharmacy, Pharyngitis, Surveys and Questionnaires, Saudi Arabia, Urinary Tract Infections, Law Enforcement, Prescription Drugs
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