Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach
Open accessAbstract
Antibiotic dispensing without a prescription poses a threat to public health as it leads to excessive antibiotic consumption. Inappropriate antibiotic availability to the community has been documented to be amongst drivers of antimicrobial resistance emergence. Community pharmacies are a source of antibiotics in low and middle-income countries (LMICs). We aimed at assessing antibiotic dispensing practices by community pharmacy retailers in Moshi urban, Kilimanjaro, Tanzania and recommend interventions to improve practice. Using a Simulated Client (SC) Method, an observational cross-sectional survey of antibiotic dispensing practices was conducted from 10th June to 10th July 2017. Data analysis was done using Stata 13 (StataCorp, College Station, TX, USA). A total of 82 pharmacies were visited. Part I pharmacies were 26 (31.71%) and 56 (68.29%) were part II. Overall 92.3% (95% CI 77.8-97.6) of retailers dispensed antibiotics without prescriptions. The antibiotics most commonly dispensed without a prescription were ampiclox for cough (3 encounters) and azithromycin for painful urination (3 encounters). An oral third generation cephalosporin (cefixime) was dispensed once for painful urination without prescription by a part I pharmacy retailer. Out of 21, 15(71.43%) prescriptions with incomplete doses were accepted and had antibiotics dispensed. Out of 68, 4(5.9%) retailers gave instructions for medicine use voluntarily. None of the retailers voluntarily explained drug side-effects. In Moshi pharmacies, a high proportion of antibiotics are sold and dispensed without prescriptions. Instructions for medicine use are rarely given and none of the retailers explain side effects. These findings support the need for a legislative enforcement of prescription-only antibiotic dispensing rules and regulations. Initiation of clinician and community antibiotic stewardship and educational programs on proper antibiotic use to both pharmacists and public by the regulatory bodies are highly needed.
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Non-prescription sale of antibiotics is profoundly common practice in LMICs, as demonstrated by the high prevalence of the practice identified in simulated clients and questionnaire-based surveys.
“The non-prescription sale of antibiotics is profoundly common practice in LMICs as demonstrated by the high prevalence of the practice identified in simulated clients and questionnaire based surveys [16, 17, 22–33].”
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- Authors
- Horumpende, P. G., Sonda, T. B., van Zwetselaar, M., Antony, M. L., Tenu, F. F., Mwanziva, C. E., Shao, E. R., Mshana, S. E., Mmbaga, B. T., & Chilongola, J. O.
- Affiliations
- Kilimanjaro Clinical Research Institute (TZ)
- Catholic University of Health and Allied Sciences (TZ)
- Corresponding author
- Horumpende, Pius G.
- Sonda, Tolbert B.
- Antony, Magreth L.
- Mwanziva, Charles E.
- Shao, Elichilia R.
- Mshana, Stephen E.
- Mmbaga, Blandina T.
- Chilongola, Jaffu O.
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-11-21
- Volume
- 13
- Issue
- 11
- Pages
- e0207465
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6248976
- OpenAlex
- W2901854350
- Cited by
- 124
- References
- 60
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 17 · 2023: 14 · 2022: 25 · 2021: 31 · 2020: 21 · 2019: 4
- FWCI
- 8.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Keywords
- community pharmacy, antimicrobial resistance, antibiotic stewardship, incomplete prescriptions, medication instructions, simulated clients, Moshi Municipality, Tanzania
- MeSH terms
- Anti-Bacterial Agents, Community Pharmacy Services, Cross-Sectional Studies, Female, Humans, Male, Pharmacists, Drug Prescriptions, Surveys and Questionnaires, Tanzania, Azithromycin, Cefixime, Drug-Related Side Effects and Adverse Reactions
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