Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India: Antibiotic dispensing practices of pharmacists in New Delhi
Open accessAbstract
WHAT IS KNOWN AND OBJECTIVE: The overall volume of antibiotic consumption in the community is one of the foremost causes of antimicrobial resistance. In developing countries like India, pharmacists often dispense 'prescription-only' drugs, like antibiotics, to patients who do not have a prescription. Not much data is available regarding detailed information on behaviour of antibiotic use by community pharmacists which is of particular significance to develop a suitable and sustainable intervention programme to promote rational use of antibiotics. A qualitative study was conducted to understand the dispensing practices and behaviour of community pharmacists to develop policy interventions that would improve the use of antibiotics at the community level. METHODS: Focus group discussions (FGDs) were held for five municipal wards of Delhi with retail pharmacists, public sector pharmacists and the office bearers of pharmacists' associations. Data on antibiotic use and resistance were collected earlier from these five wards. FGDs (n = 3 with 40 pharmacists) were analysed through grounded theory. RESULTS AND DISCUSSION: Four broad themes identified were as follows: prescribing and dispensing behaviour; commercial interests; advisory role; and intervention strategies for rational use of antibiotics. FGDs with pharmacists working in the public sector revealed that, besides the factors listed above, overstock and near-expiry, and under-supply of antibiotics promoted antibiotic misuse. Suggestions for interventions from pharmacists were the following: (i) education to increase awareness of rational use and resistance to antibiotics; (ii) involving pharmacists as partners for creating awareness among communities for rational use and resistance to antibiotics; (iii) developing an easy return policy for near-expiry antibiotics in public sector facilities; and (iv) motivating and showing appreciation for community pharmacists who participate in intervention programmes. WHAT IS NEW AND CONCLUSIONS: Inappropriate antibiotic dispensing and use owing to commercial interests and lack of knowledge about the rational use of antibiotics and antibiotic resistance were the main findings of this in-depth qualitative study. Community pharmacists were willing to participate in educational programme aimed at improving use of antibiotics. Such programmes should be initiated within a multidisciplinary framework including doctors, pharmacists, social scientists, government agencies and non-profit organizations.
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In environments where customer satisfaction or need is central, most CDRO staff opt to respond to customer's request and need without properly scrutinising the consequences or repercussions of their actions.
“In such environments where customer satisfaction or need is of a central value, most CDRO staff opt to respond to customer’s request and need without properly scrutinising the consequences or repercussion of their actions [24, 39, 40, 42–44, 46–48].”
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 [44]
The Self-medication section (page not specified) says no interviewed pharmacist reported refusing to sell prescription-only antibiotics requested without a prescription. The Commercial interests and Discussion sections describe dispensing despite inappropriate prescriptions, patient pressure, and limited awareness of antibiotic resistance. These findings support the pattern for antibiotic dispensing among the pharmacists studied in New Delhi, but not the broader claim about most CDRO staff or customer requests generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMost included studies used in-depth or face-to-face interviews (n=10), while two used focus group discussion or focus group discussion plus in-depth interview.
“Most of the included studies instituted in depth or face to face interview (n = 10) [24, 38–42, 44–47] while the other two employed a focus group discussion (n = 1) [44] or a focus group discussion plus in depth interview (n = 1) [48] to explore the reasons for dispensing antibiotics without prescription or drivers for inappropriate dispensing of antibiotics.”
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 [44]
The Methodology (page not provided) says this study used focus group discussions, supporting its identification as a focus-group study. The citing sentence also lists this source among the in-depth or face-to-face interview studies, but the supplied passages describe focus groups, not interviews. This paper cannot establish the citing review’s totals across included studies. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAcross many studies, some CDRO staff did not clearly distinguish their scope of practice or role and perceived themselves as having an expanded role encompassing diagnosing and treating patients.
“Across many studies, it was stated that some CDRO staff did not clearly distinguish their scope of practice or role, perceive as they have expanded role that encompasses diagnosing and treating patients [38, 40–45].”
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 [44]
In “Self-medication” (page unavailable), private retail pharmacists admitted prescribing antibiotics for patients with particular symptoms, supporting the treating-patients aspect. But most initially said they were neither qualified nor allowed to prescribe; the paper does not establish that they perceived diagnosis and treatment as an expanded role within their scope of practice. This single New Delhi study also cannot establish the claim across many studies. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMore than half of the included studies were conducted either in Sub-Saharan Africa (n=4) or South Asia (n=4).
“More than half of the studies were conducted either in Sub-Saharan Africa (n = 4) [24, 39–41] or South Asia (n = 4) [42–45].”
CDRO staff's poor knowledge about the consequences of antibiotic misuse and/or the importance of rational antibiotic use is among the stated reasons for non-prescription antibiotic provision.
“CDRO staffs’ poor knowledge about the consequences of antibiotics misuse and/or the importance of rational antibiotic use were among the stated reasons for non-prescription antibiotic provisions.”
Customers directly purchase antibiotics from CDROs because they cannot afford physician consultation fees.
“if they cannot afford to pay for consultation fee for physicians [39–42, 44, 45, 47, 49]”
Some CDRO staff lacked knowledge and awareness of the impact of imprudent antibiotic use on the development of AMR.
“Some CDRO staff lacked knowledge and awareness on the impact that imprudent use of antibiotics has on the development of AMR [40, 44, 46]”
Antibiotics are commonly available over-the-counter (OTC) at retail pharmacies despite being prescription drugs.
“Despite being prescription drugs, antibiotics are commonly available over-the-counter (OTC) at retail pharmacies.”
From Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers’ Perspectives across Two States (2021) · cites this paper as [23]
Several studies before and after 2014 indicate that consumers can still purchase antibiotics without a valid prescription as pharmacists still dispense antibiotics to their customers/clients/patients by attending to their symptoms.
“However, several studies before and after 2014 indicate that consumers can still purchase antibiotics without a valid prescription as pharmacists still dispense antibiotics to their customers/clients/patients by attending to their symptoms [20,23,24,25].”
From Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers’ Perspectives across Two States (2021) · cites this paper as [23]
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- Authors
- Kotwani, A., Wattal, C., Joshi, P. C., & Holloway, K.
- Affiliations
- University of Delhi (IN)
- Sir Ganga Ram Hospital (IN)
- World Health Organization Regional Office for South-East Asia (IN)
- Venue
- Journal of Clinical Pharmacy and Therapeutics
- Publisher
- Hindawi Limited
- Published
- 2011-08-23
- Volume
- 37
- Issue
- 3
- Pages
- 308-312
- ISSN
- 0269-4727 (ISSN-L)
- OpenAlex
- W2123531276
- Cited by
- 192
- References
- 26
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 9 · 2023: 13 · 2022: 19 · 2021: 20 · 2020: 18 · 2019: 15 · 2018: 18 · 2017: 12 · 2016: 13 · 2015: 11 · 2014: 11 · 2013: 6 · 2012: 1
- FWCI
- 5.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Pharmacy and Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- 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
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- inappropriate antibiotic use, community pharmacists, antibiotic dispensing, antimicrobial resistance, prescription-only drugs, pharmacy education, New Delhi
- MeSH terms
- Anti-Bacterial Agents, Community Pharmacy Services, Crime, Developing Countries, Nonprescription Drugs, Education, Pharmacy, Health Services Misuse, Humans, India, Health Knowledge, Attitudes, Practice, Patient Education as Topic, Pharmacists, Self Medication, Societies, Pharmaceutical, Urban Population, Focus Groups, Professional Role, Drug Resistance, Bacterial, Qualitative Research, Prescription Drugs
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